‘What I’m doing has to be done’

HMP psychiatrist makes no apologies for his methods, says drugs are over-prescribed

Rosie Mullaley rmullaley@thetelegram.com
Published on January 5, 2016
Rosie Mullaley/The Telegram
Dr. David Craig told The Telegram in an interview Tuesday that some doctors in this province are over-diagnosing their patients and over-prescribing drugs.

For years, he’s been slammed by patients, their families, lawyers and other members of the public.

Often painted as the heartless doctor who regularly takes away inmates’ psychiatric medications at Her Majesty’s Penitentiary (HMP), Dr. David Craig has come under heavy fire in the past decade.

His methods and highly conservative opinion on the use of psychiatric drugs at the prison have been called into question many times.

As the complaints piled up, so did the media stories, highlighting the various instances in which inmates claim to have suffered badly after being taken off medications that had been prescribed by other psychiatrists and physicians.

Follow up:

Lawyer, mental-health advocate says another psychiatrist should be hired to work with Craig

Craig’s service even prompted a call to action by the citizens’ representative in 2011 and a peer review in 2012.

It’s been a lot to take for the 60-year-old. Now, he’s speaking out.

Now that his article, “Swimming Against the Tide — Restricting Prescribing Practices in a Prison: A Personal Journey,” has been published in last month’s edition of the Canadian Journal of Addiction (CJA), Craig feels free enough to talk about his practices publicly and to respond to all the criticism.

In an exclusive interview with The Telegram Tuesday afternoon, Craig expressed his frustration with the overwhelming public bashing.

“It’s been a long, hard haul,” he said. “Oh, I tell you, I was extremely upset. Quite frankly, I thought to myself, why the hell am I doing this? I feel very strong that what I’m doing has to be done. I absolutely do (care about the well-being of the prisoners).”

Craig makes no apologies for the way he does things and says some doctors over-diagnose and over-prescribe medications to patients.

“We clearly have a prescription drug problem in this province,” he said. “And who’s writing the prescriptions?

“I would wager that 95 per cent of the prescription drugs that hit the street get there by way of legitimately written prescriptions.

“There’s something going on.”

And it was going on at HMP, too, he said.

Craig said he was an intern when he first noticed the over-prescription of psychiatric drugs at the prison in 1986. He said most inmates were seen weekly and were prescribed benzodiazepines (valium-like drugs) and HS sedatives (sleeping pills) for extended periods, “despite their recognized abuse potential and their indication for short-term use.

“I was concerned the medications were being handed out a little bit more frequently than what I thought was appropriate,” said Craig, adding that the drugs do more harm than good to many inmates who already have substance-abuse disorders. “You can’t say anything as a trainee, so, of course, I didn’t.”

But years later, he did.

In 1999, Craig was asked to take over the psychiatric practice at HMP, but he said before he did, he reminded Marvin McNutt — the director of adult corrections at the time — that his approach to prescribing psychotropic medications was conservative and that he should expect to get complaints.

“‘You can either (go) with me or you can fire me.’ That’s exactly what I said,” Craig said with a chuckle.

As part of his practice, Craig said, he gradually eliminates what he considers “unnecessary” drugs, previously prescribed by other doctors, such as Dr. Nizar Ladha, one of the province’s top psychiatrists.

“We simplified things very carefully over time and we noticed things gradually got a lot better over time,” said Craig, who admits he and Ladha don’t see eye to eye in regards to prescribing drugs.

He said the adjustment in medications are not difficult for inmates, since it is gradual.

Despite criticisms, a peer review in 2012 found Craig meets the standards of care in the psychiatric services he provides to inmates.

In all, he said, 35 complaints were made about him to the College of Physicians and Surgeons of Newfoundland and Labrador.

All were dismissed.

“If I’m doing anything like people think I’m doing, I would not have had 35 complaints dismissed,” he said.

Craig said what people should be appalled by is the over-diagnosis of mental illness in this province.

“A lot of these depression and bipolar diagnoses are highly questionable,” said Craig, adding that inmates diagnosed with depression are often merely stressed by the circumstances of their lives.

“There’s a huge over-call out there — every time someone’s unhappy, they’re depressed, every time they’re having trouble controlling their temper, they’re bipolar.

“Bipolar disorder is a very real disorder. Major depression is a very real disorder. But the validity of these diagnoses are highly questionable.”

He said about 85 per cent of inmates have substance-abuse disorder (alcohol or drugs), but only a small percentage — about five per cent — have clinical depression.

“I’m not arguing against drugs. They definitely have a place,” he said. “I am arguing against using a drug to solve a non-drug problem.

“If you’re using a drug to solve a non-drug problem, you’re diverting the person’s energy from addressing the issue to having them sit back and letting the doctor find chemical balance. … Drugs can make you feel half better, but they can stop you from doing the work you have to do to recover.”

He said other things need to be done to help mentally ill patients besides prescribing drugs.

“Mental illness is an awful lot beyond drugs and beyond physicians,” Craig said.

He said there’s a huge need for more addictions 12-step programs, such as Alcoholics Anonymous, and more help for prisoners who are under-educated, and chronically mentally ill people must be given the proper supports to function better in the community.

Craig said he plans to retire in five years, but hopes by that time the environment will have changed regarding drug prescriptions.

“I’ve come under quite a bit of fire,” he said, “but I’m doing what I can to help make things better.”