This writer worked briefly long ago with a high-energy aggressive 40s executive who hopped from company to company with a mandate to supercharge corporate performances. He had suffered three heart attacks in his career, he said, and was convinced that people don’t get heart attacks, people give heart attacks.  He did eventually succumb to one somebody gave him a few years later.

When managing interactions with governments, and Correctional Service of Canada most often in our case, this man’s far away perspective comes to mind.

Going back again to Letters posted December 31 last year, the December 29 letter to Marie Doyle, CSC’s Assistant Commissioner of Health Services, did generate a response, with a digital signature dated January 23 this year.  Again, as we did last time out, reprinting the entire letter from Ms. Doyle underscores the frustrations when civil servants won’t or can’t deal with reality.

Dear Charles Klassen,

Thank you for your correspondence dated December 29. 2025, regarding the inclusive care for people with Opioid Use Disorder (OUD) in CSC custody.  I appreciate you taking the time to share your perspective.

Health Services adheres to the Guidance for Opioid Agonist Treatment (OAT) program (August 16,2021) when supporting individuals diagnosed with a substance use disorder who request treatment.  This guideline provides evidence-based recommendations to the multidisciplinary health care team within CSC and is currently under revision.

As noted in your letter, effective October 1, 2025, CSC designated long-acting injectable buprenorphine (Sublocade) as the first-line treatment for opioid use disorder.  This decision was informed by published clinical evidence, specifically, studies related to correctional settings and support by consultation with CSC prescribers and external subject matter experts.  Moreover, this decision was also based on three key elements of the OAT program; improved safety and efficacy or administration, reduced risk of medication diversion, and enhanced outcomes during transition to community care.  To avoid abrupt disruption of care, CSC implemented a six-month transition period (October 1, 2025, to March 31, 2026).

Additionally, as highlighted in an internal memo distributed to Health Services in December 2025, Sublocade is intended to be used as part of a comprehensive treatment plan that includes counselling and psychosocial support.

A psychological treatment plan under the OAT program is delivered by a multidisciplinary team that includes the inmate, the OAT nurse, and the OAT prescriber (institutional physician or nurse practitioner).  Other health care professionals may participate as needed.  The team meets virtually or in person to address significant issues.  With the inmate’s consent, the team may also include the institutional parole officer, social programs officer, Aboriginal liaison officer, and, when appropriate, Elders or religious leaders.  Psychosocial support may include psychoeducation, motivational interviewing, individual therapy, and group interventions tailored to the inmate’s needs and responsivity factors.  The inmate’s information is documented within the Integrated Individual Treatment Plan, which is accessible to all health care providers through the inmate’s electronic medical record.

At the same time, CSC acknowledges that more can be done to improve access to consistent and comprehensive psychosocial supports for individuals with substance use disorders, including those accessing OAT.  Health services will continue to collaborate with institutional teams and partners to enhance access, consistency, and responsiveness of these supports, recognizing their essential role in treatment effectiveness, recovery, and continuity of care.

For individuals transitioning to community care who are interested in the OAT program, Health Services and the case management team coordinate the process, each with defined roles and responsibilities.  Health Services ensures continuity of care by providing prescription information to current medications, access to a naloxone kit with harm reduction education, and information for counselling, either in person of virtually.

I appreciate the time you took to share your perspective.  Your feedback helps us identify areas for improvement to better meet the needs of inmates.  Your concerns are noted and will be carefully considered as we continue to enhance the program.

Thank you again for writing,

Sincerely,
Marie Doyle,
Assistant Commissioner of Health Services.

In earlier exchanges, Ms. Doyle has always been pleasant, polite, and detailed.  She is either a sly fox or a true believer.  We tend to think she trusts that policy on paper is enough to prompt delivery of the services she describes.  If you think her candor equates to credibility, then there is still that piece of land in south-central Florida you should consider buying.

Inmates come to know policy is for public consumption with little parallel to life behind the walls.  Inmates who don’t pay attention to their policy entitlements might be surprised that they’ve been skipped over.  They would be even more puzzled if their Offender Management System (OMS) files listed their participation in one of the programs Ms. Doyle trumpets.  How does that happen?

Why will Correctional Service of Canada not consider partnering with the provincial health-care bodies across the country?

Why does CSC strongly oppose the ratification of the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT)?

A Saturday Night Live skit in the raw.