Opioid addiction treatment varies widely in Pennsylvania prisons

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Opioid addiction treatment in Pennsylvania prisons is so hit-or-miss one woman went into withdrawal while expecting access to medicines. A man was refused medication because staff said he had not shown enough ‘motivation to be sober’.

These are among the stories shared by incarcerated clients of the Pennsylvania Institutional Law Project (PILP) legal aid group in a new report that found that access to opioid addiction medications in county jails across the state is scattered, often inadequate and non-existent in many prisons – putting inmates at risk of overdose when released.

Researchers assessed the availability of opioid addiction medications in Pennsylvania County’s 62 jails – which hold people awaiting trial or sentencing and those serving short sentences, usually for minor offenses — through right-to-know requests, client interviews, and meeting minutes at state prisons since 2018.

Last year, 5,319 people died of opioid overdoses in the state, and the Philadelphia area’s 1,214 deaths in 2020 made it one of the nation’s deadliest major metropolitan areas.

Drug addiction is a health problem that affects many people in jails and prisons. A 2017 study that looked at data from 2007 to 2009 found that 58% of people serving time in state prisons and 63% of people serving time in prisons had some kind of drug use disorder. substances. According to the National Institute on Drug Abuse, only 5% of drug abusers in state prisons receive medication to treat opioid use disorder while incarcerated.

Studies show that people in prison are much more likely to die of an overdose after release than those who are not incarcerated, PILP researchers said. They made the report with funding from Vital Strategies, a nonprofit public health organization disbursing funds from Bloomberg Philanthropies to tackle the state’s overdose crisis.

When someone is addicted to opioids, it is best to offer opioid medications to prevent painful withdrawal and quell drug cravings. Some people will eventually taper off these medications; others will take it long term. But experts agree on their success rates with drug treatment are much higher than quitting cold turkey.

People are entitled to it as part of their medical treatment in prison.

Su Ming Yeh, executive director of the Pennsylvania Institutional Law Project

The study – which focused on county jails because they are often people’s first contact with the criminal justice system – found that nine county jails, most in the northern part of the state, n offer any opioid addiction medication. Eleven prisons offered medication only to pregnant women.

Sixteen prisons allowed people who were already taking opioid addiction medication to continue taking it while incarcerated, and only three — in Philadelphia, Montgomery and Franklin counties — allowed people to start taking opioid addiction medication. addiction from prison.

“Over the years, we have received reports and complaints from customers with distressing concerns,” said Su Ming Yeh, executive director of PILP. “People are entitled to this as part of their medical treatment in prison.”

Unlike state prisons, there is no centralized system for county jails, so policies on opioid addiction treatment vary from jail to jail. At the state level, Gov. Tom Wolf ordered the Pennsylvania prison system to offer addiction medication in its facilities in 2018, and prisons have rolled out multiple drug programs since.

Kevin Rousset, president of the Pennsylvania County Corrections Association — a professional organization of about 40 of the state’s county jails — said the association has undergone training and discussed the provision of addiction medications in prisons. . But the association is not a governing body and has no general rules regarding drug treatment.

Most prison administrators defer to their medical directors on how to deal with addiction among inmates, Rousset said. (The Pennsylvania Department of Health provides health care in some county jails; others contract with private health care companies.)

“We have educated the prison administrators about this – but the implementation part is where the rubber hits the road and where the resources come in,” he said.

A spokesman for Pennsylvania Attorney General Josh Shapiro said that while the office does not oversee county jails, local governments can use funds from the opioid litigation settlement that Shapiro brokered — some $1. $0.7 billion, distributed among local state entities – to fund drug programs in prisons.

The report’s authors also pointed out that some prisons that offer opioid addiction medication may not offer the most effective types. Sixteen prisons allow inmates to take only naltrexone – a kind of drug that prevents people from experiencing pleasurable pleasure when taking an opioid.

But some studies have shown that it’s not as effective at preventing overdoses as other treatment options, such as buprenorphine and methadone. They are opioids themselves, taken in controlled doses under medical supervision.

It’s a crucial distinction, the report’s authors said, because people coming out of jails and prisons have often lost their tolerance – and if they relapse and use the same dose of opioids they’ve used in the past , they are at high risk of overdose.

Buprenorphine and methadone can help drug addicts maintain tolerance and avoid an overdose. That’s why Philadelphia first launched a program to provide drug treatment for opioid use disorder in its own prison — to prevent inmates from dying of overdoses after release. .

READ MORE: Philadelphia Women’s Prison Tries Bold Life-Saving Move: Give Inmates Opioid Treatment

“We’ve come a long way in terms of the general public’s understanding of opioid use disorder, but there’s still a lot of stigma and misunderstanding about what these drugs really are and why people need,” said Sarah Bleiberg Bellos, legal practitioner. to the PILP who worked on the report.

Bleiberg Bellos also collected testimonials from PILP clients about their drug treatment experiences for opioid addiction. while he was in prison, and was struck by the difficulty for some to have access to drugs, even in prisons that provided them. Some reported delays in getting their medication once they arrived in prison, which forced them to go into withdrawal anyway.

A man incarcerated in a “large urban county jail” said he was charged with taking someone else’s buprenorphine while waiting in line to receive the drug. Although he was searched and none were found on him, he was kicked out of the prison drug treatment. program.

Bleiberg Bellos added that several prisons were unable to provide or said they do not keep statistics on the race and gender of inmates receiving drug treatment in prison, making it more difficult to track racial disparities in prison. access to treatment at a time when people of color are dying from overdoses at a higher rate than their white peers.

People of color also have less access to health care, insurance and addiction drugs in general, Bleiberg Bellos said. And since many prisons only allow inmates to continue taking addiction medication, not start new treatment, “if they don’t already have it, they won’t get it when they get it.” will be incarcerated,” she said.

Tracy Pugh, senior director of Vital Strategies’ overdose prevention program, said the organization wants Pennsylvania prisons to provide buprenorphine and methadone to people who use drugs. But it’s also important, she says, to reduce arrests for drug possession in general.

“People who are usually unable to continue treatment, it is often because they have been arrested, incarcerated or brought to justice in some way,” she said. “We need to move away from a police response and towards a health and community response.”

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