Others are incarcerated because of a crime related to a mental-health or substance-use disorder—for example, a theft or assault related to drugs.
Dr. Nader Sharifi, Correctional Health Services’ medical director and the addictions lead for all of BC Mental Health and Substance Use Services, has watched these numbers climb steadily in the 17-plus years he’s been practicing correctional medicine. Incarcerated clients who have mental-health problems upon admission doubled between 1997 and 2010, he says.
Nearly two decades and thousands of patients might harden some professionals—but Sharifi’s gentleness and compassion are as real as the first day he realized his calling was helping incarcerated people get well.
When Sharifi looked into the eyes of a client in custody, he saw something he didn’t expect to see—himself.
In 2000, Sharifi faced the worst tragedy of his life after his first wife was killed in a car accident. His loss was compounded when, unable to continue working, he also lost his home and his medical practice.
“Tragedy will sometimes clear you of preconceptions or stigma,” he says. “I realized the patients I was seeing in the hospital were not that different from me—they had difficult lives, too. I saw a lot of humanity, and knew I needed to help them.”
He quickly learned to see his patients not in terms of what they had done, but why.
“For many, it’s their life situations that have brought them here,” he says. “They’ve endured things like abuse, poverty, mental illness and addiction. These things are powerful, and debilitating. They’re also not choices.”
Sharifi also notes the over-representation of Indigenous people in correctional facilities. "They and their families have endured things we can't imagine. Trauma changes people in powerful ways—and unfortunately is often a big part of what brings people to us."
Sharifi oversees the medical team that assumed responsibility for health care at B.C.’s correctional centres just over a year ago.
Over the last year, among other things, Sharifi has helped oversee the elimination of waiting lists for opioid agonist treatment, which uses medications such as Suboxone and methadone to treat addiction and manage withdrawal symptoms. Currently, about 40 per cent of inmates in B.C.’s 10 correctional centres are on the treatment.
He and his colleagues are also working on a transition system that will help clients connect to health services so that they can continue to get well after their release rather than become a statistic of B.C.’s opioid crisis.
“People with a history of substance use are at incredibly high risk of overdose during the week of their release,” he says. “The risk is eight times higher than before they began their term with us. They haven’t been using, so their tolerance has changed, and cravings persist after detox. It’s the nature of the disease.”
Community transition teams, launching soon, will help clients connect with a doctor after their release and stay on their medication, and offer support as they navigate life on the outside.
Sharifi wants to help people understand the nature of the illness he and his team help treat every day.
“Addiction is a chronic disease,” he says. “It can get better and worse. It can relapse and remit. Relapse isn’t a failure; it’s simply part of the disease. It’s a chance to learn and grow and see what led to the relapse. The treatment is long term—but it works. It’s like insulin for someone who has diabetes. You don’t stop when they’re discharged.”
To those who wonder about investing so many resources into people who have committed crimes, Sharifi is quick to point out that prison itself—the loss of freedom—is the punishment. People shouldn’t suffer while they’re there.
“In the prison system, we continue to care for individuals in the same way we care for them in the community. We look at them as humans—holistically. People in prison are just like you and me—but often more vulnerable. And they need the proper care to get better.”
Sharifi smiles as he considers the future of his field. “There have been so many advances in this area in the last 20 years,” he says. “We have a better understanding of neuropathways, and the psychosocial and spiritual pathways to wellness. I think this will be the century of addictions medicine—and I hope that it puts me out of a job. It will be worth it, I think.”