‘I was never taken seriously’: Managing pain in prison

There is a renewed push for painkillers such as panadol to be more freely available in Australian prisons and for the pain of people in prison to be taken more seriously.

In early 2022, a simple experiment was conducted at the Townsville Correctional Complex.

Across the year, painkillers such as paracetamol and ibuprofen were made available through the prisoner buy-up, rather than only through a prescription as they were previously limited, and continue to be in most prisons in the country.

The trial expanded to the whole prison and ran for the whole year, with more than 9000 painkiller packets bought through the scheme, which allowed individuals to buy up to 10 paracetamol and 12 ibuprofen per buy-up, and to hold twice that much in their cell in total.

While the common argument against making painkillers more readily available in prisons is the risk of misuse or self-harm, there were “no significant problems or adverse events” throughout the trial.

“While some officers and clinicians were initially concerned about misuse, these fears have not been substantiated,” a report on the study said.

“Being trusted to manage their pain relief gave agency / decision-making ability to prisoners, helping to restore self-worth and health literacy, with clinicians and officers noting that this change helped to stop ‘prisoners repeatedly asking for pain relief’.”

Despite the success of this trial, it has not been more widely expanded, and it is still significantly difficult to access painkillers in prisons around Australia. This commonly requires a prescription obtained through an appointment with the prison’s doctor, and process which can take a long time.

The Nelson Mandela Rules require the same healthcare to be offered in prisons as it is in the community, but access to pain relief is far more difficult for those who are incarcerated compared to being readily available over-the-counter in the community.

In a submission to the Victorian government, VACRO has urged Justice Health to make painkillers available in prisons without the need for a medical consultation or prescription to assist those in prison dealing with pain.

The federal government’s National Strategic Action Plan for Pain Management, released in 2021, identified best practice pain management in prisons as being “critical”, while the Royal Australia College of General Practitioners have highlighted the importance of pain management in prisons because of the “high prevalence of significant physical trauma in this population”.

Despite this, the Victorian government’s Healthcare Services Quality Framework for Victorian Prisons 2023, which governs the delivery of healthcare in prisons in the state, does not include a single mention of “pain” or “pain management”.

“Multiple reviews, inquiries and inquests have found that pain is under-recognised, dismissed and poorly treated in the Victorian prison system,” the VACRO submission said.

“It is recognised that the health staff and prison officers often interpret help-seeking for pain as drug-seeking behaviour and that women reporting pain are commonly not believed.”

In the submission to the Women’s Health Advisory Council, three women detailed their experiences of dealing with pain within the Victorian criminal justice system.

One of the women, KC, describes how she was experiencing severe dental pain while in prison, with her back teeth severely decaying, leading to gum infections and dental abscesses. 

She filled in the necessary medical request form and placed it in the box, with the turnaround for this process often between one to three weeks. Once she received an appointment with the nurse, she was told they would need to be referred to a doctor as the nurse could not prescribe medication.

This process then takes up to a week, until any pain-relief medication can be prescribed. And once written up for antibiotics, those in prison are only able to access that medication for the exact number of days it has been prescribed.

It took three days into the five-day script for KC’s medication to arrive, meaning she was unable to take the full course required to combat the infection.

“This for me meant that another flare up was inevitable and when it did, I had to go through the above steps again,” KC said in the VACRO submission.

Steph also encountered significant pain issues while she was incarcerated. After experiencing sustained lower back pain, Steph begged for a CT scan but was continually refused.

“I was convinced there was something wrong but I was never taken seriously,” Steph said in the VACRO submission.

After 18 months, she finally got a CT scan which revealed a bulged disc, which eventually ruptured.

Three months after she was released from prison, a disc in her neck slipped out, pinching the nerve, with an MRI scan showing the disc was damaged beyond repair.

“When I got home I was in a great deal of pain but prison made me think it was all in my head,” she said.

“They treat you like a hypochondriac when you’re suffering. I kept thinking it was stress but deep down I was worried.

“People in prison get treated like they are overreacting about everything. My pain brought me to tears and I still wasn't treated seriously in there.”

Stacey, a transgender woman, was incarcerated for eight years in a male prison, including the notorious Port Phillip Prison. She said her pain was not taken seriously by most of the prison staff and doctors.

“Women in prison experience severe and frequent pain,” Stacey said in the VACRO submission.

“Treatment, care and management for that pain is inadequate and does not come close to equivalent with pain management in the community. In prison, women’s pain is left to worsen until it becomes critical.”