# Can inmates receive prescribed narcotics in jail? **URL:** \ **Category:** Factual Questions\ **Created:** [October 10, 2006, 4:16am UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896 "2006-10-10T04:16:05Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [October 13, 2006, 10:01pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/41 "2006-10-13T22:01:08Z")
[QUOTE=Don’t Call Me Shirley] **QtM** , can you explain the difference between malignant and non-malignant pain? [/QUOTE] Malignant pain is that pain caused by an active, progressive, destructive process, most commonly due to cancer. It may also be due to infection, or rapid degeneration. It tends to only get worse with time, and death is the usual short to medium-term consequence of the disease process which is also causing the pain. Non-malignant pain is that pain which persists after some sort of injury or deterioration to tissue, or is just there without evidence of damage to the body. The process which initiated the pain has generally been halted, or the process itself tends to be slow to progress and generally doesn’t end in death (think degenerative arthritis). The origin of the pain may be frequently unknown, too. Chronic recurrent headaches, chronic back pain of a musculo-skeletal nature, and fibromyalgia all fall into this category. > [@Irishgirl](#): > > I bow to your expertise in the field of drug-seeking junkie cons with non-malignant chronic pain. The expertise is also quite valuable when one practices privately with an affluent clientele. Or anywhere there are office patients. The disease of addiction respects no boundaries. I’ve met a formerly hopeless junkie who was also a billionaire (money may buy you what you want, but it won’t make you get what you need), a now-sober rock star (reality is for people who can’t handle drugs), and a recovering addict physician who was the personal doctor to the First Family (no, I won’t say which one). ---
**Author:** ![ArmyDocL1974](https://avatars.discourse-cdn.com/v4/letter/a/82dd89/32.png) [@ArmyDocL1974](https://boards.straightdope.com/u/ArmyDocL1974)\ **Post date:** [November 12, 2015, 9:59pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/42 "2015-11-12T21:59:22Z")
> [@tashabot](#): > > Technically you should, yes. In fact, it’s federally mandated - refusing to give medical service that is vitally needed is, I believe, considered cruel and unusual punishment. > > However, just to say it’s the law doesn’t mean it happens. There’s a prison out in Lovelock, an hour or so drive from here, where inmates routinely don’t get their medicine. There isn’t really any reason for it, either, except for maybe laziness. One guy went into diabetic shock because they wouldn’t give him his insulin for his extreme diabetes, and almost died. Still, no one does anything. > > ~Tasha This s so sad but true… I am a Chronic Pain Sufferer Myself and I am on some very strong Narcotic Medications “Dilaudid and MS Contin”… So any one who knows them knows why I can’t miss taking them… any howz I had gotten arrested "for something I was innocent of as well, but while I was in lock up for little more than 48hrs due to interrogation and booking and all before the judge let me got on “O.R.” I had been Arrested with my prescription pill bottles with my meds and doc info Inc. phone number and all… Even though they still for no reason flat told me I can’t have my meds because Criminals don’t deserve them kinds of mediation "mind you I’ve not even been convicted just accused by this point “never was convicted D.A. refused to file charges” so yes I can say they will gladly let you suffer in jail if they will in booking even though the law does call that cruel & unusual punishment no one says or does a thing about it… even though I was going though withdrawals as well its just sad how people can treat others so bad especially people who are supposed to be serving and protecting us… ---
**Author:** ![ArmyDocL1974](https://avatars.discourse-cdn.com/v4/letter/a/82dd89/32.png) [@ArmyDocL1974](https://boards.straightdope.com/u/ArmyDocL1974)\ **Post date:** [November 12, 2015, 10:01pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/43 "2015-11-12T22:01:57Z")
> [@Harmonious\_Discord](#): > > Your supposed to get your medical treatment, but like all institutions some will provide badly for implimentation. Inmates normaly go to the medical area and take the medicines. Inmates on narcotics have been forced to throw up the medicine by other inmates to get the narcotics. what forced to throw up meds wow that’s cold darn inmates lolh but that’s sad though man id be like get your own lol and if they want to try to make me do it well good luck lol ---
