About one -third of incarcerated persons have HCV. After decades of spending hundreds of billions of dollars on the war on drugs we are in the midst of another heroin epidemic. Addicts who are a danger to only themselves are imprisoned, while murderers, rapists and child molesters are released to the streets. Drug treatment, subsidized methadone clinics, legalization and taxation of drugs are the answer to addiction not incarceration. Prohibition from 1919 to 1933 did not stop alcohol and the war on drugs will not stop heroin.

Our constitution prohibits cruel and unusual punishment. The Supreme Court has interpreted this to mean that you cannot be denied necessary medical care if you are a prisoner. If you have HCV and you are in prison for life you should demand HCV treatment. If you have a short sentence treatment can usually be done when you have been released. It is the responsibility of the prison to notify you if you test positive for HCV.

Michael Paulley was my patient who was the first to get a federal court order for HCV treatment. He was incarcerated and consulted me at the Louisville VAMC for treatment of his HCV cirrhosis. The medical director of the Kentucky Department of Corrections cancelled his treatment and he filed suit. He was able to cure his HCV with pegylated interferon and ribavirin. He subsequently developed liver cancer as a complication of his cirrhosis. He was refused liver transplantation because he was in prison and he died shortly before his scheduled release.