Statistics show, and experts agree, that the United States is in the midst of an epidemic of opioid abuse. According to the Centers for Disease Control, opioid overdoses have quadrupled since 2000, with 28,648 deaths in 2014 alone attributed to heroin and prescription painkillers.
The numbers are particularly bad for former prisoners. Research in Washington State indicates that prisoners are 13 times more likely to die of an overdose in the first two weeks following their release from custody than non-former prisoners. Other studies have resulted in similar findings – that prisoners are at increased risk of dying, particularly within the first two weeks after their release, due to drug overdoses.
This may be due in part because prisoners have lost their built-up tolerance for drugs while incarcerated, and thus risk overdosing if they relapse and try to use the same amount they were using before. Additionally, released prisoners may not be aware that the potency of the drugs they were using previously has increased; for example, heroin may be cut with fentanyl, a much stronger synthetic opiate. Fentanyl has been responsible for an increasing number of overdose deaths – 62 in Los Angeles County alone in 2014.
Enter a medication called Naloxone, also known by its brand name, Narcan. Naloxone is a life-saving overdose treatment that has become a key weapon in the war on opioid abuse. Police, emergency medical technicians and hospitals have stocked Naloxone for years, and countless lives have been saved by its timely use to treat overdoses involving heroin, morphine, Oxycontin and other opioids.
More recently, state and local officials are slowly coming around to the benefits of equipping soon-to-be released prisoners with this lifesaving medication. From city and county jails in Denver, San Francisco and Seattle to state prison systems in New York and Rhode Island, prisoners are being provided with Naloxone kits and trained in their use.
The efficacy of these programs is hard to measure, but one study of Rhode Island prisoners who received Naloxone found they were able to successfully use the overdose treatment after being released. But does providing Naloxone to addicts aid in their recovery?
“I wouldn’t predict that it would stop people from using, and conversely it wouldn’t encourage them to use,” said Dr. Jody Rich, an epidemiologist and director of the Center for Prison Health and Human Rights.
Those with an investment in the carceral industry who profit from the scourge of drug use and opioid addiction have pushed back on these life-saving programs, however. Drug courts and jail officials often refuse to provide medication-assisted substance abuse treatment, typically methadone or buprenorphine, to addicted prisoners. Naloxone is often prohibited as well.
Take Maine Governor Paul LePage, for example, who has opposed efforts to make Naloxone more accessible, saying that providing the medication to family members of drug users would discourage addicts from seeking treatment. In April 2016, LePage vetoed legislation (LD 1547) to allow pharmacists to provide Naloxone to friends and family members of drug users without a prescription – as is the practice in around 30 other states.
“Naloxone does not truly save lives; it merely extends them until the next overdose,” the governor declared.
Dr. Joshua Blum, a doctor at the Denver Health Medical Center, disagreed. While he acknowledged that Naloxone is not a cure, he cited the seemingly common sense benefit of making Naloxone more widely available: surviving an overdose gives drug users a chance to seek treatment.
“Dead addicts don’t recover,” Dr. Blum stated, bluntly.
On April 29, 2016, the Maine legislature overrode Governor LePage’s veto, allowing pharmacists to dispense Naloxone to more people without a prescription.
Randy Tucker, director of the STARR Program in Durham, North Carolina, highlighted the important opportunity that Naloxone provides to jail and prison administrators.
“If we don’t pay for treatment or medication through the front end,” he said, “we end up paying even more through the back end in terms of emergency room costs, crime and recidivism.”
In April 2015, the STARR Program at the Durham County Detention Facility was the first jail-based substance abuse treatment program to provide Naloxone kits to released prisoners.
“People coming out of jail [and prison] are at the highest risk of death,” Tucker noted. “This effort is about connecting them to the right tools and the right training to prevent some of those deaths.”
New York state prisoners nearing release are increasingly being introduced to Naloxone, trained in its use and provided with overdose treatment kits.
“The first weeks and months after somebody is released from jails or prisons they have an extremely high chance of dying of overdoses,” said Dr. Sharon Stancliff, medical director of the Harm Reduction Coalition, a New York City-based organization that works on issues related to substance abuse. “They’re going back to communities where drug use is widespread, so it’s both about making sure that they stay alive in those really vulnerable times, but also giving them tools to save lives in their own community, and I think that’s a very positive message for people who are leaving prison.”
According to an April 12, 2015 position statement, the National Commission on Correctional Health Care “supports increased access to and use of naloxone in correctional facilities.”
Sources: Associated Press, www.nchrc.org, www.prisonerhealth.org, www.wnyc.org, http://towardtheheart.com, www.pressherald.com
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