If you could design a single-payer prescription benefit...

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still doesnt justify the cost difference
It also fails to justify why incarcerated criminals--who obviously are neither working, nor attending school, nor engaging in any other significant productive activities--would ever "need" to be prescribed a narcotic stimulant medication, under any circumstannces, in the first place.

I find it ironic, absurd, and downright outrageous that we taxpayers are forced to finance this exorbitant expense of providing "free" Vyvanse to prisoners, especially when there is absolutely nothing in their daily lives to require sustained mental focus.
 
It also fails to justify why incarcerated criminals--who obviously are neither working, nor attending school, nor engaging in any other significant productive activities--would ever "need" to be prescribed a narcotic stimulant medication, under any circumstannces, in the first place.

I find it ironic, absurd, and downright outrageous that we taxpayers are forced to finance this exorbitant expense of providing "free" Vyvanse to prisoners, especially when there is absolutely nothing in their daily lives to require sustained mental focus.

I've been working in a jail for the past 17 years, and that argument doesn't work on the psychiatrists who prescribe Vyvanse or other stimulants for ADHD.

Me (on the phone to a psychiatrist): "Your pt says he is on Ritalin. I'm calling to verify this, and also, do you think he needs Ritalin while he's in jail? He doesn't need to concentrate or focus on anything whilst incarcerated."

Psychiatrist: (after a moment's silence): "He's on Ritalin LA 80 mg daily. Please make sure he gets it."

OTOH, it can be argued that the stimulants help curb impulsiveness that could get inmates with ADHD in trouble when in jail.
 
I've been working in a jail for the past 17 years, and that argument doesn't work on the psychiatrists who prescribe Vyvanse or other stimulants for ADHD.

Me (on the phone to a psychiatrist): "Your pt says he is on Ritalin. I'm calling to verify this, and also, do you think he needs Ritalin while he's in jail? He doesn't need to concentrate or focus on anything whilst incarcerated."

Psychiatrist: (after a moment's silence): "He's on Ritalin LA 80 mg daily. Please make sure he gets it."

OTOH, it can be argued that the stimulants help curb impulsiveness that could get inmates with ADHD in trouble when in jail.
Well, since he must have done something pretty outrageous to land himself in jail in the first place, I'd say the Ritalin wasn't doing such a great job of controlling his so-called "impulsivity".

Obviously, I don't know the particulars in this case, but in general, it gets annoying when certain psychiatrists try to explain every unpleasant human behavior as a symptom or manifestation of some made-up mental disease process. Plenty of people shoplift because they like to acquire expensive items for free--not because they are inadvertently forced into impulsive actions secondary to their suffering from unmanaged ADHD.
 
If a prisoner had depression, should they get meds for that if they have nothing to be happy about? If they have OCD, should they get meds for that even if it doesn't interfere with their prison life?
 
Well, since he must have done something pretty outrageous to land himself in jail in the first place, I'd say the Ritalin wasn't doing such a great job of controlling his so-called "impulsivity".

Obviously, I don't know the particulars in this case, but in general, it gets annoying when certain psychiatrists try to explain every unpleasant human behavior as a symptom or manifestation of some made-up mental disease process. Plenty of people shoplift because they like to acquire expensive items for free--not because they are inadvertently forced into impulsive actions secondary to their suffering from unmanaged ADHD.

Have you had your psych clerkship yet?

I'm on mine and it has been very enlightening. You may feel differently about psych patients in general after it. Try to have some compassion.

These aren't made up disease processes.
 
If a prisoner had depression, should they get meds for that if they have nothing to be happy about? If they have OCD, should they get meds for that even if it doesn't interfere with their prison life?
Untreated OCD would not interfere with life in prison?? Is that really what you stated? I don't think you understand much about OCD, or life in prison, or the horrific interaction effect between the two. I presume you wouldn't grasp how being locked up could exacerbate clinical depression either. Personally I have no problem whatsoever when patients with these disorders are medicated for them in prison. Another very important factor is that the meds used to treat depression and OCD are not C-II narcotic substances with extremely high abuse potential.

On the other hand, the therapeutic benefits of Ritalin for a confined prisoner are virtually nonexistent (Indeed, I'm struggling to imagine even one legitimate indication for psychostimulant therapy in a jail setting). Clearly, the very serious risks of abuse/diversion of Ritalin far outweigh the scant, if any, conceivable benefits! What does he need it for?? So he can focus more attentively on the TV screen in his cell? In this setting, Ritalin is dangerous, unnecessary, an expensive waste of taxpayer money--a simply outrageous drug for prisoner!