**Author:** ![ArmyDocL1974](https://avatars.discourse-cdn.com/v4/letter/a/82dd89/32.png) [@ArmyDocL1974](https://boards.straightdope.com/u/ArmyDocL1974)\ **Post date:** [November 12, 2015, 10:19pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/44 "2015-11-12T22:19:23Z")
> [@irishgirl](#): > > If prisoners are being forced to regurgitate pills, or are “fake taking” in order to stockpile narcotics, there are simple steps that could be taken to overcome that. A nurse/doctor/health care worker could administer their medication by subcutaneous, IM or IV injection rather than an oral tablet, for example, or they could take a liquid preparation that is harder to fake swallow. > > You can get painkillers in other formulations than oral tablets- abuse of the system is not a good reason to deprive someone of adequate pain relief, especially when two minutes thinking could come up with a solution. The reason that pills get used rather than other preps is injectable meds have a shoter half life in the body than tablets do… suh as I take my meds at home by mouth it last around 5 to 6 hrs but the injections when I do get them only last 3 to 4 hrs for IM or 1 to 2 hrs for I.V. so giving the inmates pills keeps the overworked nurses from having to see the inmate every couple hrs… ---
**Author:** ![ArmyDocL1974](https://avatars.discourse-cdn.com/v4/letter/a/82dd89/32.png) [@ArmyDocL1974](https://boards.straightdope.com/u/ArmyDocL1974)\ **Post date:** [November 12, 2015, 10:31pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/45 "2015-11-12T22:31:04Z")
> [@Qadgop\_the\_Mercotan](#): > > I often prescribe narcotics to my patients, and they generally get them. > > I tend to prescribe narcotic painkillers only for moderate to severe acute pain, and for malignant pain. I tend to _not_ prescribe it for chronic non-malignant pain. That’s a good rule of thumb for any physician, not just a prison physician. > > Diversion is a problem. Other inmates shake down the patient for the med, ordering him to cheek it rather than swallow it, and threaten consequences if he tells officers about his behavior. Some inmates discover they can sell their dose. Some officers have been known to divert the medication, too. Addiction affects more folks than just inmates. > > On the prisoner units, the “controlled” medicines are distributed at set times by officers. The officers do not dispense the medication, they just make it available to the inmate for them to take at the times and dosages prescribed. The officers report it to us if an inmate refuses to take controlled meds as ordered. > > The “controlled” medicines are not just the ones with the big red “C” on them which are regulated by the Drug Enforcement Administration, they’re also the psychiatric drugs, meds to prevent seizures, meds to treat HIV, TB, and a few other things too. > > The officers hate handing out meds, and I don’t blame them. We’re trying to get medically trained folks to do the job, but it’s a huge one, and adding personnel would cost a lot of money. > > If a drug is not controlled (like HCTZ for high blood pressure, indocin for pain), the inmate keeps these meds in his cell, and is expected to take them appropriately. > > Giving the medication in liquid form or injectable form or making them come down to the nurses station to be witnessed taking it can be done, but it’s a hassle. We’ve got a finite staff, stretched thin, to do the job that needs doing. > > Perhaps this spring, at our next open house, I’ll have a spot or two open on my guest list and make an invitation for a doper or two to see where I work. Wow if you get them spots I love one if you are someplace that I can get to… as a former Army Medic would love to see haw a prison medical system works… ---
**Author:** ![hajario](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hajario/32/171_2.png) [@hajario](https://boards.straightdope.com/u/hajario)\ **Post date:** [November 12, 2015, 10:37pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/46 "2015-11-12T22:37:44Z")
Welcome to the boards. Just so you know, you are responding to posts made almost ten years ago. Some of the people who made them may have moved on. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [November 13, 2015, 12:05am UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/47 "2015-11-13T00:05:48Z")
> [@Harmonious\_Discord](#): > > Inmates on narcotics have been forced to throw up the medicine by other inmates to get the narcotics. :eek: :eek: :eek: :eek: :eek: :eek: :eek: :eek: I’ve worked in pharmacies that serviced county jails, and their policy was always “No controlled substances”, not even low-risk items like phenobarbital. If a patient needed those meds, they were admitted to the hospital. This was about 15 years ago, so I don’t know what they do now, or what other facilities might do. For me, the saddest thing was filling meds for the women’s section, because so many of them were pregnant. ☹ ETA: Didn’t realize this is a zombie thread. However, I do know that Qadgop is still around. ---
