Claiming ADHD Medications Are 'Dangerous,' Israel Prison Service Withholds Treatment From Inmates

The state corrections agency is reviewing its policy on pharmacological treatment for prisoners with attention deficit disorder following pressure by the Supreme Court

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Prisoners are seen in an Israeli prison, September 9, 2019.
Prisoners are seen in an Israeli prison, September 9, 2019.Credit: Meged Gozani

The Israel Prison Service will appoint a panel to review the agency’s policy on prescribing Ritalin and similar drugs to inmates with attention deficit hyperactivity disorder, known as ADHD. The move followed pressure from the Supreme Court, to which prisoners had appealed after a district court found the agency’s highly restrictive policy to be “reasonable.”

For years, prisoners enrolled in academic studies with a diagnosis of ADHD and a doctor’s recommendation received Ritalin or similar drugs. In 2018, the IPS policy became much more restrictive. The agency argued that the stimulants prescribed for ADHD are dangerous and addictive, have serious side effects and could end up being traded by prisoners.

In 2019 the Lod District Court declined to intervene in the IPS decision, refusing a request submitted by Relly Avisar Rave on behalf of three prisoners. In her appeal application to the Supreme Court in February, the lawyer said the IPS policy violated prisoners’ rights of to medical care.

In an opinion submitted to the court, Prof. Tomer Einat of Bar-Ilan University’s Criminology Department he said that some 60 percent of prisoners have ADHD, compared to 5 percent in the general population.

The prison service argued that the need to provide prisoners with adequate medical care must be balanced against the need to maintain order in prisons. The agency also said that medication was not necessary for the treatment of ADHD, noting that the prisons operate so-called attention centers that teach behavioral and other skills that prisoners can use to cope with attention deficit and hyperactivity disorders.

Israel Prison Service guards with a security prisoner. Israel's High Court of Justice has ruled that the country's prison conditions are inhumane.Credit: Israel Prison Service

The IPS also said that the only medical expert who is authorized to decide on administering Ritalin to prisoners is the head of the agency’s psychiatry department. But contrary to the claims of the State Prosecutor’s Office and the IPS, the current head of the department is a general practitioner, not a psychiatrist. Physicians for Human Rights Israel submitted a complaint about that to the Health Ministry, arguing that this is presumed violation of the prohibition against a doctor’s use of a title or description that implies competence or a professional status that they lack.

In March, the IPS representative at a Supreme Court session said the prison service provides “what is required to maintain [the prisoner’s] health, but not what will improve his quality of life.” The lawyer, Yochi Gensin, told the court that only one person who is incarcerated in the Israel Prison Service is given Ritalin.

Justices Isaac Amit, Anat Baron and Alex Stein challenged the government representatives. “In almost every parole board report we see [that the perpetrator] has suffered from attention deficit disorder since he was a child. That’s how they end up in prison,” said Amit. “And how many are being treated [with Ritalin] - none.” The representative of the prosecution corrected him: “No, there’s a prisoner who presented a previous background and he was allowed.” When the representative tried to claim that the petition is theoretical and that there is no justification for giving Ritalin to the prisoners who petitioned, Baron replied: “There’s a lot of information here about a subject that can’t be dismissed. It’s a serious issue. Even if there are one or two prisoners getting Ritalin, that’s negligible.”

The minutes of the hearing indicate that the justices were unable to get an answer to the question as to how the IPS formulated the new policy. “The IPS’ decision is to treat and rehabilitate prisoners by different methods. There’s a reason why Ritalin is a drug,” said Gensin.

“We know that Ritalin isn’t Acamol [paracetemol], but the question is whether there was any thinking here: If we have thousands of prisoners, some of whom should be treated with Ritalin, maybe it’s worthwhile for us?” asked Amit.

Later Amit added that “The ethical approach says that there’s also a right to receive a drug that improves the quality of life” [as opposed to an essential drug for maintaining health]. “We’re in a different world,” replied Gensin. “The IPS is not a health maintenance organization. We are obligated to maintain the prisoner’s health, and there’s a very big shortage since the National Health Insurance Law.”

Three of the five members of the panel of experts are supposed to come from outside the IPS, and it is scheduled to begin work in about three months from now. In their decision the Supreme Court justices ruled that as long as there is a need to wait for the panel’s recommendations, the requests for an appeal should be erased. However, they noted that the requests “raise a basic question regarding the use of Ritalin inside the prisons.”

“We hope that the decision to establish an external panel of experts will lead to a significant change in the policy of treating attention deficit disorder in prison,” said Niv Michaeli, the prisoners and detainees coordinator at Physicians for Human Rights, Israel.

“The position of the IPS that ADHD can be treated without medication does not accord with the accepted medical standard in Israel. It’s important for the policy to be formulated in cooperation with professionals in the medical community and not by the IPS alone. That is especially true in light of the fact that those involved in formulating the policy in the IPS lack the required expertise.”

The IPS did not respond to requests for comment.

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