In the early 1990s prisons began banning tobacco smoking by prisoners, and some banned it for prison employees as well. Estimates were that 80% of prisoners and 50% of guards were smokers, but these figures are likely conservative and a California prisoner’s assessment in 2005 that “everyone smokes” is more likely the accurate number (http://www.cbsnews.com/news/cold-turkey-in-california/). I hate cigarette smoke to the point that my wife has to calm me down when we go to Europe, where attitudes are more permissive (although not as much now as they used to be). But if I were in prison, I would smoke. It is something to do. Among the many punishments endured by prisoners, boredom is one of the greatest. As one of my prisoner-patients said to me, “every day is the same.” And when you consider multi-decade or life sentences, that is a lot of sameness and boredom. Being a prisoner is one of the more stressful lifestyles, and I am told by smokers that a cigarette or perhaps, in the case of e-cigarettes, nicotine relieves some stress. Whether it primarily relieves the stress of nicotine withdrawal is, in my opinion, more likely – smokers have never struck me as less stressed than non-smokers. Furthermore the multitude of health and well-being risks from smoking are a tough sell when a prisoner is looking at life behind barbed-wire-and-bars.
California did not get around to banning smoking until 2005, a few days (literally) before a federal judge placed the health care system in CDCR (California Department of Corrections and Rehabilitation, although it could be shortened to CDC since very little R goes on) under receivership – basically dictatorial control by a court-appointed “receiver” who reports to the judge, not the CDCR. Needless to say, CDCR health care did not get placed under receivership for its exemplary medical care.
Of course there are many good reasons to ban smoking in prisons, and it is nearly impossible to argue against it. It is getting there – from universal smoking to no smoking – that is the problem. My patients have told me that heroin is easier to kick than smoking. Part of the reason is probably the social environment that promotes smoking – advertisements, smoking actors, the irresistible urge for immature adolescents to be cool, cigarette breaks at work, associations with alcohol or sex, as a start. Heroin just doesn’t have good marketers behind it, so its use is pretty well confined to a scruffier pathetic stratum of our society.
In the 1980s a medical school university hospital where I was a member of the faculty had cigarette machines in the hospital on every floor (including the ICU) and the dean himself chain-smoked. Granted, the medical school was named after a member of the Reynolds tobacco family and it was North Carolina…but still! Really!
I have been on two hospital campuses when they went non-smoking. It was not easy to do, and both tried half-measures, such as smoking areas, or allowing smoking in the psychiatry ward. Ultimately, half-measures cannot be sustained, and a tough total ban is necessary. I found the argument for the psych unit persuasive: patients admitted for acute psychiatric conditions should not have tobacco withdrawal added to their list of problems. Tobacco withdrawal is, moreover, much easier to treat than mania or acute schizophrenia. Nicotine patches were used, of course, but there is more to smoking than nicotine addiction. Ultimately the psych unit directors had to back down and implement a tobacco ban. We (the medical administration and medical staff) nervously awaited the consequences, but nothing happened. Nada. I guess if you are stoned on high doses of psych meds, complaining about not being able to smoke drops lower on your list of bitches.
When the CDCR decided to ban nicotine patches from its drug formulary in 2011, I was the only medical executive to object. Not that it did any good. The behavioral manifestations of nicotine withdrawal when prisoners are processed at the “reception centers” could be prevented with a standard withdrawal regimen of nicotine patches for a few weeks. The behaviors one would like to prevent, when possible, are aggression toward guards, fellow inmates, and themselves. I will toss aggression toward doctors into the mix, for good measure. The medical system in prisons has a deeply entrenched, and in my opinion (which is of course correct) deeply unethical, propensity to consider itself an agent of punishment rather than an advocate for patient care. It is a very complicated issue, but prison health care providers have not acquitted themselves well as subtle thinkers of the complexities involved in giving medical care to inmates.
You are probably wondering where I am going with this…or more likely just what my problem is. An article in Thursday’s NY Times added a new twist. The benefits of selling nicotine to inmates! http://www.nytimes.com/2014/01/24/us/in-rural-jails-a-calming-vapor.html
Banning cigarettes immediately created a prison black market for smuggled cigarettes, which could be sold for a very tidy markup to bored inmates. How the inmates get away with smoking was a mystery to me, and matches or lighters are of course banned. But I consigned it to the category of things that I just really did not want to know about. The source of contraband cigarettes was probably guards in most cases – it is much easier for them to smuggle smokes (which don’t set off metal detectors, and which I suspect the other guards do not really care a whole lot about anyway) than the prisoners who, one would hope, are more closely watched than the guards. A lot of prisoners are pretty nice guys underneath all the antisocial behavior, and it would be a mitzvah to slip a few cigarettes to a nice guy prisoner who could, for that matter, make your life a little easier.