**Author:** ![Senegoid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/senegoid/32/6606_2.png) [@Senegoid](https://boards.straightdope.com/u/Senegoid)\ **Post date:** [November 13, 2015, 3:13am UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/48 "2015-11-13T03:13:20Z")
> [@ArmyDocL1974](#): > > . . . Even though they still for no reason flat told me I can’t have my meds because Criminals don’t deserve them kinds of mediation "mind you I’ve not even been convicted just accused by this point “never was convicted D.A. refused to file charges” so yes I can say they will gladly let you suffer in jail if they will in booking even though the law does call that cruel & unusual punishment no one says or does a thing about it . . . IIRC, our beloved Supreme Court, circa mid-1980’s, came out with a peculiarly _nasty_ ruling that, if you’re in jail awaiting booking or awaiting trial on some charges, then since you haven’t been convicted yet, your [del]incarceration[/del] detention isn’t punishment. Therefore, you have no protection against cruel/unusual treatment, because that treatment _isn’t_ punishment. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [November 23, 2015, 8:45pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/49 "2015-11-23T20:45:37Z")
> [@ArmyDocL1974](#): > > Wow if you get them spots I love one if you are someplace that I can get to… as a former Army Medic would love to see haw a prison medical system works… I’m still in prison, doing Corrections Medicine. Let me know if you want a job, we’re hiring. 😃 And now, nearly 10 years later than my original post on this topic, the pendulum has swung much further the other way on opioid use, out in the private sector, and in prison. Oxycontin is a dirty word now, and the over-prescribing of opioids has resulted in thousands of unintended overdose deaths in that time interval. But I haven’t had to change my prescribing habits much as a result, as I was wary of those drugs to begin with. I found methadone to be more problematic than helpful, and now tend to avoid prescribing it; proportionally more of the unintentional OD deaths happen with methadone than any other opioid. I do hope **Diggleblop** found some relief in the intervening years. His posts after those of this thread indicated a lot of struggle with the issue, before his banning. ---
**Author:** ![Tim\_T-Bonham.net](https://avatars.discourse-cdn.com/v4/letter/t/46a35a/32.png) [@Tim\_T-Bonham.net](https://boards.straightdope.com/u/Tim_T-Bonham.net)\ **Post date:** [November 23, 2015, 9:10pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/50 "2015-11-23T21:10:13Z")
> [@psychonaut](#): > > What makes you think that injections, with all the paraphernalia and personnel they require, are a “simple” alternative to pills? Manpower issues aside, having a sharp object anywhere near an uncooperative and possibly violent inmate seems to be inviting many more problems than it would solve. I have a friend who worked as the nurse in a county jail for many years before retiring. In our county (Hennepin, Minnesota) inmates can continue to receive any prescribed medications while incarcerated – but the drugs are locked away, and must be given by the jail nurse. Twice a day, patients with prescribed medications were brought to her nursing station to receive their medications from her. They had to be taken in her presence, and she gave any injections needed (even ones like insulin, which the patient gave to themself when not incarcerated). And she never had any trouble with " uncooperative and possibly violent inmates" – in fact, she mentioned how pleasant & cooperative they all were. As she said, I’m the only person they see all day whose job is to make them feel better. (Plus I have 2 big deputies within earshot, and a whole line of other prisoners waiting to get their meds. If I get injured and sent to the hospital, nobody else gets their meds that day – and they would be unhappy with the prisoner who injured me.) ---
**Author:** ![Flyer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/flyer/32/7298_2.png) [@Flyer](https://boards.straightdope.com/u/Flyer)\ **Post date:** [November 23, 2015, 11:44pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/51 "2015-11-23T23:44:51Z")
Since this has been resurrected, I have a somewhat related question. What happens if an inmate has an allergy severe enough to require an Epi-pen? ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [November 24, 2015, 12:00am UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/52 "2015-11-24T00:00:07Z")
