Dawn Ruzich, Gateway Foundation, contributed to this study.

Introduction

An estimated half a million Illinois residents engage in non-medical use of prescription drugs each year.^[1] Admissions to U.S. emergency departments for misuse of prescription drugs increased from 2004 (626,470 visits) to 2011 (1,428,145 visits)—a 127 percent increase.^[2] Prescription drugs are used most frequently among individuals ages 25- to 29-years old, 34 to 44, and 45 to 54 years old.^[3] Opioids (prescribed to treat pain), central nervous system depressants, such as tranquilizers, sedatives, and hypnotics (used to treat anxiety and sleep disorders), and stimulants (used to treat attention disorders and narcolepsy) are the most commonly misused prescription drugs.^[4] Individuals can obtain prescription drugs to use non-medically in a variety of ways—from family members or friends; online; pain clinics or doctors; and/or drug dealers.

An estimated 65 percent (1.5 million) of individuals in U.S. prisons and jails meet the criteria for substance use disorders (SUD) compared to 9 percent in the general population.^[5] These individuals are more likely to have additional contacts with the criminal justice system and re-offend upon release compared to those without SUD.^[6] However, little is known about prescription drug use for nonmedical reasons among those in corrections.^[7] This study sought to gather information regarding prescription drug use among a sample receiving substance abuse treatment with WestCare Illinois at Sheridan Correctional Center and Adult Transition Center-Crossroads. This article is one in a series focusing on issues disproportionately affecting those in prison; other articles highlight the issues of synthetic drug use and traumatic experiences and posttraumatic stress disorder.

Study Overview

In April 2016, Illinois Criminal Justice Authority (Authority) researchers, in collaboration with WestCare Illinois, administered a paper survey to 573 males residing in two Illinois correctional facilities receiving substance abuse treatment: Sheridan Correctional Center and Adult Transition Center-Crossroads.^[8] The survey collected information on demographics, prescription drug availability, prevalence/use, effects, and treatment.^[9] The survey documented prevalence, availability, motivation, and method of use of prescription drugs among incarcerated individuals.

Authority researchers also matched participants to data collected by WestCare clinicians. The clinical data collected includes client demographic information and the Addiction Severity Index (ASI) assessment.^[10] The ASI is an assessment tool developed by the Treatment Research Institute completed in one-on-one interviews with WestCare clinicians to create a diagnostic impression of client’s severity of substance use, potential treatment problems, and other life areas that may be impacted by substance use. These other areas include: medical, employment, alcohol and drug, legal, family/social, and psychiatric issues. WestCare clinician estimates of respondent needs for treatment were calculated into an ASI severity score, ranging from 0 (no treatment necessary) to 9 (treatment needed to intervene in life-threatening situation).^[11]

Lastly, Authority researchers matched survey participants to their criminal history information using the Illinois State Police Criminal History Record Information (CHRI) database housed and maintained at the Authority. The study was approved by the Authority’s Institutional Review Board, the oversight body for all research involving human subjects.

Limitations

All research studies have limitations, and this study was no exception. First, individuals surveyed may have had difficulty recalling prescription drug use prior to incarceration. Second, participants may have been hesitant to provide truthful information because they were surveyed while residing in prison. Although participants were informed of their rights as research subjects including their right to confidentiality, some participants may have still had concerns over disclosing past illegal drug behaviors. Third, researchers obtained a convenience sample of individuals at the two correctional facilities that were enrolled in substance abuse treatment with the WestCare Foundation; therefore, the findings are not generalizable to other populations or populations within the Illinois corrections system.

Main findings

Of the 573 inmates surveyed, 46 percent (n=262) reported using prescription drugs to get high at some point in their lives prior to incarceration. Among the total sample surveyed (N=573), 25 percent were White, 48 percent were Black, and 11 percent were Hispanic. Respondents’ ages ranged from 19 to 63, with an average age of 35 years old and a median age of 33.

Individuals in the full sample had, on average, 16 total prior arrests, with an average of five prior drug arrests and three prior violent arrests. There was a median of 14 prior arrests, with a median of four prior drug arrests and two prior violent arrests.

