It's High Time Pennsylvania Prisons Go Smoke-Free

I recently began practicing psychiatry in two Pennsylvania prisons.  Pennsylvania is behind the curve on tobacco control.  While at least 18 states and the District of Columbia prohibit tobacco smoking in all of their prisons, Pennsylvania allows it in all but a few cases.  During the first two months of my practicing in the one prison, for which I am the general psychiatrist in care of 400 and some inmates, I have already found four prisoners who started their smoking habits for the first time in their lives in Pennsylvania prisons.  A fifth relapsed after many years of abstinence.

The bizarre fact is that many Pennsylvania county jails prohibit smoking as does the admission prison for our region.  Thus, the convicts who were smokers have been abstinent for tobacco for at least several months before arriving at their home prison where they will serve out the rest of their sentence. 

Unfortunately, at my prison, there is absolutely no encouragement not to relapse into smoking.  Nicotine is not even considered a drug addiction, the smoking status of inmates in not documented, and tobacco use is never listed as a medical problem in the inmate's problem list, although all other addictive and dangerous drugs are.  Of course, tobacco is the #1 preventable cause of death in its own right and the leading gateway drug to marijuana and cocaine.

The states which currently prohibit tobacco possession in all prisons are the following:

Utah: many years; Idaho : 1995; Indiana: August, 1997; New Hampshire: 1999; Colorado: 1999; Minnesota: before Feb., 2001; Oregon: 2000; Maine: 2000; New York: Jan., 2001; Maryland: July, 2001; Nebraska: Feb. 2002; Iowa: April, 2002; Delaware: November, 2002; Vermont: Jan., 2004; District of Columbia: Aug., 2004; Washington: Nov., 2004; California: Jan., 2005; Oklahoma: Feb., 2005; Arkansas: Feb., 2005.  More bans are sure to come.

Canadian Provincial and Canadian Federal prisons also now ban smoking.

No state has ever rescinded its ban on tobacco. 

Of course, tobacco contraband is present wherever it is banned.  The black market price of cigarettes is a measure of how effective the bans are.  Although prisoners usually have very little money, cigarettes reportedly cost from $3 to $5 each in states where they are banned.  Prison officials in both Nebraska and Oregon both report that illicit drug use in their prisons has dropped since tobacco bans.  Whether that is due to a decrease in available money for drugs since the money is being used to buy cigarettes or due to another phenomenon is unclear. 

Just maybe, getting off of a very addictive drug, nicotine, weakens the urges to use other addictive drugs.  Research shows that the more health risks a person engages in, the less health conscious the individual. 

Oregon notes that the prisoners no longer have matches, which eliminates a safety hazard.  Many prisons mention a decrease in cleaning costs.  Indiana reports firing 44 corrections employees for smuggling tobacco into the prison and reprimanding 127 more over a 3 1/2 year period of time.  While some have mourned this loss of employees, these might not have been the best employees overall.  The firings were most likely due to selling cigarettes to inmates, while the reprimands may include employees bringing tobacco for their own consumption or accidentally forgetting to leave tobacco at home.

There are additional savings in health care costs for state government in caring for inmates who are not lifers.

One thing for sure, the lives of tens of thousands of Pennsylvania prisoners would be improved by forced abstinence in prison.  At least a small percentage would continue to be abstinent after release.  The percentage of abstinence after discharge probably increases as the length of forced abstinence increases. 

As a part of drug prevention counseling, it is routine to encourage drug addicts to avoid drug users after return to the community.  Roughly 98% of all alcoholics, and cocaine and heroin addicts are cigarette smokers.  By avoiding smokers, the risk of developing friendships with addicts is markedly reduced.  Also, a very high percentage of robbers, burglars, and other criminals are smokers.  By avoiding smokers, former criminals are much less likely to drift into a sub-culture of crime.