Estimated Use of Prescription Medications Among Individuals Incarcerated in Jails and State Prisons in the US

Abstract

ImportanceAlthough incarcerated individuals experience higher rates of chronic conditions, little is known regarding the use of prescription medications in jails and prisons in the US.ObjectiveTo characterize treatment with prescription medications in jails and state prisons relative to noncorrectional settings in the US.Design, Setting, and ParticipantsThis cross-sectional analysis using 2018 to 2020 data from the National Survey on Drug Use and Health (NSDUH) estimated the prevalence of disease among recently incarcerated and nonincarcerated adults in the US. The study used 2018 to 2020 IQVIA’s National Sales Perspective (NSP) to quantify the distribution of medications to incarcerated and nonincarcerated populations. The NSP provides national dollar and unit sales of prescription medications across multiple distribution channels, including prisons and jails. The study population included incarcerated and nonincarcerated individuals from NSDUH. Seven common chronic conditions were assessed. Data were analyzed in May 2022.ExposuresMedications being sent to correctional facilities vs all other settings in the US.Main Outcomes and MeasuresThe main outcomes were distribution of medications to treat diabetes, asthma, hypertension, hepatitis B and C, human immunodeficiency virus (HIV), depression, and severe mental illness to incarcerated and nonincarcerated populations.ResultsThe proportion of pharmaceuticals distributed to jails and state prisons to treat type 2 diabetes (0.15%), asthma (0.15%), hypertension (0.18%), hepatitis B or C (1.68%), HIV (0.73%), depression (0.36%), and severe mental illness (0.48%) was much lower compared with the relative burden of disease among this population. The incarcerated population in state prisons and jails accounted for 0.44% (95% CI, 0.34%-0.56%) of estimated individuals with diabetes, 0.85% (95% CI, 0.67%-1.06%) of individuals with asthma, 0.42% (95% CI, 0.35%-0.51%) of hypertension, 3.13% (95% CI, 2.53%-3.84%) of hepatitis B or C, 2.20% (95% CI, 1.51%-3.19%) of HIV, 1.46% (95% CI, 1.33%-1.59%) of depression, and 1.97% (95% CI, 1.81%-2.14%) of severe mental illness. After adjusting for disease prevalence, the relative disparity was 2.9-fold for diabetes, 5.5-fold for asthma, 2.4-fold for hypertension, 1.9-fold for hepatitis B or C, 3.0-fold for HIV, 4.1-fold for depression, and 4.1-fold for severe mental illness.Conclusions and RelevanceIn this cross-sectional, descriptive study of the distribution of prescription medications for chronic conditions in jails and state prisons, the findings suggest that there may be underuse of pharmacological treatment in correctional facilities relative to the nonincarcerated population. These findings, which require further investigation, may reflect inadequate care in jails and prisons and represent a critical public health issue.

Medication Access in Prisons and Jails—Some Answers, More Questions

“…Perhaps most notably, this study 2 further illuminates the paucity of data on the health and health care available to those incarcerated in US prisons and jails. Although the authors make important attempts to estimate prescription drug availability behind bars, no uniform system currently exists to measure the quality of care and the availability of medications in the health care systems of prisons and jails.…”

“…The findings of Curran and colleagues 2 are important especially given that undertreatment of medical and behavioral health conditions in carceral settings extends beyond individual-level health outcomes. For example, public health experts consider prisons and jails a crucial target for achieving the United Nations’goal of hepatitis C virus eradication by 2030 given the high prevalence in such settings.…”

“…In this issue of JAMA Health Forum , Curran and colleagues 2 take a novel approach to glean insight into the quality of care behind bars. They use data from the National Survey on Drug Use and Health and from IQVIA’s National Sales Perspective to estimate disease prevalence and access to pharmaceutical treatments, respectively, for 7 chronic conditions (diabetes, asthma, hypertension, hepatitis B and C, HIV, depression, and severe mental illness) in prisons and jails.…”

“…These national results are consistent with prior survey studies that have shown that medications to treat hepatitis C or opioid use disorder are largely underprescribed in prisons and jails. 3 , 4 The study by Curran and colleagues 2 suggests that such patterns exist at a national scale and across a number of common chronic medical and behavioral health conditions. However, the explanation for these findings is likely nuanced.…”

“…Again, in the same Pew Foundation report, the Texas prison system reported the lowest proportional health care budget spent on pharmaceuticals due to partnerships, which allowed it to take advantage of the federal 340B Drug Discount Program. 5 Importantly, Curran and colleagues 2 found that the lowest disparity in drug distribution was in hepatitis C medications, which are among the most expensive single medications for treating a chronic health condition. This surprising finding may be attributable to states establishing collective purchasing agreements to obtain these medications at substantially lower costs.…”