Respondents reporting prescription drug use

Respondents reporting any prescription drug use in their lifetimes ranged from 19 to 62 years old, with an average age of 33 years old and a median age of 30 years old. Thirty-six percent of those who reported prescription drug use were White, 37 percent were Black/African American, and 10 percent were Hispanic.

Survey responses and arrest records indicated 24 percent of respondents who reported any prescription drug use were serving time in corrections for drug charges. On average, these respondents had 16 prior arrests, averaging between five and six prior drug arrests and two to three prior violent arrests. Respondents had a median of 13 prior arrests, with a median of four prior drug arrests and two prior violent arrests. In their lifetimes, respondents reported serving an average of four years of incarceration, with a median of two years.

Type and frequency of drug use

Although almost all of those surveyed had prior contact with the criminal justice system (82 percent), 32 percent of those who reported any prescription drug use reported never participating in prior drug or alcohol treatment (Figure 1). On average, respondents reported two prior treatment episodes, with a median of one prior treatment episode. There was a very weak, positive correlation between number of prior arrests and number of previous drug treatment episodes[r(260) = .162, p < .05]. However, this association may be related to receiving treatment within a correctional setting; the majority identified previous treatment at a correctional facility. This suggests that more time spent in a correctional institution may provide more opportunities for access to some form of treatment or recovery support services.

Figure 1

Number of prior treatment episodes for drug or alcohol treatment in lifetime (n=222 prisoners)

Data source: WestCare Foundation ASI assessment data, 2016

Note: 15 percent of the sample did not provide an answer as to whether or not they had previously received drug or alcohol treatment (n=40).

On average, respondents who reported ever using prescription drugs in their lifetimes first tried alcohol or drugs when they were 12 or 13 years old. Marijuana and alcohol were the most commonly used drugs. Forty-three percent of respondents reported their first drug used was marijuana, 27 percent reported first trying alcohol, and 8 percent reported trying both marijuana and alcohol.

On a scale of 0 (no treatment necessary) to 9 (immediate treatment to intervene in life-threatening situation), respondents had an average ASI alcohol severity score of 3, a median score of 4, and most frequent score of 5.^[12] The ASI alcohol severity score indicated that, on average, those who reported previous prescription drug use had a slight to moderate problem with alcohol. In addition, respondents had an average ASI drug severity score of 4 and a median score of 5, with 5 as the most frequent score reported. This, too, indicated that on average, respondents who reported previous prescription drug use had a moderate problem with drugs.

Figure 2 lists the substances considered “major problems” by prisoners who reported any prescription drug use 12-months prior to incarceration. For 40 percent of respondents, alcohol and one or more other drugs (unspecified) were reported as the major problem and 21 percent reported multiple drugs (unspecified) were a major problem. This suggests that polysubstance use may be prevalent within substance using populations; however, researchers were unable to compare the two populations for this study.

Figure 2

Substances reported as a “major problem” (n=222 prisoners)

Data source: WestCare Foundation ASI assessment data, 2016

Notes: 15 percent of those surveyed did not respond (n=40)… Percentages may not equal 100 percent due to rounding.

Of respondents who reported any prescription drug use, 35 percent reported daily drug problems and 18 percent reported daily alcohol problems in the 30 days prior to incarceration. Specifically, within the 30-days prior to incarceration, respondents reported using marijuana (36 percent), heroin (13 percent), alcohol to intoxication (16 percent), any alcohol (19 percent), and more than one substance (20 percent) for all 30-days. More than half of the respondents indicated they had practiced no substantial, voluntary months of abstinence (52 percent) or years of abstinence (70 percent) from drug or alcohol use.

Thirty-nine percent of respondents indicating prior prescription drug use reported they were not at all troubled by drug problems, while 22 percent indicated they were extremely troubled by drug problems. A majority of respondents who reported any prescription drug use identified that they were not at all troubled by alcohol problems (57 percent), with 16 percent reporting they were considerably or extremely troubled by alcohol use.

