Prescription practices for psychotropic medications in the community and in prison populations: review of current literature

Recent questions have been raised about the perceived high rates of prescription of psychoactive drugs to federal inmates. There is a concern that there may be an increased risk for off-label abuse of psychotropic medication in prison settings to control disruptive behaviour.

A literature review of prescription practices for psychoactive drug both in the general population and in prisons was conducted focusing on the Canadian context.

In the general population, psychotropic medications are used to treat a wide range of mental disorders. An estimated 10% - 20% of the general population use prescribed psychotropic medications.

Among prison inmates, international studies report the prevalence of prescribed psychotropic medication use at 20% for males, and between 40% - 50% for females.

A recent Canadian national study of federal inmates reported that 30% of inmates had a prescription for at least one psychotropic medication (Farrell-MacDonald, Keown, Boudreau, Gobeil, & Wardrop, 2015). These results suggest that the prevalence of prescribed psychotropic medication use among inmates is nearly four times greater than in the Canadian population possibly reflecting the high rates of current mental disorder in this population.

‘Off-label’ use of medication, that is, use of a drug in a population, for an indication or at a dosage or method of administration for which it has not been approved, is common, especially in paediatrics, psychiatry, among the elderly, in transplant medicine, HIV/AIDS treatment, and in cancer treatment. International studies report that as many of 30% - 50% of prescriptions for psychotropic medications are for off-label use.

Medical practitioners argue that there are many good reasons for prescribing drugs off-label, and off-label prescribing is tacitly supported by professional associations, hospitals and even government agencies. However, off-label use of psychotropic medications is not without risk, including unknown, adverse side effects and possible legal liability. These concerns are especially germane when considering the use of psychotropic medications in prison populations in which the lack of treatment resources, the high rate of substance use disorder, and the captive nature of the population may increase the possibility that psychotropic medications could be misused.

Off-label prescription of medication, including psychotropic medications, is common medical practice. Given only the largely anecdotal evidence currently available about the use of psychotropic medications and their off-label uses among prison inmates, there is a strong need to undertake research to examine the prevalence of approved and off-label use of psychotropic medication in the prison environment, and to identify any potential concerns with their use. This study is currently being undertaken by the Correctional Service of Canada.

Brown, G. (2017). Prescription practices for psychotropic medications in the community and in prison populations: Review of current literature. (Research Report R-382). Ottawa, Ontario: Correctional Service of Canada.

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