Marketing Psychiatric Drugs to Jailers and Judges
On a rainy Monday morning in April, more than a hundred sheriffs, doctors, nurses, and jail guards from around the country sat in a ballroom on the outskirts of Nashville, sipping on coffees and listening to Daniel Potenza, a psychiatrist from New Hampshire, describe one of their most vexing problems: treating schizophrenia.
The conference, on medical care inside America’s jails and prisons, had been put on by an organization that sets standards for treatment in correctional facilities. Potenza paced the stage, talking animatedly about a national mental-health epidemic that had burdened jails and prisons. He flipped to a presentation slide showing that nearly half of all inmates diagnosed with schizophrenia were “non-adherent,” meaning that they weren’t taking their daily medications as prescribed.
Then, Potenza suggested a solution: a single shot of long-acting antipsychotic medicine, whose effects last for as long as three months, administered to patients while they’re still incarcerated. To show how this might help, Potenza presented a hypothetical scenario in which an inmate with schizophrenia becomes eligible for release but is denied parole because a medical provider describes the person as non-adherent. Parole-board members might be willing to reconsider if they could ensure that the person would receive his or her medications as prescribed ahead of release. In some cases, a “treatment resistant” patient who is simply forgetful might agree to the shot. However, in some cases, a judge might order a shot to be administered without the patient’s permission.
Potenza didn’t recommend a specific drug, and he was presenting at the conference at his employer’s expense, having been invited by its organizers. But if you looked inside the conference program, you would learn that the keynote address on schizophrenia had been underwritten by Alkermes, an Irish company that manufactures one of the long-acting medicines, Aristada. If you walked through the exhibit hall, you would see Alkermes banners hanging from the rafters, along with a booth of salespeople expounding on the benefits of the antipsychotic drug. An Aristada flyer they passed out featured two buildings—a