> [@Flyer](#): > > Since this has been resurrected, I have a somewhat related question. What happens if an inmate has an allergy severe enough to require an Epi-pen? Then I order them an epi-pen, and it is kept at the officer’s desk on his unit. He’ll have to ask for it if he needs it. In my nearly 14 years in corrections medicine overseeing 23,000 inmates and reviewing nearly all inmate deaths over that time, I’ve seen no one die from lack of more timely access to an epi-pen. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 24, 2015, 3:45pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/53 "2015-11-24T15:45:45Z")
> [@WhyNot](#): > > granted, none of us can swear for sure that \*\*Qadop \*\*is an actual prison doc, but he’s got a long history with no obvious contradictions that makes us believe his claim, and he’s very well respected around here Actually, I can swear to having evidence he is a real prison doc. At the time [the events in this thread occurred](http://boards.straightdope.com/sdmb/showthread.php?t=566554) it was possible, with a bit of digging on news sites, to obtain the real name of Dr. Mercotan and with a bit of googling confirm that he is, indeed, a medical doctor and he does work at a prison in Wisconsin. He’s a very nice guy (great human disguise, Mercotan technology is amazing for that) and I’m sure, particularly given that he works with unsavory people as part of his job, he understands completely why I confirmed he was telling the truth about his identity prior to dropping by his home. I suspect, if someone was truly determined they could make the same confirmation (it is, of course, a lot easier to dig up the info when you know his face-to-face name). Plug his name into google and both he and his workplace are on the top of the first page of results (followed by a bunch of other guys with the same name from all over the place who do other things for a living). That, and when I went to visit him not only were all the neighbors convinced he was a prison doctor, but when I stopped for directions at a random gas station in Ozaukee County, Wisconsin the two folks behind the counter said “Oh, the XXX place? The prison doc?” so if he _did_ bribe the locals to lie for him he must have paid off _the entire county_ to make sure anyone I encountered would adhere to the official story. 😉 Maybe I could have slipped away at one point during my visit and gone scrounging for documents, but aside from that being rude I was much too distracted by the vast Tolkein collection and the TARDIS-like quality of the rambling residence. Also, somewhat concerned about falling into non-euclidean geometry somewhere in there and getting lost or emerging into another continuum. I am _still_ convinced there’s a doorway to Narnia somewhere in there, probably in the back of the long closet built into the area under the upper walkway in the passage leading to the guest suite, the bit that goes by/over the garage. He knows what I’m talking about, unfortunately, I can’t come up with a shorter way to describe the location. Basically, though, both my own research prior to my visit and what I saw and heard there pretty much confirms, to me at least, that he honestly and fairly represents himself on this forum. Except for the whole species-disguise thing. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [November 24, 2015, 7:27pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/54 "2015-11-24T19:27:36Z")
It’s all true, my local reputation is quite infamous. As is that of my house. ---
**Author:** ![bufordtjustice](https://avatars.discourse-cdn.com/v4/letter/b/22d042/32.png) [@bufordtjustice](https://boards.straightdope.com/u/bufordtjustice)\ **Post date:** [September 24, 2017, 5:38am UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/55 "2017-09-24T05:38:56Z")
> [@Qadgop\_the\_Mercotan](#): > > Oh, and just because you enter my prison with a documented history of taking Oxycontin 80 three times a day with valium 20 three times a day, don’t expect me to not change your medications to what I feel is appropriate, once I’ve assessed you. Once you’re in my institution, I and my minions are your doctor, not the gullible guy you’ve been seeing for your back pain. > > If you’re on that med for pancreatic cancer, you can depend on getting equivalent doses of similar potent narcotic analgesics for me at need. But if you’re on it for chronic musculo-skeletal low back pain, we’ll be exploring alternate treatment plans. Sound like your on a power trip to me…If the doctor prescribed me that i would expect to get it…Not come to some power driven doctor like you…And for you to say that your fellow doctors are gullible makes me sick…Sounds like your dick head…Glad i dont have legal problems and have a ass like you… ---