In fact, I know plenty of psychiatrists (the good ones with some common sense) won't even prescribe stimulants to patients who live IN THE COMMUNITY--unless the patient either has a job and/or attends school (i.e., a reason to focus). And, to relate this final thought back to our incarcerated patient,they would certainly never, and I mean NEVER, prescribe speed to a patient with a CRIMINAL RECORD, who also did not work, did not study, and had barely performed a single difficult responsibility in his entire life.
 
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Have you had your psych clerkship yet?

I'm on mine and it has been very enlightening. You may feel differently about psych patients in general after it. Try to have some compassion.

These aren't made up disease processes.
You are correct that I have not done my psych clerkship yet.

However, before returning to medical school, I was employed full-timed in the mental health field for nearly ten years as a master's-prepared clinician--six years of which I spent working the overnight shift in the admissions department of an impoverished acute care psychiatric hospital. So for quite a few years I had the experience of providing direct care to severely decompensated patients in the throes of all the most devastating mental illnesses in the book--which were typically co-occurring with raging active drug addictions as well.

But maybe when I do start my psych clerkship, if I'm lucky, I'll be able to reconnect with some of the personal qualities such as optimism, idealism, hope, faith, trust, unintentionally-condescending-naivety, gullibility, ignorance--and, most of all, sanctimonious self-righteousness--which are so clearly evident in your post.

Trust me, I recognize them all as clearly as the morning sun, because I used to possess them all too about 12 years ago. To tell you the truth, I wouldn't even mind rediscovering some of my former sanctimonious self-righteousness, because I'll never forget the warm-fuzzy feeling it gives you inside to realize that you are so much more compassionate and tuned-in with human suffering than anyone else.
 
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Indication for stimulants during incarceration
Narcolepsy

Boom, roasted
You know, I actually considered that (and snickered to myself wondering how long it would take for somebody to eagerly bring it to my attention)--but then I disqualified that justification too. Since it's not like there's a whole lot to do in prison, so I figured that long naps and random episodes of nodding of might not be such a bad way to spend your days in the slammer.

But I'd bet the chances he has narcolepsy are slim to none, anyway.
 
Untreated OCD would not interfere with life in prison?? Is that really what you stated? I don't think you understand much about OCD, or life in prison, or the horrific interaction effect between the two. I presume you wouldn't grasp how being locked up could exacerbate clinical depression either. Personally I have no problem whatsoever when patients with these disorders are medicated for them in prison. Another very important factor is that the meds used to treat depression and OCD are not C-II narcotic substances with extremely high abuse potential.

On the other hand, the therapeutic benefits of Ritalin for a confined prisoner are virtually nonexistent (Indeed, I'm struggling to imagine even one legitimate indication for psychostimulant therapy in a jail setting). Clearly, the very serious risks of abuse/diversion of Ritalin far outweigh the scant, if any, conceivable benefits! What does he need it for?? So he can focus more attentively on the TV screen in his cell? In this setting, Ritalin is dangerous, unnecessary, an expensive waste of taxpayer money--a simply outrageous drug for prisoner!

In fact, I know plenty of psychiatrists (the good ones with some common sense) won't even prescribe stimulants to patients who live IN THE COMMUNITY--unless the patient either has a job and/or attends school (i.e., a reason to focus). And, to relate this final thought back to our incarcerated patient,they would certainly never, and I mean NEVER, prescribe speed to a patient with a CRIMINAL RECORD, who also did not work, did not study, and had barely performed a single difficult responsibility in his entire life.

I think you missed the point of her post.
 
you are correct that i have not done my psych clerkship yet.

However, before returning to medical school, i was employed full-timed in the mental health field for nearly ten years as a master's-prepared clinician--six years of which i spent working the overnight shift in the admissions department of an impoverished acute care psychiatric hospital. So for quite a few years i had the experience of providing direct care to severely decompensated patients in the throes of all the most devastating mental illnesses in the book--which were typically co-occurring with raging active drug addictions as well.

But maybe when i do start my psych clerkship, if i'm lucky, i'll be able to reconnect with some of the personal qualities such as optimism, idealism, hope, faith, trust, unintentionally-condescending-naivety, gullibility, ignorance--and, most of all, sanctimonious self-righteousness--which are so clearly evident in your post.

Trust me, i recognize them all as clearly as the morning sun, because i used to possess them all too about 12 years ago. To tell you the truth, i wouldn't even mind rediscovering some of my former sanctimonious self-righteousness, because i'll never forget the warm-fuzzy feeling it gives you inside to realize that you are so much more compassionate and tuned-in with human suffering than anyone else.

lol 😀
 
If a prisoner had depression, should they get meds for that if they have nothing to be happy about? If they have OCD, should they get meds for that even if it doesn't interfere with their prison life?
If a prisoner is balding, should he get Propecia? If a prisoner wants longer eyelashes, should they get Latisse?
 
