Hamilton's inmates keep dying and more could be done to save them, study says

Since 2012, at the Hamilton-Wentworth Detention Centre, a steady stream of body bags have been carried out the door.

Eight mendied of drug overdose inside the jail in a six-year period, and now, a new study from McMaster University suggests that not enough is being done to help inmates access opioid dependence treatments inside the province's correctional facilities.

"There's no question that a much better job could be done,"said Dr. LoriRegenstreif, a contributing author for the study, which was released today in the scientific journalPLOSONE. "And there's no question that the resources aren't there,"

The study included completion of an online survey by 27 physicians, who reported working in 15 of 26 provincial correctional facilities for adults in Ontario.

Regenstreifspent a year working as a doctor in the Barton Street jail back in 2016. She says substance abuse for inmates using smuggled-in contraband was quite high.

"I was always amazed by how much," she said.

The study found that about half of the doctors polled prescribed methadone to treat patients, while the other half prescribed buprenorphine/naloxone to treat opioid dependence.

'It's not really a high priority'

Buprenorphine and methadone are used to treat withdrawal symptoms (which are incredibly intense for opioid users), while naloxone is used to treat overdoses in an emergency.

According to the study, all of the doctors polled who used methadone said they continued treatment if it was initiated before the person was arrested but only 36 percent reported they also started patients on this treatment inside a jail.

Of the doctors who prescribed buprenorphine or naloxone, just over three quarters reported they continued that treatment if the inmate started it before his arrest, but only 23 per cent started patients on that same treatment after the fact.

The most common reasons doctors gave for not prescribing the treatments were not having an exemption to prescribe methadone, other doctors being responsible for the service in the institution, not being interested in adding the treatment to clinical work and not having the knowledge needed about these treatments.

Regenstreif says there werealso "varying degrees of nursing support" when it came to literally bringing the medication to an inmate on a daily basis, as it has to be supervised.

"It's a little bit labour intensive for the administrative and nursing staff to oversee that, and it's not really a high priority," she said.

"There also has to be the will to put [the tools needed] there, and the money that would be required and the philosophical support, the ideological support, to actually see correctional settings as an opportunity to help people get better, rather than to make them suffer until they get back out and possibly do more damage than they did when they came in."

Ministry says it's taking action

The Ministry of Community Safety and Correctional service says it is "committed to ensuring that those in need have access to the right supports within our correctional facilities and in our communities."

"All inmates receive health assessments when they are admitted, and as needed while in custody," said spokesperson Andrew Morrison, in an email. "Inmates with substance use disorder are assessed for withdrawal, and have access to a variety of supports including psychiatrists, psychologists, and social workers. Opioid Substitution Therapy, including both methadone and suboxone, is available to assist with managing opioid addictions."

Morrison also said that the province is "taking action to prevent inmate overdoses and to treat addictions so that inmates can safely re-integrate into the community upon release from custody."

But in recent years, overdoses in Hamilton have not been prevented. An inquest into eightoverdose deaths that happened at the Barton Street jail was originally called back in 2015, but hasbeen delayed multiple times.The inquest is now set for April 9.

Since the inquest was first called, multiple other inmates have died, while ambulances have been back and forth to the jail several times because of overdoses.

The most recent,Brennan Bowley, died last month. His family believes the cause was an accidental overdose.

Former regional coroner Dr. Jack Stanborough, who was previously set to preside over the inquest, has criticized the way the coroner's office has handled the file.

Stanborough previously said he was "paid to go away" and dismissed for criticizing the ministry too harshly during other inquests.

adam.carter@cbc.ca