A Legal Right to Clozapine Therapy for Incarcerated Individuals With Treatment-Resistant Schizophrenia

Abstract

People with serious mental illnesses increasingly are being treated in jails and prisons, and during incarceration are afforded a constitutional right to medical care. This right pertains to both general medical and mental illnesses and both acute and chronic conditions. However, incarcerated patients with treatment-resistant schizophrenia (TRS) often are not offered clozapine, the only medication for this debilitating illness approved by the U.S. Food and Drug Administration. In this column, the authors argue that incarcerated individuals with TRS have a statutory and constitutional right to treatment with clozapine.

Psychiatric and legal considerations for ketamine treatment within prison settings

“…Although benzodiazepines should not be used as a long-term treatment due to their side effects including cognitive impairment and dependence, prison populations frequently receive this medication with the intention of bridging the onset of action of antidepressants and antipsychotics ( 57 ). Regarding schizophrenia, the implications of equivalent medical care extend to the administration of clozapine due to its unparalleled effectiveness ( 59 ). The use of clozapine among individuals with treatment resistant schizophrenia shows an overall response rate of approximately 40% in the general community ( 60 ).…”

“…In conclusion, the persistent disregard for research on prison health carries substantial consequences for mortality rates, disease prevention, and the fundamental right to health. It is imperative to consider not only the legal dimensions, as expounded upon here, but also the medical implications ( 59 , 67 ). The scarcity of studies exploring disorder-specific pharmacological interventions within the prison environment can be attributed to methodological complexities, such as monitoring follow-up and selecting appropriate outcome measures ( 46 , 53 ).…”