SANTA FE, N.M. — Erica says she was prescribed the drug Wellbutrin for depression while in county jail and later in state prison. But, she says, she didn’t always swallow the drug as she was supposed to; she would sneak it back to her cell and snort it for a high.
“They call it prison coke,” says Erica, 28, who served a sentence for drug trafficking and other charges and later landed back in prison for a parole violation.
Wellbutrin, an antidepressant, is a psychotropic medication and as the number of mentally ill has increased in state prisons, so has the number and percentage of inmates who are prescribed psychotropic drugs for depression, schizophrenia, bipolar disorder and other conditions.
But many of those medications may be abused for their “high,” sleep-causing effects or aid in sexual function. Some can be snorted or injected. The psychotropic medication Seroquel, for example, is known as “baby heroin.”
About 33 percent of all inmates in New Mexico prisons – including both men and women – were on psychotropic medications as of April 30, up from 25 percent in 2012 – roughly double what one expert says he would have expected. By comparison, the prescription rate was 10 percent for federal inmates in 2014.
The rate is much higher among female inmates in the state prison system, soaring to about 70 percent at New Mexico’s only women’s prison, in Grants, as of April 30, according to statistics from the Department of Corrections. For men in the prison system, the rate was much lower, about 30 percent.
Jeffrey Metzner, a University of Colorado psychiatrist who works and conducts research in the field of correctional mental illness, said he would expect to see psychotropic medications prescribed for about 15 percent of male inmates and 30 percent of female inmates.
In response to questions from the Journal, the behavioral health unit of the Corrections Department issued a statement saying New Mexico’s rate of psychotropic drug prescriptions for inmates is high, particularly for women. The department is taking steps to address the issue, including “establishing a treatment philosophy that leads to lowering the numbers of inmates on psychiatric medications without compromising needed care,” the statement said.
Psychotropic medications are defined as those drugs capable of affecting the mind, emotions and behavior. Research has shown that inmates will feign illness to obtain some psychotropic medications or buy the drugs or extort them from inmates with prescriptions.
Inmates at the San Juan County Adult Detention Center allegedly drank jailhouse liquor and snorted Wellbutrin before getting into a brawl with guards last December.
Erica, who says she has gotten sober since release from prison, says she snorted Wellbutrin behind bars because it helped with her meth addiction.
“That’s how some people get by,” she says. “A lot of people in prison are drug addicts. They will do anything for a high.”
Other former inmates at the women’s prison also described abuse of psychotropic medications, including Wellbutrin and Seroquel. Researchers have found that prescribed drugs, because they are legal and present in prisons, are easier for inmates to obtain than illegal drugs.
“If the women didn’t have that type of drugs, there would be a lot more … smuggling of drugs into prison,” says former Grants inmate Denise Davis Lucero.
There is good reason that jails and prisons have been described as America’s new asylums for the mentally ill.
New Mexico’s only state-owned and -operated psychiatric hospital, in Las Vegas, has 157 behavioral health beds for adults. By comparison, 2,036 inmates in state prisons have received clinical services for chronic mental illness this year, according to the Corrections Department. The state also has a 104-bed unit in Los Lunas for the most seriously mentally ill inmates, including the homicidal.
The number of inmates receiving clinical services for chronic mental illness has grown 29 percent in three years, and there has been a parallel growth in the number of inmates receiving psychotropic medications. A total of 2,166 inmates have received the drugs this year, up 29 percent from 2012.
There were a total of 6,597 female and male state inmates as of April 30, and nearly 71 percent of the women and 28 percent of the men were receiving psychotropic drugs, according to the Corrections Department.
“Seventy-one percent sounds very high to me,” Metzner said of New Mexico’s psychotropic drug prescription rate for women inmates. He said one possible explanation is that mental health care services in prisons are understaffed and psychiatrists could be overprescribing because there is limited time to assess inmates and provide alternative therapy.
