When you're in jail, methadone is a valuable contraband drug — even when it comes from someone else's vomit. A CBC News investigation has learned the Nova Scotia Health Authority is taking steps to limit the practice of smuggling regurgitated methadone behind bars. The move follows the death of Clayton Cromwell, 23, from a methadone overdose in the Central Nova Scotia Correctional Facility in Burnside on April 7, 2014.
The health authority, which administers the drug to inmates who have a prescription, quietly enacted several policy changes in provincial jails one month later.
"If you are caught 'cheeking' the medication, you will be very quickly cut off the methadone," said Dr. Risk Kronfli, clinical director for Nova Scotia offender health services.
Offenders 'Cheeking' Drugs can Get Creative
Kronfli said offenders use a lot of tricks to "cheek" methadone so they can later sell it to other inmates, such as shoving bread in their mouths to absorb the liquid. "Some people put a condom, hook it up to the last tooth, so you actually swallow. The content goes into the condom instead of going into your stomach," he said. Others resort to throwing it up the methadone when they return to their cell, and filtering the liquid drug through a sock.
Cromwell was not in the methadone program.
The drug is prescribed to people fighting an opioid addiction or suffering from chronic pain. Since the young man's fatal overdose, Kronfli said rules have become stricter with three new policies.
Longer Monitoring Period
Inmates are now monitored for 30 minutes after taking methadone. Before Cromwell's death, they were held in a room with video surveillance for 20 minutes. Kronfli believes the extra 10 minutes allow enough time for medication to break down. "This is why we felt that the 30 minutes is important to let it pass from the duodenum and hopefully the stomach," he said. "After that, it's going to be very difficult."
Mandatory Strip Searches
Following the monitoring period, each male inmate is now strip-searched — a practice previously done only in "highly suspicious" situations, according to Kronfli. "That really allowed a lot of variability from one correctional worker to another, from one offender to another," he said. "Now they standardized the approach, which I think is a much better approach."
Female inmates are not strip-searched. Instead, they are held in the monitoring room with corrections staff watching them closely. Kronfli said there aren't enough corrections workers to monitor all male inmates closely.
On average, the Burnside jail has 40 inmates taking methadone each day, out of a total jail population of 300. Currently, six inmates are female. An additional three inmates, on average, take methadone during weekend sentences. At the Cape Breton Correctional Facility, about 10 per cent of inmates are in the methadone program.
Equipment Bought to Properly Measure Doses
In response to Cromwell's overdose death, the health authority also purchased equipment to properly measure methadone doses. "We thought that we should get those metered machines, which leaves very little potential for human error when we are dosing the medication," said Kronfli.
Devin Maxwell, lawyer for the Cromwell family, said the new policies acknowledge there is a problem. But he still wants to see more done. "There's a lot of things that go on in that jail that they don't know, about and there's a lot of contraband in that jail and they frankly don't have a handle on it," Maxwell said.
Cromwell Case going Forward
Maxwell doesn't believe Cromwell bought contraband methadone, saying he wasn't "a user of that kind of drug."
"It's impossible for them to know exactly what happened that night, which is unfortunate because I think it speaks to the overcrowding, the understaffing and the lack of security that exists in that prison."
Cromwell was in the Burnside jail awaiting a court appearance for allegedly violating probation in a drug trafficking case. Maxwell said his criminal past involved marijuana — not opioids.
Halifax Regional Police concluded its investigation into Cromwell's death with no charges.
"I'm not surprised that they still do not know exactly what happened in this case. I'm not surprised they are still in the dark as to exactly how Clayton died and how it was that he overdosed," said Maxwell.
Cromwell's mother, Elizabeth Cromwell, is proceeding with her lawsuit against the province. She alleges the jail failed to set up sufficient safeguards to prevent the flow of the potentially dangerous drug through the prison.
By Angela McClover - CBC/Nov. 7, 2016
Photos: 1- cbc; 2-ap (insert methadone)