By Carol Milano

Inmates in Washington's eight largest prisons received 85,000 doses of morphine and 329,000 of Oxycodone over a recent three-year period, claim newscasters at KIRO TV in Seattle. Investigative reporter Chris Hulse contends the system "allows many prisoners to stay high around the clock," receiving narcotics for anything from toothaches to backaches.

KIRO says inmates often "cheek" pills, to double-dose or sell -- before or after release. Hulse's sources hinted of unreliable narcotics counts, and many prescriptions written just to keep inmates calm and orderly.

Are prison narcotics as overused as KIRO suggests, or is Washington an anomaly? Are nurses abetting prescription abuse?

Washington State Nurses Association (WSNA) staff, in Seattle, were unaware of KIRO's expose. "If the nurse carries out the prescription order and delivers medications as prescribed, that is within their nursing practice," says Ann Tann Piazza, WSNA spokesperson. "For questions, suspicions or complaints about appropriateness, amount or frequency of a prescription, that concern needs to be raised with whichever licensing board governs the prescriber. They make the call about whether this is inappropriate prescribing."

The National Commission on Correctional Health Care (NCCHC) in Chicago sets standards and accredits about 500 correctional health systems. "We don't see every prison in America, but this is very unusual," says Edward Harrison, president. "I haven't heard about this as a practice the way they reported it. KIRO mentioned cheeking pills -- something a skilled nurse would be able to prevent: give the pill with liquid, check the mouth, and make sure they were swallowed."

"Prisons have high potential for [narcotics] abuse and selling," agrees Kleanthe Caruso, RN, MSN, CNAA, CCHP, Vice President of Patient Care Services/ Chief Nurses Officer, University of Texas Health Center at Tyler. "All the meds are oral -- easily hidden and recovered, to be used for trafficking and trading. They're a highly desirable commodity."

Caruso supervises 1,400 Texas correctional nurses, represents ANA on NCCHC's board, and chairs ANA's group revising "Scope and Standards of Nursing in Correctional Settings." Aware of no abuses as serious as KIRO's allegations, Caruso observes, "questions of narcotics use and pain meds come up a lot at ANA's national review. Prison pain control options are very limited."

Difficulties include many inmates entering as substance abusers, forced to go 'cold turkey.' Withdrawal symptoms can lead to a clinic, where nurses, often the first to see the inmate, make assessments and referrals to the medication provider. "Determining true pain is difficult, and only partly objective. If someone's convincing enough, you have to carefully weigh the actual problem so you're treating people who do have a need. Potential for abuse must be tempered with, are we restricting care?"

In an optimal environment, says Caruso, meds are scrutinized, monitored and controlled. Texas' 75 state prisons use narcotics sparingly, and carefully. Caruso estimates that possibly 100,000 RNs and LPNs work in jails, juvenile detention centers, prisons, and other government correctional facilities. "The ANA code of ethics applies in any setting where a nurse is providing care," she maintains. Standards for prison nursing are at

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