‘Cruel and inhumane’: Forced drug withdrawals in prison

The practice of forcing people to withdraw from drugs in prisons without access to opioid substitution therapy has been found in breach of human rights.

The practice of forcing people in prison on short sentences to involuntary withdraw from opioids rather than provide substitution therapies is “cruel and “inhumane” and in breach of the Charter of Human Rights, a Victorian coroner has found.

In Victorian prisons, opioid substitution therapy, usually in the form of methadone, is available to people in prison with an opioid addiction. But a six week “stabilisation” period is required before the treatment can start.

This means that people in prison on remand or on a short sentence cannot access these treatments and are forced to undergo involuntary withdrawal, something which is significantly dangerous, can be deadly, and is against medical advice in the general community.

Coroner Simon McGregor this week ruled that Veronica Nelson’s death at the Dame Phyllis Frost Centre in early 2020 was the result of complications from withdrawing from opiods, and that her death was preventable.

He found that Nelson was not given proper treatment for drug withdrawal, and was instead given a standard withdrawal pack, which consists of “one-size-fits-all” doses of suboxone, something which was insufficient.

“The severity of her withdrawal could be anticipated, and failing to adequately treat it with a titrated dose was described as ‘inhumane’,” McGregor said.

If Nelson had been in the community, she would have been able to “avoid the painful process of withdrawal altogether”, and medical advice would have been to discourage withdrawal, McGregor found.

The impact of the six-week waiting period and forcing people in prison on short sentences to withdraw from opioids is in breach of the state’s Charter of Human Rights and should be “urgently” reviewed, the coroner said.

“The effect of the six week stabilisation period is to prevent most people with substance use disorder entering custody for short periods from being prescribed pharmacotherapy. Instead, they will undergo involuntary detoxification / withdrawal and often unnecessary pain and suffering,” he said.

“Significantly, opioid withdrawal is not without risk and places the person at higher risk, when released into the community, of fatal overdose.”

The view that a short prison sentence can be helpful for someone with a drug dependency to “dry out” is “misconceived”, McGregor said.

“For people with drug dependence, short periods of imprisonment often exacerbate underlying causes of their drug use, disrupt any community support in place and add to housing and employment difficulties,” he said.

The coroner recommended that Justice Health in Victoria immediately amend its guidelines to enable medical practitioners to prescribe opioid substitution therapy to women whose health may be at “significant risk” by being required to undergo opioid withdrawal, and to “urgently” review guidelines to ensure everyone with opioid dependencies are given access to substitution therapy upon reception at prison, regardless of the length of their sentence.

Last year, a doctor told the coronial inquest that the six week waiting period before undergoing substitution therapy is not clinically necessary, and that it does not occur in the general community.

This makes the practice contrary to the guiding aim of prison healthcare to provide a level of care that is equivalent to healthcare in the general community.