Exploring Polypharmacy in the BC Correctional Health Setting.

Abstract

Background: Greater burdens of comorbidity and exposure to unique environmental factors predispose incarcerated individuals to polypharmacy and inappropriate prescribing. There is limited literature investigating polypharmacy within the correctional health setting.

Objectives: To determine the median number of medications prescribed per client at facilities in British Columbia, to determine the proportion of clients meeting the definition for polypharmacy, to identify the top medication categories prescribed, and to screen for potential drug therapy problems among those with polypharmacy.

Methods: An observational point prevalence study of adult clients with one or more active medications on the census date at 5 correctional health facilities in British Columbia was conducted. Clients were excluded if they had one-time or no medication orders on the census date.

Results: Of the 500 clients screened, 420 were included in the final analysis. Across the centres, the median number of medications ranged from 3 to 5 per client, and the rate of polypharmacy ranged from 23% to 41%. Of the scheduled medications, opioid agonist therapy and psychotropics were the leading categories prescribed across all facilities. Non-opioid analgesics were the top "as needed" medications prescribed at 4 of the 5 facilities. The leading potential drug therapy problem identified was drug interactions resulting in additive sedation.

Conclusions: Polypharmacy was present within all facilities in this study, with more than 25% of clients affected at 3 of the sites. The top medications prescribed aligned with those identified in the literature; however, there remain opportunities for therapy optimization.