Frequency of prescription drug use

Respondents most frequently reported only using prescription drugs a few times (30 percent) or one to five times per week (22 percent) within the 12-months prior to incarceration (Figure 3). Twenty percent of those who reported prescription drug use in the 12 months prior to incarceration were using almost every day.

Figure 3

Reported frequency of prescription drug use in the 12-months prior to incarceration (n=258 prisoners)

Data source: ICJIA and WestCare prisoner survey, 2016

Note: 1.5 percent of those surveyed did not respond (n=4). Percentages may not equal 100 percent due to rounding.

Methods of obtaining prescription drugs

Respondents most frequently reported obtaining prescription drugs through a drug dealer (62 percent) and/or a friend or relative (60 percent) (Figure 4).

Figure 4

Reported methods of obtaining prescription drugs within the 12-months prior to incarceration (n=262 prisoners)

Data source: ICJIA and WestCare prisoner survey, 2016

Note: Respondents could select multiple methods.

Methods of use

Participants most frequently reported using prescription drugs by swallowing (74 percent), snorting (41 percent), and drinking (36 percent) within the 12 months prior to incarceration (Figure 5).

Figure 5

Reported methods of prescription drug use within the 12-months prior to incarceration (n=262)

Data source: ICJIA and WestCare prisoner survey, 2016

Notes: Respondents could select multiple methods. Buccal method is use in cheek area. Parachuting method is swallowing drugs by rolling/folding crushed or powdered pills into paper to avoid the taste. Sublingual use is placement under the tongue.

Reasons for use

Of the 262 respondents who self-reported prescription drug use, more than half indicated they used prescription drugs for the desirable effects and/or to relax (Figure 6).

Figure 6

Reported reasons for prescription drug use within the 12-months prior to incarceration (n=262 prisoners)

Data source: ICJIA and WestCare prisoner survey, 2016

Note: Respondents could select multiple reasons.

Reported effects

More than half of respondents reported a pleasant high (70 percent) and drowsiness (58 percent) from the drugs they used (Figure 7). Less than 20 percent of respondents reported excessive sweating, clumsiness, nausea, nervousness, blurred vision, vomiting, panicking, inability to control laughter, shortness of breath, headache, or chest pain.

Figure 7

Reported effects of prescription drug use within the 12-months prior to incarceration (n=262 prisoners)

Data source: ICJIA and WestCare prisoner survey, 2016

Summary

In this study of inmates in SUD treatment at Sheridan Correctional Center and ATC-Crossroads, 46 percent reported prescription drug misuse in the 12 months prior to incarceration. On average, these individuals were 32 years old (median of 31-years old), first tried drugs around the ages of 12 and 13 years old, and most frequently reported polysubstance use.

A majority of those who reported prescription drug use said they used them to relax and for their desirable effects. This is consistent with other research findings.

Sixty percent of prisoners in the sample reported obtaining prescription drugs from friends or relatives, indicating the need for education on the potential dangers of prescription drugs, appropriate storage, and proper disposal of unused prescriptions.

Opioids are one of the most highly abused prescription drugs, predominately used to manage pain.^[13] However, opioids activate a region in the brain that causes euphoria and the sample most frequently identified euphoria as a reason for prescription drug use.^[14] Central nervous system depressants, which also are highly abused, result in drowsiness or a calming effect.^[15] This is consistent with the current study findings that majority of those who reported prescription drug use did so to relax.

The link between offending and substance use is well documented.^[16] This suggests that appropriate evidence-informed treatment should be incorporated into corrections and prison and jail re-entry programs, including the use of medication-assisted treatment for opioid use disorders when appropriate.^[17]

Close to half of the prisoners in the sample misused prescription drugs, raising concerns of continued misuse during imprisonment. It is well documented that prisoners find ways to obtain illegal drugs, including prescriptions, despite security measures in place to prevent drugs from entering prison.^[18] Continued diligence is needed to thwart prescription drug diversion and misuse within the prison system.