More Canadian federal prisoners waiting for opioid treatment

Health professionals warn that delaying opioid agonist treatment, which keeps withdrawal symptoms at bay, increases the chance of an overdose. But data show the wait list for treatment has increased in federal penitentiaries since March.

Wait lists grew from March to June 2020, with Alberta showing largest increase

The Edmonton Institution in Alberta, which is the province with the lion's share of inmates in federal penitentiaries who are on a wait list to get to opioid agonist treatment. (Trevor Wilson/CBC )

For the last 18 months, Ricky Leslie's been cut off from Suboxone, the prescription medication the federal inmate relied on to keep his withdrawal symptoms of opioid addiction at bay, lessening his chances of yet another overdose. 

"They're making me suffer, they're putting my life in danger every day," Leslie said of Correctional Services Canada during an interview with CBC News from Port Cartier Institution, a federal penitentiary in Quebec, where he is currently incarcerated. 

Leslie said his attempts at staving off cravings have led him to use illicit substances instead. 

"Every time I use or whatever, it might be my last time," he said. 

"That's not fair for me or my family."

Leslie is on a wait list for what the CSC calls "opioid agonist treatment," a catch-all term for medical substances, including Suboxone, that replace opioids to help those with addiction issues.

As of June, he was one of 14 people on the wait list in his prison alone, and across the country, the number of inmates waiting for the potentially life-saving treatment has continued to grow throughout the pandemic.

In the 52 penitentiaries run by the federal government, 494 inmates are on a wait list, an increase from 447 in March, the last month Ottawa publicly posted numbers

"The longer the wait list you get, the more people that are high risk of a fentanyl overdose," said Dr. Lori Regenstreif, an assistant clinical professor of family medicine at McMaster University in Hamilton, Ont.

The federal body declined an interview for this story, and would only address general numbers in statements, not Leslie's situation. 

"Throughout the COVID-19 pandemic, the provision of health services continued," the CSC said in an emailed statement, "although there has been a need to prioritize services and resources."

'Treated unfairly'

The 50-year-old is from Edmonton, where he was serving his sentence for robbery and assault until the end of July, when CSC transferred him to Quebec. 

"I got assaulted by four offenders in Edmonton," Leslie said. "I wanted to mediate," but federal authorities decided to move him instead. 

The current distance from his loved ones has only exacerbated his addiction problems, he said, which he has been dealing with for decades. 

Ricky Leslie, 50, seen here in November 2019, says he is finding it difficult to cope with the lack of medical treatment for his opioid addiction. (Submitted by Ricky Leslie)

 "They're the ones who support me and are behind me," he said of his two daughters. 

Leslie's court record shows he has been in and out of the correctional system since 2001, mostly on robbery and assault charges. 

He began serving his latest sentence in February 2017. At the time, it took more than a year and a complaint to the Canadian Human Rights Commission to temporarily put him on Suboxone. 

According to that document, he had been addicted to opioids since approximately 1997, when he was working on oil rigs in northern Alberta. "I was stabbed by a dirty needle and contracted Hepatitis C," he wrote. "This seriously affected me mentally and physically."

He also wrote that he has overdosed approximately four times since then.

Leslie was placed on opioid agonist treatment in November 2018. But in March of last year, he said security guards accused him of "diverting" the Suboxone, which means trading it with other inmates instead of using it. They summarily removed him from treatment. 

Leslie denied he ever did that.

"You're standing in front of an officer and in front of a nurse," he said. "How are you going to take powder out of your mouth? Wouldn't it be all over your face? Wouldn't it be all over your lips?" 

Leslie, who is Métis, referred to himself as an Aboriginal offender, and said he was being treated unfairly. "How does a person have to wait that long to get back on Suboxone?" he asked.

Dangerous to cut off, experts warn 

CBC spoke to two medical experts who warned it is dangerous to suddenly cut off patients from opioid substitutes. 

"The symptoms are pretty debilitating," said Josh Fanaeian, an emergency physician and addiction specialist in Edmonton. 

Josh Fanaeian, an emergency physician in Edmonton, warns against cutting off those with addiction issues from medical treatment. (Trevor Wilson/CBC )

"It's almost like the worst flu you can get. Severe sweats, shakes, fever-like symptoms, muscle and bone aches."

To fight these symptoms, he said patients who are cut off from treatment might try accessing drugs off the street, which could lead to further health issues, including overdoses. "You put a penny into prevention," he said, "saves a dollar in treatment down the road." 

Regenstreif, who has worked as a physician an Ontario jail, also said that prevention while behind bars would help once an inmate is released into the general public.

"The sooner you set them up for treatment, the better," Regenstreif said.

Both physicians likened addiction to a chronic disease. 

"You wouldn't fault someone for going on medication if they had diabetes," Fanaeian said. 

Dr. Lori Regenstreif, an assistant clinical professor of family medicine at McMaster University in Hamilton, Ont., says federal correctional facilities too often examine opioid agonist treatment through a correctional lens rather than a public health lens. (Craig Chivers/CBC )

For Regenstreif, one problem in the federal penitentiary system is that priorities are set though a correctional lens, instead of public health. 

"Once a facility has X amount of funding, are they going to spend it on nurses or are they going to spend it on more correctional officers? I don't know how they budget," she said.

Treatment increases over four years: CSC 

Correctional Services Canada cited Ricky Leslie's human rights complaint in explaining why it could not comment about him.

In its statement, it said the number of patients on opioid agonist treatment increased from 920 in December 2016 to 2,242 in June 2020, with a 21 per cent increase since December 2019.

"Over the past three years, in the context of the Canadian opioid crisis, the demand for treatment has dramatically increased and continues to increase," according to the CSC's website.

The federal body also said all decisions related to a prescription of medication are "made by a health care professional." 

CSC did not provide an explanation for exactly why the wait list grew between March and June, other than mentioning COVID-19.

Regenstreif acknowledged the pandemic has made many things more difficult, but said waiting for prescribed medication is not the same as waiting for a hair cut.

"We're not talking about ... an optional thing, we're talking about an essential service," she said.

Regional disparities

The CSC's statements also could not explain the regional differences between its penitentiaries.

According to the June 2020 figures, of the 494 inmates on wait lists in Canada, 169 — more than one-third — were in Alberta, and wait list numbers grew more in that province from March to June than in the entire country.

Though the CSC did manage to eliminate wait lists completely for two Alberta locations, the Drumheller Institution and Grierson Centre, the number of Alberta inmates waiting for opioid agonist treatment grew from 118 to 169 over that time.

By contrast, Ontario's wait list shrunk, from 48 inmates in March to just 20 in June.

As for Ricky Leslie, he enlisted the help of the Alberta Prison Justice Society to try and get him back on Suboxone. 

"When he's released, if he's treated, he's less likely to reoffend," said Kate Engel, a lawyer and the secretary for the society. "If he's languishing in jail without treatment, that's going to increase his chances of reoffending."

Kate Engel is a lawyer who works with Alberta Prison Justice Society, which has taken up Ricky Leslie's case. (Sam Martin/CBC)

The society was urging Correctional Services Canada to put him on Suboxone by Aug. 14. That date has now come and gone, with no sign of when his wait might end.


Raffy Boudjikanian

Senior reporter

Raffy Boudjikanian is a senior reporter with the CBC's Parliamentary Bureau in Ottawa. He has also worked in Edmonton, Calgary and Montreal for the public broadcaster.