PILL POPPERS

Investigative Reporters and Editors, Inc. The IRE Journal, May/Jun 2006 by Halsne, Chris

Inmates given easy access to painkillers; sources say 'they hand it out like candy'

I imagine morphine is a godsend to a soldier whose leg has been torn off by a land mine. Cancer victims also may find a modicum of comfort in the time-release painkiller. But I had questions when I found out morphine pills are routinely handed out to Washington state prison inmates who complain of everything from a sore back to a hurt toe.

Last July, nurses who worked inside various correctional institutions shared with us their concerns that the prisons were overprescribing highly addictive narcotics. One nurse told us, "They hand it out like candy." Another stated, "I pretty much saw inmates stoned all the time." They told us the real reason prison doctors overmedicated inmates was to placate inmates, to make them easier to manage. Their testimony was compelling and consistent.

It also was going to be difficult to prove. The privacy rules in the Health Insurance Portability and Accountability Act (HIPAA) were clearly standing in the way of full disclosure.

Colorado provides answers

Tracking the finances of taxpayer-funded painkillers was not as simple as we first imagined. The raw pills in question cost about $500,000. Compared to the overall Department of Corrections health budget, it was a drop in the bucket. The costs of distributing the drugs, however, were untold millions more. Nurses described the three-times-a-day "pill line" for inmates as "total chaos." Extra security measures had to be taken near the drug cabinets. Doctors and nurses had to oversee the handout. Rapists, murderers, and thieves had to be moved in and out of a small room repeatedly.

One drawback for our investigative team was that we could not gain access to an unaltered pill line. I believe that because prison officials knew we were coming, they may have handpicked agreeable inmates to be on television. That's why the testimony of the nurses was so important. While we did agree to hide the identity of one nurse to protect her job, we balanced that secrecy with another on-camera nurse who backed up our hidden source's claims.

It took three months for the Department of Corrections to partially fulfill our Open Record Act request, which finally gave us the hard numbers to back up the nurses' claims. The state only provided data for the eight largest prisons, and included only certain drugs. Over a three-year period, pharmacy logbooks showed general population inmates took at least 329,000 oxycodone pills and 85,000 doses of morphine. Overall, inmates consumed about a million doses of painkillers.

Our first task was to take those numbers, which sounded big, and give them some perspective. We couldn't find any scientific studies. State health officials were clueless, not even knowing where to start. Washington prison doctors basically challenged us to prove their painkiller distribution was not "normal."

Ultimately, the answer came from Colorado. We determined its prison system has the same basic population and racial breakdown as Washington's prison system. Investigative producer Bill Benson figured by reviewing Colorado's painkiller distribution, we'd see if there might be a problem here.

The numbers were polar opposites. Colorado wasn't prescribing any morphine or oxycodone to general population inmates. Other narcotics were used sparingly. Colorado, in fact, had determined that neither of those pills was safe to have inside a facility unless it was in the lockdown section of the prison hospital.

We also learned that because most morphine and oxycodone pills are timerelease and cannot be crushed in water, as can other painkillers, prisoners routinely sell or horde morphine and oxycodone by "cheeking," the nurses told us. Unless security staff is diligent about checking the mouth of every inmate in the pill line, it's easy for them to hide prescriptions, the nurses explained.

Wild variations

The most important statistic we found was not the sheer numbers of narcotics in prison, but the inconsistent distribution per institution.

Researchers told us fluctuations were really the key to spotting potential problems. It's reasonable to assume that on average, each prison would prescribe about the same amount of painkillers per inmate. By building an Access database from prison pharmacy distribution charts, we found wild variations. For example, at one correctional facility, inmates averaged less than one oxycodone pill per year. At another, they received 63 each.

When we shared this information with the Washington Department of Corrections, they became concerned and launched an internal investigation just before our first report aired. They found enough evidence of wrongdoing to expand their investigation, and the Washington State Health Department has put together a team of five professionals (a doctor, a pharmacist and three nurses) to get to the root of the troubles with painkillers. That outside investigative team already has expanded its examination to include psychotropic drugs.