Some Tennessee county jails came up with a good old American entrepreneurial approach of selling e-cigs to prisoners through the commissary, which usually deals with staples of prison life like ramen and chips. In addition to the profit to the system, they noted a calming effect on prisoners and fewer behavioral problems in those who used e-cigs. The markup is 400%, which is considerably worse than the markup on wine at nice restaurants. And as the Macon County chief deputy sheriff pointed, it is cheaper than fixing broken noses. I will bet that it never happens in California.
California did not get around to banning smoking until 2005, a few days (literally) before a federal judge placed the health care system in CDCR (California Department of Corrections and Rehabilitation, although it could be shortened to CDC since very little R goes on) under receivership – basically dictatorial control by a court-appointed “receiver” who reports to the judge, not the CDCR. Needless to say, CDCR health care did not get placed under receivership for its exemplary medical care.
Of course there are many good reasons to ban smoking in prisons, and it is nearly impossible to argue against it. It is getting there – from universal smoking to no smoking – that is the problem. My patients have told me that heroin is easier to kick than smoking. Part of the reason is probably the social environment that promotes smoking – advertisements, smoking actors, the irresistible urge for immature adolescents to be cool, cigarette breaks at work, associations with alcohol or sex, as a start. Heroin just doesn’t have good marketers behind it, so its use is pretty well confined to a scruffier pathetic stratum of our society.
In the 1980s a medical school university hospital where I was a member of the faculty had cigarette machines in the hospital on every floor (including the ICU) and the dean himself chain-smoked. Granted, the medical school was named after a member of the Reynolds tobacco family and it was North Carolina…but still! Really!
I have been on two hospital campuses when they went non-smoking. It was not easy to do, and both tried half-measures, such as smoking areas, or allowing smoking in the psychiatry ward. Ultimately, half-measures cannot be sustained, and a tough total ban is necessary. I found the argument for the psych unit persuasive: patients admitted for acute psychiatric conditions should not have tobacco withdrawal added to their list of problems. Tobacco withdrawal is, moreover, much easier to treat than mania or acute schizophrenia. Nicotine patches were used, of course, but there is more to smoking than nicotine addiction. Ultimately the psych unit directors had to back down and implement a tobacco ban. We (the medical administration and medical staff) nervously awaited the consequences, but nothing happened. Nada. I guess if you are stoned on high doses of psych meds, complaining about not being able to smoke drops lower on your list of bitches.
When the CDCR decided to ban nicotine patches from its drug formulary in 2011, I was the only medical executive to object. Not that it did any good. The behavioral manifestations of nicotine withdrawal when prisoners are processed at the “reception centers” could be prevented with a standard withdrawal regimen of nicotine patches for a few weeks. The behaviors one would like to prevent, when possible, are aggression toward guards, fellow inmates, and themselves. I will toss aggression toward doctors into the mix, for good measure. The medical system in prisons has a deeply entrenched, and in my opinion (which is of course correct) deeply unethical, propensity to consider itself an agent of punishment rather than an advocate for patient care. It is a very complicated issue, but prison health care providers have not acquitted themselves well as subtle thinkers of the complexities involved in giving medical care to inmates.
You are probably wondering where I am going with this…or more likely just what my problem is. An article in Thursday’s NY Times added a new twist. The benefits of selling nicotine to inmates! http://www.nytimes.com/2014/01/24/us/in-rural-jails-a-calming-vapor.html
Banning cigarettes immediately created a prison black market for smuggled cigarettes, which could be sold for a very tidy markup to bored inmates. How the inmates get away with smoking was a mystery to me, and matches or lighters are of course banned. But I consigned it to the category of things that I just really did not want to know about. The source of contraband cigarettes was probably guards in most cases – it is much easier for them to smuggle smokes (which don’t set off metal detectors, and which I suspect the other guards do not really care a whole lot about anyway) than the prisoners who, one would hope, are more closely watched than the guards. A lot of prisoners are pretty nice guys underneath all the antisocial behavior, and it would be a mitzvah to slip a few cigarettes to a nice guy prisoner who could, for that matter, make your life a little easier.
Some Tennessee county jails came up with a good old American entrepreneurial approach of selling e-cigs to prisoners through the commissary, which usually deals with staples of prison life like ramen and chips. In addition to the profit to the system, they noted a calming effect on prisoners and fewer behavioral problems in those who used e-cigs. The markup is 400%, which is considerably worse than the markup on wine at nice restaurants. And as the Macon County chief deputy sheriff pointed, it is cheaper than fixing broken noses. I will bet that it never happens in California.
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