California is fighting fentanyl with a new tactic: addiction treatment in prisons (2023)

In the sweltering 100-degree heat of last afternoon at Valley State Prison in Central Valley, California, inmates gathered around small windows in the prison yard to take their daily dose of buprenorphine, an opioid addictive drug.

At the window, Quennie Uy, a nurse, scanned the prisoners' ID cards, then took strips of medication and slid them through a sliding panel under the window. One by one, the prisoners put the strips in their mouths and then flashed them with their hands - proof that they had not pocketed the drug to satisfy their cravings.

The daily ritual is part of a large-scale health experiment in California to reverse the often lasting harm of opioid use before, during and after incarceration. The state's efforts also reflect the beginnings of a potential shift in the nation's approach to addiction treatment in an often-overlooked section of American society.

"For the first time, there is a trend towards increasing access to treatment in prisons and prisons," said Dr. Justin Berk, an addiction medicine physician at Brown University and former medical director of the Rhode Island Department of Corrections. "There is a better understanding that if we are going to treat the opioid overdose crisis, one of the highly targeted populations for treatment is those in prisons and jails."

But addiction treatment is still only available sporadically in the country's prisons and prisons. By 2021, only about 630 out of about 5,000 correctional facilities in the U.S. dispensed opiate drugsThe Opiate Project in Prisons and Prisons, a group led by Dr. Berk, who investigates the treatment of prisoners.

The Biden administration is trying to change that, aiming to increase the number of detention centers and prisons offering treatment for opioid dependence and to introduce treatment programs in all federal prisons by this summer. There are representatives of both parties in Congresslook for a range extensiontreatment in the weeks preceding the detainee's release.

Lack of treatment for opioid addiction in correctional facilities, said Dr. Ruth Potee, medical director at the Franklin County Prison in western Massachusetts, "is like running a psychiatric hospital without treating mental illness."

Prolongation of treatment

In 2019, California prisons registered theirshighest overdose mortality rateand the highest overdose fatality rate in the nationwide prison system. In the same year, state legislators enacted amulti-year planGovernor Gavin Newsom, Democrat, for drug treatment in prisons.

Today, the state is one of the few in the country to have a comprehensive treatment program for the entire prison system, which has led tosignificant reductionin case of death from overdose. The program is expensive, with a budget of $283 million for the current fiscal year. But in January, California became the first state to receive approval from the Biden administrationuse Medicaid for correctional health care, allowing officers to use federal funds to pay for opioid treatment.

Prisoners have a constitutional right to health care. But standards of care can vary from state to state, said Regina LaBelle, who served as director of the Office of National Drug Control Policy under President Biden. Some prisoners can only receive treatment if they received it before the prison, while others move between prisons and jails without ongoing treatment. A short stay in prison often leads to withdrawal symptoms.

At Valley State Prison in Chowchilla, California, near the vast almond fields northwest of Fresno, inmates are screened for substance use upon entering the facility, allowing staff to prescribe buprenorphine to inmates at the start of their sentence.

Prison staff and inmates should "help them get to where they feel comfortable enough to at least listen to someone talk about their addiction," he said, leaning against a bathroom in a cell he shares with several inmates.

Current and former California inmates have said in interviews that visitors can sometimes smuggle opioids into state prisons. Some inmates said that smells such as vinegar or smells coming from machines could trigger memories or drug cravings.

At Valley State Prison, addiction treatment is combined with group behavior therapy. The same morning while Mr. Meza was doing push-ups, a group of inmates stood against the walls of a small classroom to practice apologizing, which included a scenario where an inmate had stolen some of someone's daily phone time.

Across the hall, textbooks strewn across tables, a sophomore was discussing the science of substance use, trying to understand the roots of addiction.

Some inmates say that without treatment, an inmate may become vulnerable to re-offending when released. "They go hand in hand - they're linked," says Trevillion Ward, an inmate who works in the prison canteen, explaining how drug use can increase the risk of incarceration. Mr Ward said he went back to drugs and returned to prison about three years after serving his first sentence.

"I didn't have the skills to go out and deal with the stress of life," he said. "As a result, as soon as things got serious and hectic, I went back to drugs."

Risks after discharge

People in prisons and prisons areParticularly vulnerableto fatal overdose soon after release when tolerance to strong opioids such as fentanyl may be impaired.

When inmates leave Valley State Prison and other California state prisons, they are offered naloxone, and people undergoing treatment for opioid dependence are also given a 30-day supply of buprenorphine. This continuity is necessary for treatment to be effective, said Dr. Shira Shavit, a physician at the University of California, San Francisco, and executive director of the Transitions Clinic Network, a group of clinics that provide health care to people released from prison or detention.

The transition to the outside world can be excruciating, and parole activities are sandwiched between work, moving to an apartment, securing benefits, and going to doctor's appointments.

Robert Banuelos, who was released from a California prison in June, said that when his supply of buprenorphine ran out 30 days after his release, an emergency clinic near San Diego was unable to confirm his insurance status. With the help of Sharon Fennix, who runs the Transitions Clinic Network hotline after nearly 40 years in prison, he confirmed he had Medicaid. Recently, Mr. Banuelos moved to Los Angeles and was fighting for a new prescription for buprenorphine, worried that any interruption in treatment could lead to a relapse.

"Loneliness is terrible," he said of his attempts to find friends and work. He added: "I feel like I can't move, even with daily buprenorphine tablets. I feel like my hands are tied behind my back."

This afternoon, Delilah Sunseri, a wedding waitress who spent some time in prison and now lives in her car, checked into a mobile health clinic in San Jose where health professionals were administering buprenorphine injections to patients who had previously been incarcerated. Mrs. Sunseri was there with her monthly dose of medicine.

Ms Sunseri said she chose to live in her car because she was concerned about living around other drug addicts, whether at a friend's house or in a temporary apartment.

"There are people who say, 'Oh, you did it to yourself. You know, you got yourself into this mess. You have to get out of it,” she said. "But it's a disease."

Just before arriving at the clinic, her daughter Blaise Sunseri received the same injection, determined not to go back to fentanyl. She said the younger Ms. Sunseri had spent some time in a string of California prisons. Both women required treatment to stabilize their drug use after release. Delilah Sunseri said addictive drugs were not available during her time in prison, where she said inmates overdosed in the yard and died.

He said that while in prison, he saw prisoners at risk of instant relapse. He said some people plan their drugs after they get out of prison, thinking they can avoid an overdose. The prisoners spent their time "thinking about it, fantasizing about it," Brady said.

Karen Souder, a former food truck owner, put her life back together after serving a prison term with the help of buprenorphine, which she continued to use after her release with the help of Dr. Shavit. The drug "really gets me through the day," said Ms. Souder, who now clears roads for the California Department of Transportation.

She was stable on buprenorphine and said she found joy in the freedom to bathe or put on makeup.

The day she was released this year, she went to lunch with a woman who helped run a gardening class she was taking in prison. At the Red Lobster where they ate, Mrs. Souder saw the flowers and plants outside the restaurant and marveled at their beauty. The sky was blue. They took pictures in front of the plantation. There were no fences around them, Ms Souder said. "We sat there for a minute," she added, "just taking a deep breath."