Correctional facilities refuse to provide medically assisted treatment for opioid withdrawal and people are dying at alarming rates as a result.
NOTE: We at Apportis feel that this subject needs further discussion in the public sector. We have published Mr. Abraham’s article in its entirety for our subscribers. This is his work, we are just hoping to bring it to our corner of the universe. Philip Payne is not the author, but our blog tool posts the name of the person who creates the post, much apologies to Roshan Abraham, this is his fine work that we want to share.
When Matthew Herring was arrested in 2016 for a probation violation and sent to Dutchess County Jail* in upstate New York, he brought his medication with him. Herring, 22, had struggled with an opioid addiction for eight or nine years at that point, and had been in and out of jail since 2011, his mother Patricia Herring said. So he stashed an FDA-approved treatment drug called buprenorphine in his body to soften a painful withdrawal.
When the guards found it, however, he was thrown into solitary confinement for four days, where he suffered from withdrawal, his mother said. “They don’t have any compassion,” Herring said of her son’s treatment by correctional officers. “He’s puking his brains out, they’re laughing.”
Then, 72 days after his release from jail, Matthew died from an overdose. Herring asserts the lack of treatment on the inside played a role. “He was sick and suffering,” she said. “He was never offered medical treatment that he as human being deserved.”
People recently released from incarceration in the United States suffer alarmingly high rates of overdose deaths. A Massachusetts study found overdose deaths went up a staggering 120 percent the two weeks after release compared to the general public.
Opioid withdrawal is extremely painful and in some cases fatal; people have died in jails as a result of extreme dehydration linked to withdrawal, which causes diarrhea and vomiting. Yet only three percent of state and county correctional facilities across the U.S. carry any of the three FDA approved drugs for opioid addiction treatment: methadone, naltrexone and buprenorphine. Often when the drugs are available, it’s left up to law enforcement to decide who has access.
Overdose deaths went up a staggering 120 percent the two weeks after release.
Advocates agree the main roadblock to more states providing medically assisted treatment (MAT) to incarcerated people is stigma associated with drug use. Many correctional employees view the treatments as just another avenue for addiction, or argue it will be traded illicitly on the inside. While the National Sheriff’s Association recently released a guide to using MAT in jails, a 2016 survey of correctional officers in nine states found that officers viewed MAT as a “treatment of last resort” rather than evidence-based medicine.
There are also cost issues: sheriffs in county jails in New York said it would be hard to provide the drugs without substantial funding, though advocates have countered that the cost of not giving treatment could be higher, due to hospital visits and return jail visits. Nonetheless, the budget cuts across both public and private health care providers for incarcerated people can cut deep.
But plaintiffs who were denied treatment have been mounting successful lawsuits, strengthening the case for the treatments nationwide: an April ruling in Maine and a ruling in Massachusetts last December both held that keeping someone from medication assisted treatment violates the Americans with Disabilities Act. A bipartisan Senate bill introduced by Senators Markey and Murkowski would fund $50 million of grants for MAT in jails and prisons.
Progress is slow. Bills in the NY State Legislature would have made the treatments available to everyone in the state’s prisons and county jails, but the proposal faltered at the end of 2019’s legislative session. Instead, Governor Andrew Cuomo expanded opioid treatment in prisons and jails across the state: with $4 million distributed to counties and $1.2 million to state prisons under the latest state budget. Some programs will also provide Naloxone, an overdose prevention drug, to those returning home.
The reach of those programs is limited: MAT is only available at eight of New York’s 54 state prisons, and only in interventions like parole diversion, pregnant women and people serving short sentences. These pilot programs are seen by advocates as far too gradual for the full-blown epidemic inside the state’s prisons and jails.
In the meantime New York’s county jails can still punish people for bringing the potentially life-saving medication into jail with them. In January, the Ulster County Sheriff’s office announced on its Facebook page the “arrest” of someone already incarcerated after a cell search turned up Suboxone, the brand name for buprenorphine. It was the second such arrest in six months, and Ulster County has seen its opioid death rate go up 345 percent between 2010 and 2018. This is why, a few months after the Sheriff announced that arrest, county executive Pat Ryan announced federal funds would be used to provide MAT, including in Ulster County Jail—a sea change from their approach earlier in the year.
New York’s county sheriffs still have wide latitude to punish people who smuggle the treatments inside. “They operate like fiefdoms,” said Dionna King, New York Policy Manager of the Drug Policy Alliance. “The sheriffs have a lot of autonomy.”
Jails can still punish people for bringing the potentially life-saving medication into jail with them.
One formerly incarcerated person—who wanted only to be identified as “Joseph” for fear of retribution—said that bringing opioid treatment drugs inside an institution is a common precautionary measure. Some heavy opioid users don’t leave the house without tabs of Suboxone stashed in their bodies. “Motherfuckers don’t leave their house unless they have 10 Suboxone stuck in their ass. That’s how it is with us,” he said. “It’s basic medical attention they just deny us.”
He described a visceral experience going through withdrawal in Albany County Correctional Facility. In April 2017, he was arrested and charged with possession of narcotics with intent to distribute. Guards laughed at him when he asked for treatment, despite a medical history showing he was a seizure risk without it.
“All I’m asking for is general medical care, man,” he said he told the guard. “These people just looked at me like I’m a junkie.” He said he was brought to a hospital for his withdrawal symptoms only through a nurse’s intervention. Earlier this year, Albany County announced it would offer all three MAT drugs in their jail.
In Rhode Island, the only state that offers all three FDA approved drugs to incarcerated people, there has been a similar trend. Dr. Josiah Rich, a Brown University professor of medicine who helped implement the state’s plan, said he had heard plenty of incidents in which people smuggled buprenorphine into the jails. Suboxone, the brand name version of buprenorphine, is distributed on small tabs that can be hidden easily. He had heard cases of people slipping tabs inside crayon wrappers or under a stamp.
But after treatment was offered in Rhode Island prisons, overdose deaths reduced 61 percent, and trading drugs in the facilities went down.
Patricia Herring, like many advocates, wants opioid addiction to be treated as a disease, not criminalized, and for more treatment to be made available in the community as well in jails. She said she finds herself wondering why her son was punished for bringing in a substance that wouldn’t have harmed anyone.
“Punishment is not the cure for the disease,” she said. “At all.”
Editor’s Note: Matthew Herring was arrested in 2016, not 2017, for a probation violation, not a parole violation. While he was eventually sent to Altona, the jail where he smuggled in suboxone was Dutchess County Jail. And while he was 24 when he died, he was 22 when that arrest happened. The story has been updated to reflect these changes.