It is common knowledge that America has the highest incarcerated population in the world, with 2.2 million adults incarcerated in local, state, and federal jails and prisons. Of the 2.2 million incarcerated, about 300,000 have a history of heroin use, and 80,000 identified as dependent on narcotics. Despite the staggering population of opiate-dependent incarcerated individuals, many of the nation’s jails and prisons fail to provide evidence-based treatment widely available in the community setting.
In August, the New York Times reported on the lack of medication assisted treatment programs in U.S. prisons, highlighting that out of the nation’s 5,100 jails and prisons, fewer than 30, according to the federal Bureau of Justice Assistance, offer opioid users the most proven method of recovery. Several county and state prisons are gradually integrating Medication Assisted Treatment (MAT) as an option to address the growing need. New York State, home of DPA’s headquarters, has yet to fully embrace in-prison MAT, despite the effectiveness of Riker’s long-running Key Extend Entry Program (KEEP) and recommendations made in the Ending the AIDS Epidemic report.
Failure to provide efficacious drug treatment options and transitional support has deleterious effects on reentrants who resume use upon release. Research on reentrant mortality revealed that newly released individual are particularly vulnerable to fatal overdose due to their diminished tolerance. In Bronx County, 63% of those who died from fatal overdose in 2016 have a history of criminal justice involvement – mainly substance related. This staggering statistic reveals a significant treatment and overdose prevention gap; resulting in deaths that could have been prevented.
To reduce the risk of fatal overdose, New York State provides naloxone training, and distributes kits to reentrants in three facilities. While this is a welcomed step forward, incarcerated drug users endure painful withdrawal, receive inadequate, abstinence-based treatment and are at risk of overdose while incarcerated or upon release.
More than 80 percent of people in the New York’s state prisons are in need of substance abuse treatment, and about 10 percent are heroin users. According to correctional health experts, most incarcerated individuals in the United States receive substance abuse education rather than evidence-based treatment, and that is true in New York State correctional facilities as well. New York has the largest methadone treatment system in the US and over a 1,000 of buprenorphine prescribers. Yet, only two New York jails offer methadone and buprenorphine. In refusing to provide MAT, prisons in New York and throughout the nation are denying individuals the most effective treatment for their condition, as well as failing to provide health care that is comparable to what’s available in the community setting – needlessly placing thousands of people at risk of overdose.
Dr. Ross MacDonald, the medical director of New York City’s correctional health program, declared that every person who enters New York City’s main jail with an opioid addiction represents an opportunity for treatment, and the possibility of saving a life. For over 30 years, Rikers Island has provided opioid dependent detainees with MAT through the KEEP program. Studies on KEEP patient outcomes show that those on the maintenance programs were more likely to complete treatment, and follow-up with aftercare post-release. Efforts to improve the KEEP program will benefit those begin maintenance and continue in the community setting; however, a number of individuals sentenced to prisons upstate are tapered off effective medication.
To address the dearth of evidence based treatment options in New York State prisons, The New York Office of the Drug Policy Alliance, in partnership with Legal Action Center and John Jay’s from Punishment to Public Health consortium will host a one-day on drug treatment and harm reduction options for drug users incarcerated in New York’s prisons.
This convening will serve as an opportunity to learn about the efficacy of evidence-based treatment options and harm reduction resources from those with direct experience working in the correctional setting both nationally and internationally.
In light of the growing opioid epidemic, it is imperative to ensure that evidence-based, effective drug treatment and harm reduction resources are available to all.
Dionna King is a policy coordinator with the Drug Policy Alliance.