Prison Healthcare
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 saw an increase of violence in prisons. This violence may not be due to illicit Spice use and 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 may 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. Relaxed 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 effects given by the gabapentinoids, the new benzos, which you can seek for that old ankle fracture and back pain. Gabapentinoids can give a high on their own, 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”, but you may seek Mirtazapine, as you cannot sleep (perhaps partly caused by the cocaine), and you may want a bit of weight on. The anti-depressant detaches you from your emotions (that’s partly how they work in depression), releasing you from guilt and remorse.
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 were designed to stop the overthinking in a psychosis and schizophrenia, but here the tranquilisers block thought, further imagination and hope and they also make you fatter.
With this concoction of these prescribed medications you now are free of anxiety, grief, guilt, remorse and hope. You are detached and 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.
Gapabentinoids and opiates are a lethal combination. Apart from anything else they block with the opiod antidote Naloxone. Patients arriving in prison have their Gabapentindoids quickly reduced to stop but will still be given detox or maintenance for their opiate dependency.