In June 2002, some 300 Mafia prisoners declared a hunger strike, calling for an end to the isolation conditions and objecting to parliament's Antimafia Commission proposal to extend the measure. Apart from refusing prison food, the inmates had been constantly banging the metalwork of their cells.[8][9][10] After the protest began in Marina Picena prison in central Italy – the prison's inmates include Salvatore Riina, the reputed "boss of bosses" – it spread rapidly across the country, in spite of inmates supposedly having no way to contact one another. Mobsters of different ranks in eight prisons had joined.

The European Court of Human Rights and others have been very critical about 41 bis and similar hard regimes.