There has an exponential in the use of gabapentin and pregabalin medication amongst prisoners over the last decade. These drugs are now almost exclusively used by those with other dependencies in prisons. During this time of increasing use of these gabapentinoids and other prescribed medications, we are seeing an increase in violence in prisons. The violence may be not all be due to illicit Spice use and the past reductions in the number of security staff.
I am the suspicious that us doctors may not be doing any good. Doctors do not have any medication to treat crime, but our best of intentions may now be causing criminal side effects.
Many of my prisoner patients have recognised themselves in the following scenario:
You have a criminal tendency, making you feel nervous, or you have heroin habit, whereby you have to “find” £100+ a day for that. This make you very nervous, an anxiety state. You go to your kind GP who gives you diazepam at least, but clonazepam is your preferred benzo choice (10x more potent). You now feel relaxed and invulnerable. You feel better inside yourself, but you are now worse to others. You can thieve more. Then there is that paradoxical aggression these medications give, so that knife you have with you is now more likely to be used. Of, course you prefer the similar effect given by the gabapentinoids, the new benzos, which you can seek for that old ankle fracture and back pain. Gabapentinoids they make heroin highs better and cheaper, and any spare capsules can be sold on.
Your life is now a mess, and you feel grief, guilt and remorse. These are uncomfortable sensations, which should protect you from more damaging high-risk behaviour. These feelings are depressing and annoying. Your GP now adds in an SSRI for your “depression”, preferably Mirtazapine, as you cannot sleep (partly caused by the cocaine), and you want a bit of weight on. The SSRI detaches you from your emotions, releasing you from guilt.
You now have ideas that others do not like you, you have no insight as to why that is so. Your mood swings are violent, disinhibited, so now you now have added quetiapine or olanzapine to the cocktail. These major tranquilisers block all further imagination and hope and make you fatter.
With this concoction of these prescribed medications you now are free of anxiety, grief, guilt, remorse and hope. You have no feelings for others. You now have full blown Iatrogenic antisocial personality disorder with multiple convictions.
Weight goes on and on, blood sugar rises. You are now diabetic.