Prisons contend with spike in overdose deaths

Last week in northwestern Washington state, jail staff rushed seven inmates to the hospital after they apparently overdosed on fentanyl. Two weeks ago, five prisoners at the Maricopa County Jail in Arizona were hospitalized after overdosing. In the span of one week in March, 13 inmates in Milpitas, Calif., overdosed on fentanyl. So far this year, at least three jail inmates have died from fentanyl in Dayton, Ohio, and sheriff’s department staff are investigating what they call a “troubling” trend.

Nationally, about 353,000 inmates, or 1 in 5 incarcerated people, are behind bars for crimes related to addiction. Most inmates never get the opportunity to enroll in a rehabilitation program, much less receive the support they need to reintegrate into society without relapsing. Staffing shortages in correctional facilities and the synthetic opioid boom are exacerbating the problem, leaving more inmates than ever before vulnerable to overdose.

Drug overdoses are the third leading cause of death for inmates, and the numbers are climbing at a much faster rate than in the general population.

Between 1999 and 2019, drug overdoses in the United States shot up from about 16,800 to 70,600, according to the Centers for Disease Control and Prevention. In prisons, federal data indicates that drug and alcohol overdose deaths climbed more than 600 percent between 2001 and 2018. Deaths spiked 381 percent in local jails.

American prisons have become “drug dens,” said Michael Hallett, a criminology and criminal justice professor at the University of North Florida. Hallett attributes the problem to a perfect storm of understaffing, synthetic opioids, and few rehabilitation options.

According to Hallett, a top source of illicit drugs in prisons is prison workers, specifically underpaid staff in understaffed prisons. In 2020, Texas severely limited in-person visits due to COVID-19 concerns and restricted mail to curtail the flow of contraband. A joint investigation by The Texas Tribune and The Marshall Project found that drug use increased due to prison employees bringing in drugs. Hallett said inmates often coerce correctional staff in understaffed prisons to smuggle in drugs, noting it’s often “not only for side money but for their personal safety.”

“The Bureau of Prisons is suffering a staffing crisis of epic proportions,” union leader Shane Fausey told the U.S. Senate Judiciary Committee in September. “They have been pushed beyond the breaking point.”

The BOP authorized 43,369 positions in January 2016, but active employees had fallen to about 35,000 by September 2022. A record 3,000 employees retired in 2021, and Fausey said the department expected 3,000 more to retire by the end of last year.

Hallett studies rehab programs in prisons and jails across the country. In Florida, Hallett’s home state, Gov. Ron DeSantis activated 300 National Guard members in November to help staff guard towers and patrol prison perimeters, freeing up correctional officers to interact with inmates. Hallett said the move was “woefully inadequate.” He called for state prisons to receive federal oversight, he said, along with a dramatic increase in staff and trained addiction counselors.

Fewer staff members mean fewer drug rehab opportunities. “It’s not uncommon for volunteer, faith-based programs to be the only programs available,” Hallett said.

The lack of drug rehab programs in prison increases inmates’ need for treatment after incarceration. But newly released prisoners often find their criminal records limit their options for recovery support.

A 2018 study in North Carolina found that recently incarcerated people were almost 42 times more likely to die from an overdose than the general population. A similar 2017 study in Massachusetts indicated the risk to be 120 times higher.

“They’re just desperate for relief. They self-medicate with opiates and underestimate their change in tolerance,” said Eric Geisler, a board-certified addiction specialist and a member of the Christian Medical and Dental Associations. He recently retired as medical director for Serenity Lane, a residential rehab program with seven Oregon campuses. The program doesn’t take sex offenders or former inmates with a history of violent crime.

Geisler said inmates who haven’t been treated for their addiction are at a higher risk of overdosing since they don’t realize their drug tolerance dropped behind bars.

The Oregon legislature is considering a bill requiring state prisons to provide substance abuse treatment with medications such as naltrexone and buprenorphine. Geisler, who helped transition Serenity Lane from abstinence-only methods to medication-assisted treatment three years ago, said regular injections while an inmate is in prison and recently released could mean the difference between life and death. He pointed to Rhode Island, where state prisons utilize medication throughout their facilities and overdose deaths among the recently incarcerated fell by more than 60 percent, according to a 2018 study.

In Chesterfield County in central Virginia, when the 10th resident fatally overdosed in 2016, Sheriff Karl Leonard took matters into his own hands. Instead of releasing addicts only to watch them die or shuffle them right back into the county jail, he cleared a housing unit and started the Heroin Addiction Recovery Program. “In the beginning, everyone was nervous. It was different,” said Bailey Hilliard, the program manager. “It’s not something that people had done.”

Seven years later, more than 2,500 people have come through the program. The program’s name changed to Helping Addicts Recover Progressively. But the strategy of giving fellow offenders power to counsel their peers and hand out consequences hasn’t changed. Unlike many similar programs, HARP accepts gang members and some felons charged with violent crimes. Inmates still receive support once they leave jail.

Marlon Turner, 46, spent more than 18 years incarcerated for drug-related charges. Prison was a revolving door that did nothing to break the cycle of crime and substance use which could have easily ended in a fatal overdose. “Thank God I didn’t add to the statistic of the mortality rate,” he said. “But I still was walking dead.”

All that changed in July 2020 when he was booked into the Chesterfield County Jail where he joined Leonard’s program. He spent 17 months in HARP and, since his release, works with other inmates as a certified peer recovery specialist.

In addition to providing trauma-informed care and mental health treatment, HARP partners with faith-based groups. “I have more church volunteers than I know what to do with. It’s really beautiful,” said Hilliard.

Hallett said faith-based programs are key to treating inmates holistically. They “introduce people to the possibility of redemption while at the same time providing people with a sympathetic community that is willing to work with them,” he said. “Learning the possibility that forgiveness is available is the first step.”