**Author:** ![cochrane](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cochrane/32/10441_2.png) [@cochrane](https://boards.straightdope.com/u/cochrane)\ **Post date:** [September 24, 2017, 7:50am UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/56 "2017-09-24T07:50:38Z")
Oh for Christ’s sake! Reported. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 24, 2017, 3:48pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/57 "2017-09-24T15:48:59Z")
Ah, the clientele doesn’t change, either in prison or on the 'net. :rolleyes: I’m thrilled to see that what I wrote in 2006 about how to properly prescribe opioids (which made me an exception to the trends back then) is now being advocated by the highest medical authorities in this nation as the way to prescribe opioids in 2017. _They shoulda come to me soonah._ So thanks for bumping the thread, so I can bask in my own fantasticness. 🆒 ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [September 24, 2017, 4:14pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/58 "2017-09-24T16:14:35Z")
> [@bufordtjustice](#): > > Sound like your on a power trip to me…If the doctor prescribed me that i would expect to get it…Not come to some power driven doctor like you…And for you to say that your fellow doctors are gullible makes me sick…Sounds like your dick head…Glad i dont have legal problems and have a ass like you… Just because a doctor, some doctor, prescribed something for you does not mean it is the best treatment whether you are in prison or not - that is, after all, the whole concept behind second opinions. Yes, some doctors ARE gullible. Some doctors are also behind on latest treatments and medical practice. Some doctors are burnt out. Some are even nasty people. What people NEED from medicine is not always what they WANT from medicine. That’s two different things although if you’re lucky there will be a great deal of overlap between them. I used to work at a clinic that served addicts, and we also had a contract with the Federal Bureau of Prisons to help transition people back to the outside world. A lot of prisoners have a problem with entitlement that, joined with a little doctor-shopping, makes for a toxic combination. Addicts tend to want to just medicate both pain and problems away rather than doing some hard work to address the source of that pain and problem instead of merely medicating the symptoms. Combine that with addiction to legal, prescription medication which is a serious problem in this country and you can get a situation where an MD is acting as an enabler, whether he or she knows it or not. Sure, you might be getting X, Y, or Z for your chronic lower back pain but for most people with that problem proper exercise will do more long term to alleviate that pain that pills, and even if some pain medication is still needed, needing less is better than needing more. I encourage you to read some of Qadgop’s past threads on serving the medical needs of prisoners where he has gone into some detail about his reasoning, his practice, and dealing with patients that can be highly unpleasant that he has no choice other than treat - because unlike a doctor on the outside Qadgop has far less freedom to avoid difficult, even violent and dangerous patients. He’s not an ass, he’s not power-tripping, he’s actually trying to help his patients whether or not those patients (or you) can see that. Again, what a patient WANTS and what a patient NEEDS is not always the same thing. ---
**Author:** ![Colibri](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/colibri/32/1841_2.png) [@Colibri](https://boards.straightdope.com/u/Colibri)\ **Post date:** [September 24, 2017, 7:02pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/59 "2017-09-24T19:02:38Z")
> [@bufordtjustice](#): > > Sound like your on a power trip to me…If the doctor prescribed me that i would expect to get it…Not come to some power driven doctor like you…And for you to say that your fellow doctors are gullible makes me sick…Sounds like your dick head…Glad i dont have legal problems and have a ass like you… **Moderator Warning** **bufordtjustice** , insulting other posters is not permitted on this site except in the BBQ Pit forum. This is an official warning. Do not do this again. I suggest you spend some time on this site to learn the standards of behavior here before posting again. Colibri General Questions Moderator ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [September 24, 2017, 7:17pm UTC](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896/60 "2017-09-24T19:17:21Z")
Still a fascinating thread. Thank QtM! [Previous page](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896.md?page=2) [Next page](https://boards.straightdope.com/t/can-inmates-receive-prescribed-narcotics-in-jail/375896.md?page=4)