WATERBURY, Vt. -- Seroquel is an anti-psychotic drug designed for people struggling with schizophrenia or bipolar disorder.
Its possible side effects include high blood sugar, which can lead to diabetes, and tardive dyskinesia, which manufacturer AstraZeneca describes as "uncontrollable movements of the face, tongue, or other parts of the body" that can become permanent.
But it has been widely prescribed in Vermont prisons, where about 46 percent of inmates were on some kind of psychotropic medication last year, a fact seen as disturbing by prison rights advocates and corrections officials alike.
By the state's own estimates, Vermont has the highest percentage of inmates on psychotropic medication of any state in the country and the highest number of inmates getting more than one psychiatric medication. The next-closest state had 24 percent of its inmates on such drugs, state Department of Corrections health director Dr. Susan Wehry told a legislative committee last year.
Those figures count the full range of psychiatric drugs, everything from antidepressants to anti-psychotic medications like Seroquel. Because of the anti-psychotics' greater mind-altering effects and potential side effects, much of the concern has been focused on them.
"The problem in prison is (drugs are) given to a lot of people to quiet them down," said prison mental health expert Dr. Terry Kupers, a California psychiatrist. "They're over-prescribed for people who are not psychotic but who are not sleeping or who are causing disruptions in the prisons," he said.
According to internal Vermont Department of Corrections records obtained through a freedom of information request by The Associated Press:
Experts say drugs are often used by prisons instead of more intensive -- and expensive -- talk therapy.
"Paradoxically, prisoners are both overmedicated and undermedicated," said David Fahti, a lawyer with the American Civil Liberties Union's National Prison Project.
They're undermedicated when prison health authorities won't supply the drugs the inmates had been prescribed on the outside, Fahti said. "And they're overmedicated in the sense that often medication is used as a substitute for ... very staff-intensive mental health treatment," he added.
The ACLU often goes to bat for prisoners who complain they're not being given the drugs they need. Rarely if ever does it get a case of a prisoner medicated against his or her will, Fahti said.
One former prisoner, a 34-year-old man released in April from the Northern State Correctional Facility in Newport after serving part of a three-to-12-year sentence for aggravated assault, said he was diagnosed with diabetes after being put on Seroquel while inside.
"No one in my family has ever had diabetes," said the man, who asked that his name not be used because he remains on probation and fears he could be sent back to prison in retaliation for speaking out.
Wehry, a psychiatrist, said the state has been trying to reduce inmates' drug dependency. She said it introduced a formulary -- a list of preferred drugs -- in September, and began requiring special permission for prison health providers to prescribe Seroquel. Use of that drug is down sharply since then, she said.
She said the high numbers of inmates on psychiatric drugs is less a function of prisons than of prisoners.
Many arrive with substance abuse problems and soon learn some anti-psychotic drugs provide "a little buzz," she said in the interview. Many also arrive with several active prescriptions. "It is not at all uncommon for an offender to come in on three, four, five, or six medications for similar conditions," Wehry told lawmakers.
Inmates pressure health providers to prescribe drugs like Seroquel and threaten to file grievances if denied. "Quite frankly, I think docs get worn down," she told AP.
In 2004, four Los Angeles psychiatrists wrote the American Journal of Psychiatry about inmates faking mental illness to get Seroquel, which they would grind up and snort.
"Such abusive self-administration seems to be driven by (the drug's) sedative and (anti-anxiety) effects (to help with sleep or to "calm down") rather than by its anti-psychotic properties," the doctors wrote. "Accordingly, the drug has a 'street value' -- it is sold to other inmates for money -- and is sometimes referred to simply as 'quell.'"
In the interview, Wehry backed away from the numbers she'd given to lawmakers.
She said exact rankings were hard to obtain, because states differ in which medications they include when describing prisoners' use of psychotropic drugs. But she said Vermont is a leader, "in the top five, definitely."
If it's anything close 46 percent -- Wehry said this past week that the most recent quarterly report had 40 percent of Vermont inmates on some type of psychiatric drug -- "that's a very high percentage," said one national expert on mental health care in prisons.
"The question is why," said Dr. Jeffrey Metzner, a Denver-based psychiatrist who has studied prison mental health systems around the country, including Vermont's. "They ought to figure out why."
Wehry said some of the drugs are used "off-label," meaning they are given for symptoms -- such as sleeplessness -- for which they weren't originally designed.
Asked whether he considered it good medical practice to give someone Seroquel for sleep alone, Metzner said no.
With no national numbers ranking of states' use of the drugs, Wehry said she has had to rely on anecdotal information about other states' practices. From recent postings on an Internet listserve used by corrections mental health officials, she offered this sample of percentages of inmates in other states who are getting any of the broad range of psychiatric drugs:
Alabama, 6 percent; Connecticut, 10 percent; Kentucky, 20 percent; and Wisconsin, 20 percent.
There's wide agreement that prisons have become the new mental hospitals. Beginning in the 1960s, state psychiatric hospitals have shrunk or shut down, with patients released in hopes they would be treated in the community. But community services have been spotty and chronically short of funds, with many of the mentally ill left wandering the streets and getting into trouble.
The result, according to a federal Bureau of Justice Statistics report released last September, is that an estimated 56 percent of inmates in state prisons, 45 percent in federal prisons and 64 percent in county and local jails have some form of mental illness.
Metzner disputed that study, saying it relied on self-reporting by inmates and that the resulting numbers were very high. He said in most U.S. prison systems, 14 to 15 percent of inmates are mentally ill.
Kupers, who has testified as an expert witness for prisoners' rights advocates in California and other states, said if anti-psychotic drugs are being used too much in prisons, the solution is in improvements in prison mental health care -- such as talk therapy and daily activities aimed at honing social skills.
"If they're warehousing them in segregation and just giving them pills to quiet them down, that's not treatment," Kupers said.
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