Governments wanting to impose pain and suffering on prisoners have an array of physical and psychological techniques at their disposal. In western democracies, the use of physical torture is hard to hide so creativity has been required to develop techniques that leave no marks; one of most well-known is ‘waterboarding’ – practised on prisoners at Guantanamo.
Pharmacological torture is another technique employed in Guantanamo. This involves the forced use of drugs to cause pain or sedate victims so they are more likely to talk. A variation on this theme involves taking medication away from prisoners who need it. This can also cause intense suffering and distress, especially if the medication is addictive. Forcing prisoners into rapid detoxification or to go ‘cold turkey’ is also a form of pharmacological torture.
Prisoners denied methadone
The New Zealand Corrections Department employed this technique for 35 years by taking methadone off opiate addicts who committed crime and ended up in prison. The Department’s “Protocol for Methadone Treatment Programmes in Prisons” says they did this to “reduce and, or, eliminate the dependency on addictive drugs by people remanded in, or sentenced to prison.” It didn’t work. Forced withdrawal in prison is not a recognized treatment for drug addiction and most of these prisoners relapsed as soon as they were released.
The reality is that methadone programmes substantially reduce criminal offending by removing the need for addicts to commit crime to get their fix. It was not until 2008 that the Corrections Department crawled out of its pre-historic mind-set and allowed prisoners to stay on methadone for the duration of their sentence.
But management’s prejudice towards the use of any kind of addictive medication in prison persists. Their disapproval is formalised in Section 6.1.1 of the Department’s Medicine Policy. This tells prison doctors that:
“Prescribing medication that can be misused/abused or has some economic value in a prison environment (or example benzodiazepines, opioids, zopiclone) is actively discouraged. A clinically suitable alternative medication or treatment option is preferred.”
In response to an Official Information Act request, the Department advised that there is no list of suitable alternatives. This means that when prisoners are ill, or critically injured, and are in severe pain, the Department expects doctors to prescribe panadol. The Ombudsman identified the over prescribing of panadol in a report issued in 2005 titled: Investigation of the Department of Corrections in relation to the Provision, Access and Availability of Prisoner Health Services.
Denying opiate painkillers to prisoners in severe pain is tantamount to torture – and has contributed to a number of deaths in prison. Richard Barriball committed suicide in Otago prison within a week after the prison doctor took away three different pain medications he had been prescribed by specialists at Dunedin hospital. His story is described in a previous post on this website.
Prisoners denied non-addictive medication
It’s not just pain killers. Non-addictive drugs are also taken off prisoners. In The Effects of Imprisonment on Inmates and their Families Health and Wellbeing, Dr Michael Roguski and Fleur Chauvel interviewed 63 New Zealand inmates, chosen at random, about their medical treatment in prison. The authors wrote:
“Temporary and permanent discontinuation of medication occurs when prisoners are remanded, sentenced to prison and/or transferred between prisons. Permanent discontinuation appeared to be more geared towards medications with specific street values…”
A previous post, The Ritalin Rules in prison, describes the difficulties that prisoners with ADHD experience obtaining ritalin in prison. However, prisoners on anti-depressants or anti-psychotic medication, with almost no street value, often have that discontinued as well. Roguski and Chauvel went to say:
“Inmates prevented from accessing medication experienced extreme anxiety. Some of this anxiety was attributed to concern over ensuring one’s health care is maintained and the fact that discontinuation, even temporary, can be life threatening.
“Severe distress was reported by participants who had had their medications permanently discontinued. This was especially true in situations where inmates experienced a forced “cold turkey” withdrawal (i.e. no substitution or countdown). Most dramatic negative outcomes were reported by people who had a forced withdrawal from benzodiazepines and when psychiatric medication was not reinstated.”
In other words, even though prisoners on methadone are now able to stay on it, other medications are often temporarily withdrawn or permanently discontinued. Prison doctors who comply with this practice and refuse, because of prison policy, to prescribe medications which are clinically justified are in breach of their medical ethics.
Refusing to provide a prisoner with appropriate medication is tantamount to torture. In February 2013 Juan Méndez, Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, issued a report and accompanying press release which said:
“Medical care that causes severe suffering for no justifiable reason can be considered cruel, inhuman or degrading treatment or punishment, and if there is State involvement, it is torture.”
Paragraph 54 of his report says:
“Denial of pain treatment involves acts of omission rather than commission, and results from neglect and poor Government policies… (It) will constitute cruel, inhuman, or degrading treatment or punishment… when the suffering is severe (and) when the State is, or should be, aware of the suffering, including when no appropriate treatment was offered; and when the Government failed to take all reasonable steps to protect individuals’ physical and mental integrity.”
Paragraph 55 says:
“When the failure of States to take positive steps… condemns patients to unnecessary suffering from pain, States … violate an affirmative obligation under the prohibition of torture and ill-treatment (A/HRC/10/44 and Corr.1, para. 72).”
Paragraph 56 says:
“Governments must guarantee essential medicines – which include, among others, opioid analgesics – as part of their minimum core obligations under the right to health, and take measures to protect people under their jurisdiction from inhuman and degrading treatment.”
When the Corrections Department, on behalf of the New Zealand Government, coerces doctors to breach their medical ethics, primarily by acts of omission, this imposes inhuman and degrading treatment on prisoners. This is a form of psychological torture; and such practices produce the same rates of PTSD as physical torture.
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