Misuse of noncontrolled medications

Abstract High rates of substance use disorders have long existed in jails and prisons. Limited access to controlled or illicit substances in carceral settings may explain diversion and misuse of medications not typically considered for recreational or nonmedical use. While prescription medications are sometimes used to achieve a “high,” they may also be sought to ease discomforts commonly experienced in carceral settings. Specific motivations include achieving euphoria, sedation, hallucination, management of insomnia, and enhancement of the effects or mitigation of the side effects of other prescribed or nonprescribed substances. Some incarcerated persons may feign or exaggerate mood, anxiety, psychotic, or somatic symptoms with the goal of being prescribed medications with the desired effects, usually taking them at doses or using routes of administration with substantial medical risks. Equally concerning is the diversion of prescribed medications to a third party. Many prescribed medicines have a “street value” in carceral settings. A patient with a legitimate need for medication, who may already have poor illness insight, may be enticed or coerced into transferring their medication to a peer. This creates several dangerous problems. The patient who is the source of diverted medications may worsen or fail to improve, which may lead to dose escalation, an incorrect conclusion about a treatment failure, poor functioning, and behavioral sequelae including disruptive or violent conduct. Meanwhile, the recipient is exposed to medication risks without the benefits of informed consent or medical supervision. This chapter presents information on specific classes of noncontrolled medication identified as higher risk for misuse, methods used, and approaches to minimize the problem.