A statement by the behavioral health unit of the Corrections Department said, “The overall mental health staffing pattern is good. However, at a few locations, an increased number of mental health staff may be beneficial. Also, it is noted that in rural locations, difficulties are faced with recruiting licensed mental health practitioners.”
The unit also said in a statement, “Not all patients require psychiatric medications, and counseling is often effective in addressing the mental health/emotional challenges that inmates experience.”
The statement said the Corrections Department has begun meeting with its medical contractor to address the challenge of the high rate of inmates on psychotropic medications. The percentage of inmates entering prison on psychotropic drugs and the number of inmates who have completed psychiatric regimens and no longer require psychiatric services will be evaluated, the statement said.
Also, the statement said, the department’s next contract for medical services for inmates will require the contractor to provide cutting-edge approaches to address the prescription rate of psychotropic drugs.
Prisons outside New Mexico have been accused of overprescribing psychotropic medications as a way to keep inmates sedate, but Jerry Roark, director of adult prisons for the Corrections Department, said he doesn’t believe that is the case here. “We do not want to use drugs as a security tool,” Roark said.
Prescription rates for psychotropic medications differ sharply not only among male and female inmates but also among prisons.
For example, about 18 percent of inmates at the privately run Lea County Correctional Facility in Hobbs were on psychotropic drugs as of April 30, compared to nearly 49 percent at the publicly run Penitentiary of New Mexico in Santa Fe and more than 43 percent at the publicly run Western New Mexico Correctional Facility in Grants.
The psychotropic drug prescription rate for male inmates was 31 percent in all publicly run facilities, compared to 23 percent for men in privately run prisons. (The women’s prison is privately run.)
The penitentiary is the state’s only super-max prison, and there is a greater level of mental illness among inmates with the highest security risks, said a statement from the behavioral health unit of the Corrections Department. Also, the department tries not to send the most seriously mentally ill inmates to private prisons, the statement said.
“Overall, the psychiatric prescription variance (among prisons) is a product of the inmate constituency, the level of mental illness and the prescribing practices of individual psychiatrists,” the statement said.
Under a Corrections Department policy, inmates are barred from having self-carry prescriptions of psychotropic medications, and the drugs must be delivered to inmates in a form that impedes illicit hoarding.
At the women’s prison, according to former inmates, psychotropic drugs are dispensed in crushed form and inmates are provided cups of water. However, despite being watched by nursing staff, some prisoners spit the drugs and water back into the cups and take the cups and the substances to their cells, former inmates say. Prisoners let the substances dry, allowing the drugs to then be snorted or injected.
“They were just doing anything they could to get high,” says Lucero, the former inmate at Grants.
Buproprion, the generic name for Wellbutrin, has been widely identified in research as a psychotropic medication that is abused by inmates. Outside prison walls, it has been called the “poor man’s coke.”
Prescription rates for buproprion vary widely across the state’s prison system. About 12 percent of inmates at both the women’s prison and at the Penitentiary of New Mexico’s were prescribed buproprion as of April 30. The rate was less than 2 percent at the Lea County Correctional Facility.
Another psychotropic medication widely identified as subject to inmate abuse is quetiapine, which is sold under the brand name Seroquel. It’s an antipsychotic used to treat schizophrenia, bipolar disorder and depressions, but it’s also known among inmates for its sleep-causing effects.
Referred to as “baby heroin,” “Suzie Q” and other names, quetiapine can be crushed and snorted. Women inmates who take the drug call it going to “Seroquel Hill,” says Erica, the former Grants inmate.
Prescription rates for quetiapine are low across the prison system. As of April 30, only 42 of 6,597 female and male inmates were prescribed the drug. Eleven of the 42 were women.
According to Metzner, the Denver psychiatrist, most states have taken buproprion and quetiapine off their prison formularies, meaning any prescriptions of the drugs by psychiatrists must be reviewed and approved by other medical personnel.
New Mexico has taken quetiapine but not bupropion off its formulary. “However, the potential for abuse of (buproprion) is well known and administration procedures are strict,” according to the statement from the behavioral health unit of the Corrections Department.