Combating Rx Drug Misuse: Incarcerated Women’s Proactive and Reactive Policy Recommendations

• Author: Michelle Smirnova,Jennifer Gatewood Owens
• Published date: 01 October 2019
• Date: 01 October 2019
• DOI: http://doi.org/10.1177/0887403418786549
• Subject Matter: Articles

https://doi.org/10.1177/0887403418786549

Criminal Justice Policy Review

2019, Vol. 30(8) 1229 –1249

© The Author(s) 2018

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DOI: 10.1177/0887403418786549

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Article

Combating Rx Drug

Misuse: Incarcerated

Women’s Proactive

and Reactive Policy

Recommendations

Jennifer Gatewood Owens1

and Michelle Smirnova1

Abstract

Given the rapid increase in prescription (Rx) drug misuse, overdose, and drug-related

arrests, the purpose of this study is to identify strategies to combat Rx misuse from

the perspective of former Rx drug misusers who are presently incarcerated. Using

semi-structured interviews, we elicited such recommendations from 33 incarcerated

women in the Midwest with histories of Rx drug misuse. The policy recommendations

put forth by the women tended to be proactive rather than reactive and focused upon

more vigilant surveillance and prevention efforts by medical professionals. While

there was little mention of the criminal justice system or incarceration, women did

also advocate for better treatment and rehabilitation options. Users affected by Rx

misuse suggested more proactive approaches in dealing with Rx misuse that would

ultimately shift drug control responsibilities from law enforcement to doctors.

Keywords

incarceration, prescription drug misuse, interviews, policy

Introduction

In 2016, an estimated 6.2 million noninstitutionalized Americans over the age of 12

misused a prescription (Rx) pain reliever, tranquilizer, stimulant, or sedative (Substance

1University of Missouri–Kansas City, MO, USA

Corresponding Author:

Jennifer Gatewood Owens, Assistant Professor, Department of Criminal Justice and Criminology,

University of Missouri-Kansas City, Cherry Hall, Room 438, 5030 Cherry Street, Kansas City, MO

64110-2447, USA.

Email: owensjen@umkc.edu

786549CJPXXX10.1177/0887403418786549Criminal Justice Policy ReviewOwens and Smirnova

research-article2018

1230 Criminal Justice Policy Review 30(8)

Abuse and Mental Health Services Administration [SAMHSA], 2017a).1 Women are

more likely to suffer from chronic pain, be prescribed Rx pain relievers, be prescribed

higher doses, use Rx pain relievers for a longer time, and become dependent upon

them more quickly than men (Centers for Disease Control and Prevention [Centers for

Disease Control and Prevention (CDC)], 2017). Although women are less likely to die

from an overdose of Rx painkillers, their overdose rates are increasing much faster

than that of men (CDC, 2017). As the United States attempts to combat Rx misuse, one

group with extensive knowledge about drug use remains largely overlooked and

understudied: incarcerated women.

Researchers have noted the conspicuous absence of prisoners’ information in

nationally representative data sets on health and drug use (Ahalt, Binswanger,

Steinman, Tulsky, & Williams, 2012). For example, the National Survey on Drug Use

and Health, the national’s “primary source of information on the prevalence, patterns,

and consequences of alcohol, tobacco, and illicit drug use in the general U.S.” does

not include institutionalized populations (e.g., prisons and jails; SAMHSA, 2017b),

yet over 1.5 million people were under state or federal correctional authority in 2016

for drug law violations (Carson, 2018). Furthermore, the only data collection that

might be able address Rx misuse by inmates, the National Inmate Survey, does not

collect data on Rx drug use separately from other illicit drugs (i.e., dichotomous drug

use questions about ‘other opiates’ are grouped with Methadone and then grouped

with another question on heroin when published (Bronson, Stroop, Zimmer, &

Berzofsky, 2017).

While information on Rx misuse by imprisoned individuals is limited, research on

other illicit drug use indicates that prisoners are far more likely to use drugs and meet

the criteria for dependence than nonincarcerated populations. Of note, over 58% of

state prisoners and 63% of sentence jail inmates (as opposed to those awaiting sen-

tencing) meet the criteria for abuse or drug dependence as opposed to only 5% of the

public over 18 years of age (Bronson et al., 2017). Female inmates are also signifi-

cantly more likely to meet the Diagnostic and Statistical Manual of Mental Disorders

(4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for dependence or

abuse and to have used drugs in the month prior or during the offense than male

inmates (Bronson et al., 2017). Drug use is a contributing factor to incarceration, par-

ticularly for women as a larger proportion of women are held in state prisons for drug-

related offenses than men. Just over 14% of males but nearly 25% of females are

sentenced for drug-related offenses as of 2015 (Carson, 2018). In some states, like

Missouri, drug-related offenses accounted for nearly half (46%) of new female admis-

sions in 2015 (Missouri Department of Corrections, 2015).

The utilization of offenders’ input, or “offender-level evidence,” is lacking in many

areas of criminal justice (Lowenkamp, Holsinger, Robinson, & Cullen, 2012, p. 13).

Given the extensive knowledge and experience with illicit drugs as well as Rx drugs,

it is surprising that incarcerated populations are not consulted about whether current

policies are effective or whether they have recommendations as to how to reduce Rx

misuse. In addition, prisoners are less likely to be under the influence of drugs and

they may have had more time to reflect on their experiences, making for ideal