Just before the pandemic hit, back when my Washington Corrections Center (WCC) job assignment was Maintenance crew, I fell off a ladder and landed on my back. Washington State Department of Corrections (WDOC) does prescribe opioid painkillers when it decides a prisoner’s pain level warrants it, but did not decide so for mine.
I never pursued them because I knew there was no point, and instead spent the next two years requesting an alternative, before one day, a WDOC provider offered to prescribe amitriptyline, saying that certain doses were used to manage pain.
Amitriptyline (brand-name Elavil) is used for chronic nerve pain, but whether it would have helped I’ll never know. Anyone who’s been incarcerated here a long time knows that unless you can’t live without it, the harms of being prescribed psychiatric medication here are going to outweigh any benefits. I declined the offer.
Amitriptyline is an old-school tricyclic antidepressant that’s often used as a sedative. In prison culture, at WCC and other facilities around the country, this means it’s considered an antipsychotic like quetiapine (better known by brand-name Seroquel), regardless of its actual classification.
Countless prisoners have had similar talks with similarly well-meaning but uninformed medical staff.
Psychiatric medications are a risk factor in Washington Offender Needs Evaluation, the classification assessment that determines a prisoner’s “likelihood of reoffending.” I told the provider that I didn’t know whether having amitriptyline on my file could jeopardize my clemency hearing, so I couldn’t take the risk.
The provider explained to me that privacy laws protect disclosure of any prescriptions or diagnoses in my file, and so I didn’t need to worry. I explained to the provider that while the Washington State Clemency and Pardons Board doesn’t have direct access to my psychiatric file initially, it does have access to anything documented by WDOC security officers, which can prompt the Board to request my file. If requested, it will be sent.
Countless WDOC prisoners have had similar talks with similarly well-meaning but uninformed medical staff. This is partly because Psych is part of WDOC’s job-screening process, and prisoners fear that one way or another psych meds will prevent them from getting the assignments that would allow them to save money or be near their families. WDOC did not answer Filter‘s request for comment.
A psychiatrist signs off on your fitness for all work assignments, and the notes they leave on your file are not redacted. These notes won’t specify a diagnosis or medication, but will often include some statement like Patient is stable, which will be read by a job supervisor, who will then wonder, As opposed to what?
The supervisor will start asking around about whether the prisoner is dangerous. And, since dangerous prisoners are a security threat, whomever they ask for inside intel about that prisoner is going to give it to them. Often the intel comes from other prisoners.
The reason one prisoner might know another prisoner’s medical history—or think they know it—is that psych notes aren’t the only weak point in the privacy protections we’re supposed to have. For many, the even more harmful thing is Pill Line.
Twice a day, guards call over the intercom “Pill Line; Pill Line.” Everyone sees who gets up to go.
WDOC prescribes medications one of two ways: Keep On Person (KOP) or Pill Line (PLN). KOP is the less controlled of the two, and includes most selective serotonin reuptake inhibitor (SSRI) antidepressants like Prozac, plus everyday medications like Aspirin or Tylenol. (Most people can’t afford to buy those over the counter from commissary.) Medical typically fills KOP prescriptions one month at a time, like pharmacies do with many medications on the outside.
PLN, on the other hand, is for medications that are highly stigmatized, associated with “diversion,” or both. This includes almost all antipsychotics, mood stabilizers, opioid analgesics including Suboxone, and hormones taken orally. Amitriptyline is usually PLN, but sometimes offered KOP depending on the parties involved. If WDOC does not trust prisoners to keep a medication on their person, the only way to access it is to report to Pill Line.
Pill Line is a sort of ongoing HIPAA violation in physical form. Twice a day, before breakfast and usually after dinner, guards call over the intercom “Pill Line; Pill Line.” Everyone sees who gets up to go. Everyone who goes at some point sees which pills the other people in line are there for, since all of this happens out in the open.
For insulin, the callout over the intercom is “Diabetic Line.” Pill Line is for everything else that can’t be dispensed KOP, but anyone who reports daily is presumed to be on antipsychotics or mood stabilizers. It does not matter whether or not this is true.
I’ve known hundreds of people on psychiatric medication go to medical and report that they’re “cured.”
Fear of being associated with psychiatric medications, especially the more stigmatized ones, is the biggest factor in who ends up with what medications and why. If someone is prescribed, for instance, a 10-day regimen on a muscle relaxer, getting it would mean being seen standing in Pill Line. That alone keeps people from seeking care, even for serious injuries.
The stigma of Pill Line is what keeps prisoners who aren’t prescribed psychiatric medication from accessing other kinds of medications when they need them. But there’s a different access barrier powerful enough to make just about any prisoners who are prescribed psychiatric medications discontinue them, even the antipsychotics or mood stabilizers they’d been taking for most of their lives.
I’ve been incarcerated in WDOC for 28 years, and it’s not an exaggeration to say that I’ve known hundreds of people on psychiatric medication, even less-stigmatized SSRIs, go to medical and report that they’re “cured” and no longer need their prescription. Nothing about them or their prescription had changed up to that point; what changed is they became eligible for camp.
Read Part 2 of this story here
Photograph via City of Philadelphia