But maybe when I do start my psych clerkship, if I'm lucky, I'll be able to reconnect with some of the personal qualities such as optimism, idealism, hope, faith, trust, unintentionally-condescending-naivety, gullibility, ignorance--and, most of all, sanctimonious self-righteousness--which are so clearly evident in your post.

Trust me, I recognize them all as clearly as the morning sun, because I used to possess them all too about 12 years ago. To tell you the truth, I wouldn't even mind rediscovering some of my former sanctimonious self-righteousness, because I'll never forget the warm-fuzzy feeling it gives you inside to realize that you are so much more compassionate and tuned-in with human suffering than anyone else.

You should try to settle down. Maybe some meds would help?

You know, I actually considered that (and snickered to myself wondering how long it would take for somebody to eagerly bring it to my attention)--but then I disqualified that justification too. Since it's not like there's a whole lot to do in prison, so I figured that long naps and random episodes of nodding of might not be such a bad way to spend your days in the slammer.

But I'd bet the chances he has narcolepsy are slim to none, anyway.

Narcolepsy is an actual neurological disorder and not just "being sleepy" and "taking long naps." Can you think of any reason that this disorder might be debilitating or perhaps even hazardous for an incarcerated person? You do realize that most prisoners don't spend every waking moment of the day sitting in their cells, right?
 
Well, most of the DSM diagnoses for mental illness require that the symptoms interfere with your life in some way (harm relationships, employment, education, etc), so technically, if you go to prison with some mental illnesses you would actually lose them.
 
On the other hand, the therapeutic benefits of Ritalin for a confined prisoner are virtually nonexistent (Indeed, I'm struggling to imagine even one legitimate indication for psychostimulant therapy in a jail setting). Clearly, the very serious risks of abuse/diversion of Ritalin far outweigh the scant, if any, conceivable benefits! What does he need it for?? So he can focus more attentively on the TV screen in his cell? In this setting, Ritalin is dangerous, unnecessary, an expensive waste of taxpayer money--a simply outrageous drug for prisoner!

In fact, I know plenty of psychiatrists (the good ones with some common sense) won't even prescribe stimulants to patients who live IN THE COMMUNITY--unless the patient either has a job and/or attends school (i.e., a reason to focus). And, to relate this final thought back to our incarcerated patient,they would certainly never, and I mean NEVER, prescribe speed to a patient with a CRIMINAL RECORD, who also did not work, did not study, and had barely performed a single difficult responsibility in his entire life.

All true but maybe the Ritalin will help him turn his life around? Lol!

His job is getting a job
 
You know, I actually considered that (and snickered to myself wondering how long it would take for somebody to eagerly bring it to my attention)--but then I disqualified that justification too. Since it's not like there's a whole lot to do in prison, so I figured that long naps and random episodes of nodding of might not be such a bad way to spend your days in the slammer.

But I'd bet the chances he has narcolepsy are slim to none, anyway.

There's probably more pressing concerns such as imminent combat
 
If a prisoner had depression, should they get meds for that if they have nothing to be happy about? If they have OCD, should they get meds for that even if it doesn't interfere with their prison life?

A reasonable point; however, OCD or depression result in distress, while the hypoactivity of the frontal cortex resulting in inattention and impulsivity that characterizes ADHD is more of a problem for the person's societal functioning. ADHD is not, in itself, a condition causing innate suffering.

Stimulants improve a person's attention, but they don't confer skills the patient does not have. That's why we call them "homework pills."

I was talking to an inmate the other day who was on 80 mg Biphentin, and wanted a dose increase, wanting to know what the "maximum dose" of Biphentin was, insisting that his dr in the community was giving him 100 mg daily. He's a healthy young guy who is also on Seroquel to help him sleep (apparently,when you ingest 80 mg of methylphenidate daily, insomnia is a problem), and gabapentin for "pain."

I don't know if we're helping troubled people by heaping more drugs on them. But I see lots of physically healthy people with duelling psychiatric diagnoses getting staggering doses of conflicting meds. And lots of drug-seeking behaviour around the stimulants, not to mention bupropion, quetiapine and gabapentin.
 
You should try to settle down. Maybe some meds would help?



Narcolepsy is an actual neurological disorder and not just "being sleepy" and "taking long naps." Can you think of any reason that this disorder might be debilitating or perhaps even hazardous for an incarcerated person? You do realize that most prisoners don't spend every waking moment of the day sitting in their cells, right?
I know that narcolepsy is a real (and dangerous) neurological condition that requires medical management.

For once, I was trying to show a little sense of humor.
 
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