Incarcerated individuals in Ontario are about 30 times more likely to die of opioid toxicity than people who aren’t imprisoned, an emergency room doctor and researcher told the coroner’s inquest into six drug-related deaths at the Hamilton-Wentworth Detention Centre.
Pointing to a study she helped conduct, Dr. Claire Bodkin told the inquest that between 2015 and 2020, 8,460 people in Ontario died from opioid toxicity. About 26 per cent of them were incarcerated at some point during that period.
“That was certainly higher than I expected,” Bodkin said, and shows people in provincial jails are at “extremely high risk” of an opioid-related death.
Bodkin, also a part-time professor, works with organizations including McMaster University, Hamilton Health Sciences and the Hamilton Social Medicine Response Team. She’s among about 15 witnesses who were set to testify before the inquest, which began Monday and is examining the deaths of Jason Archer, Paul Debien, Nathaniel Golden, Igor Petrovic, Christopher Johnny Sharp and Robert Soberal.
Inmates need to be set up for success, doctor says
“Prison health is public health,” Bodkin told the inquest at the start of her testimony.
In provincial jails, where the average stay is two to three months, she said, inmates interact with people in the community. They need to receive support in prison and be set up for success when they’re discharged, she added.
Upon request from the coroner’s office, Bodkin delivered a presentation on opioid deaths of inmates, the complexities of delivering health care in prisons, treatment for people with addictions and preventing overdoses.
The inquest is mandatory under Ontario law because the men died while incarcerated. Through examining witnesses, analyzing official records and seeking testimony from experts, the jury seeks to determine how the men died and may make non-binding recommendations to prevent similar deaths.
Providing continuity of care ‘a big challenge’
When someone is incarcerated, Bodkin said, the person should have immediate access to opioid agonist therapy, a medical treatment for people dependent on opioids. She said she’s currently not aware of any data on how many people in Ontario jails need that treatment.
Bodkin said there also needs to be back-end work to ensure people discharged from prison know where to access further treatment and their health-care providers can verify when they had their last dose of medication.
Providing that continuity is “a big challenge,” she said, adding that while she knows to call the jail health-care team to verify patients’ past treatment, not every doctor does.
Bodkin noted her research shows the risk of death from opioid toxicity is notably high for people released from prison. The study looking at 2015 to 2020 found about 11 per cent of individuals who experienced incarceration and died from opioid toxicity died within two weeks of release.
Early in the week, the jury heard the six men at the centre of the inquest received varying forms of health care, much of it related to drug addiction.
Bodkin said prisoners also have high rates of chronic diseases, childhood trauma and brain injuries, which should all factor into the care they receive.
She also told the inquest that harm reduction is as important as treatment.
“Clinically, we don’t think about these as two separate things. We think about them as a spectrum of options.”
Harm reduction means recognizing people will use drugs even when they’re told not to, and to try to “reduce the health impacts, the social impacts and the legal impacts,” of doing so, Bodkin said.
Harm reduction services like needle exchanges and supervised consumption sites have been a topic of heated debate on P.E.I. CBC’s Tony Davis talks to advocates and public health officials about what harm reduction is, and how those services are intended to work.
Examples include checking the content of street drugs to know what’s in them, and providing clean needles and drug paraphernalia to reduce the risk of infection.
There are limited harm reduction pilots underway in the federal corrections system, Bodkins said, and she’d heard good things about a project in which inmates can use drugs under medical supervision.
Bodkins said on principle, she would recommend that and further measures, such as prisons providing access to clean drug-use equipment and naloxone, which reduces the effects of opioid overdoses.
The sooner naloxone administered, the better: Bodkin
The availability of naloxone in prisons came up in a 2018 inquest into deaths at the Hamilton-Wentworth Detention Centre. It also arose during the recent inquest into five deaths at the Niagara Detention Centre. Inmates do not have direct access to naloxone in either jail.
In the Niagara inquest, Patrick Sproat, deputy superintendent of the facility, said he worried that if inmates were to have independent access to naloxone, they may choose not to report overdoses to staff and instead try to treat them themselves.
On Thursday, Jerry Wu of the John Howard Society of Canada — which advocates for the incarcerated — told Bodkin that’s a common argument against increasing naloxone access in prisons.
“I don’t think it’s a good argument,” Bodkin said, adding it would be better to address the reasons why people don’t come forward.
In response to questions from Wu and Vilko Zbogar, who represents the Prison Harm Reduction Coalition, Bodkin said the sooner naloxone is administered, the better. She said it’s easy to use and there is minimal risk of misuse or harm.
In at least four of the deaths under investigation, the men received naloxone. That often occurred within five to 10 minutes of a corrections worker responding.
In addition to lawyers for the coroner’s office, Wu and Zbogar, several people are allowed to question witnesses, including the families of Sharp and Soberal. The five jurors may also ask witnesses questions.
Earlier this week, the inquest heard from corrections consultant Andrea Monteiro, who created a report that will serve as a basis of fact for the hearings. She analyzed thousands of institutional records and created a timeline of events around the men’s death.
Two senior jail officials have been witnesses so far, as has a psychiatrist at the jail. Health-care managers and workers at the detention centre are set to speak in the coming days.
The virtual inquest is being broadcast publicly. Dr. John Carlisle is the presiding officer.