Transition of pharmacology from community to corrections

Abstract Psychopharmacology is a challenging field that includes much art as well as science. Clinicians usually depend on self-report when making decisions regarding medication selection and dosing. When a patient becomes incarcerated, there are multiple potentially conflicting, or synergistic, situations. Different formularies, environmental stressors, support groups, and practice patterns all may contribute differentially to medication management decisions. In addition, community medication regimens may have been determined while ongoing illicit drug use confounded the diagnostic picture. Collaboration between clinician and patient may have been poor, and treatment adherence may in turn have been marginal. Many similar issues apply when a patient transfers from a jail to a prison or from one prison to another. Preparation and review of transfer summary sheets and more detailed records are just as important in these situations and should be seen as the minimum standard in policy and in practice. Ideally, continuity of care and discussions about diagnosis or treatment are best achieved through direct communication. A telephone exchange between treating psychiatrists is likely better than reviewing documentation alone. This chapter discusses both the issues and pragmatic management opportunities that can lead to improved patient care and enhanced functioning.