Weekly Update: April 2, 2024
Lessons from the War on Drugs We Have Not Learned


Highlighted Stories

Editor's Note
Today's highlighted stories talk about how we are losing the ongoing war on drugs, which we have obviously already lost. In the Washington Post’s article, a judge, in agreement with the Department of Justice, disallowed an organization in Philadelphia from running a safe injection site. In the Politico article, an administrator from the Drug Enforcement Agency, Thomas Prevoznik, reported during the Rx and Illicit Drug Summit in Atlanta that relaxation of rules concerning the prescribing of MOUDs had not dramatically increased the prescribing of these medications. This surprising result was attributed to the fact that doctors and pharmacists don't want 'them' (meaning people wanting to treat their addiction) in their waiting rooms. The next story from the New York Times is about the recriminalization of drug use in Oregon. The mayor of Portland believes one of the reasons for the failure of Measure 110, the decriminalization measure passed in 2020, was in part due to the fact that the state had not set up an adequate number of treatment centers before decriminalization went into effect. However, the following article, an editorial from the Washington Post, takes a much more skeptical view of the decriminalization experiment in Oregon and believes not only a carrot (treatment) but also a stick (criminalization) is still needed. And finally in Connecticut, the Yale School of Medicine, is recommending that some of the money the state received from the legal settlements against opioid drug manufacturers should be used in the transitioning of incarcerated individuals out of custody to ensure that these people have full access to MOUD.

What all of these stories have in common, is our inability to frame how we can recover from having lost the war on drugs and what the next steps might be to truthfully address the extent to which opiate use disorder has permeated our society and our correctional system. The past several editors' notes have been discussing the challenges of incorporating MOUD to treat opiate use disorder behind the wall and the implicit stigmatization ('them') that comes with opiate use disorder. Until we, as a society, are ready to recognize that behavioral health disorders are not questions of character failures, but rather questions of brain chemistry which as the Washington Post Editorial suggests can create significant challenges to meaningful access to treatment, we will neither be able to truly address the price we have paid for the war on drugs, both in the community and behind the wall.

On another note, below you will find a registration for COCHS’ Dan Mistak’s webinar on behalf of the National Center For Medical Legal Partnership. Dan will be discussing effective strategies to address the unique health and social needs of individuals involved in the criminal justice system. Also, if you missed it, last week, COCHS released Dan’s Dear Colleague letter entitled, New SAMHSA Rule and State Regulations: Expanding Access to Methadone in Corrections Amidst Threat of ADA Enforcement .

War On Drugs
Washington Post: Philadelphia nonprofit loses latest bid to open supervised drug-use center
A Philadelphia health organization does not have the right to operate a facility where people can consume illicit drugs under the supervision of staffers trained to prevent overdoses, a federal judge ruled. The decision marks a victory for the Justice Department, which argued that such facilities violate federal law, and for critics who say the centers enable users, increase crime and attract drug dealers. It deals a blow to advocates of overdose prevention centers who believe they are crucial spaces that save lives as the nation grapples with an increasingly deadly illicit drug supply and an unprecedented number of overdose deaths.

Politico: Docs don’t want to treat ‘them’
Turns out that lifting restrictions on doctors prescribing buprenorphine, a controlled drug used to treat opioid use disorder, is only the first step to expanding access to addiction treatment. Speaking the Rx and Illicit Drug Summit in Atlanta, Georgia, Prevoznik said the total volume of buprenorphine prescriptions dispensed since the law entered into force has remained around 1.4 million and hasn’t spiked up as expected, Carmen reports. “The biggest thing I heard and continue to hear from prescribers and pharmacists … is they continue to call those who suffer from opioid use disorder ‘them,’ like they don’t want ‘them,’ they don’t want to treat ‘them’ in their practice,” Prevoznik said.

New York Times: Oregon Is Recriminalizing Drugs. Here’s What Portland Learned.
When Oregon embarked on a landmark plan three years ago to decriminalize hard drugs (Measure 110), it wagered that a focus on treatment over punishment would create a new model for drug policy around the country. But after a deluge of overdose deaths and frequent chaos in the streets of Portland, Gov. Tina Kotek signed into law on Monday a measure to restore criminal penalties for drug possession. Portland Mayor Ted Wheeler says: "To decriminalize the use of drugs before you actually had the treatment services in place was obviously a huge mistake. The state would build up its behavioral health services, and when it reached a certain threshold, then they would decriminalize. It shouldn’t have gone the other way around."

Washington Post: Recriminalizing drugs, Oregon offers a cautionary tale
Oregon Gov. Tina Kotek (D) signed legislation this month to end her state’s disastrous experiment with decriminalizing hard drugs, rolling back a 2020 ballot initiative she previously supported. Oregon’s experience shows that compassion is important for addicts, but so are consequences. Responding to the social ills of drug abuse requires a mix of carrots and sticks. The Centers for Disease Control and Prevention reports that the number of annual overdoses in Oregon rose 61 percent in the two years after decriminalization took effect, compared with 13 percent nationwide. Unintentional opioid overdose deaths in Oregon spiked from 280 in 2019 to 956 in 2022, according to the state health authority.

WSHU: Could CT opioid settlement funds combat addiction in, after prison?
Nearly three-quarters of people behind bars in the state have a substance use disorder requiring some level of treatment, according to a report from the Connecticut Sentencing Commission, compared to only 17% of the national population overall. For most of the last decade, formerly incarcerated people have accounted for roughly half of the annual overdose deaths in Connecticut. Now, millions of dollars from several large legal settlements are beginning to flow into the state to help combat the deadly opioid epidemic. Experts from Yale University’s Schools of Medicine and Public Health recommended that officials use part of the funding to ensure that people in and transitioning out of the Department of Correction’s custody have access to all three FDA-approved medications for opioid use disorder — methadone, buprenorphine and naltrexone.

National Center For Medical Legal Partnership: Advancing Health Equity for Patients Impacted by the Criminal Justice System (April 30, 11 AM Pacific Time)
Join COCHS' Dan Mistak will discuss opportunities and effective strategies for utilizing Medical-Legal Partnership (MLP) to address the unique health and social needs of individuals involved in the criminal justice system.

Hepatitis C

Los Angeles Times: A deadly but curable disease is thriving in L.A.’s jails. That’s unacceptable
During my five years as a doctor in Los Angeles County’s jail system, I personally saw hundreds of patients with hepatitis C who were not being treated for the potentially deadly but curable disease. While hepatitis C treatment improved incrementally during my tenure, the system continues to fall woefully short of the sort of concerted effort that could dramatically reduce the toll of the infection within and beyond the jails. One might expect medical providers in jail to test for the disease broadly and treat it promptly. Monitoring and managing contagion is important in any correctional medical system, and it’s routine in ours for other diseases, such as tuberculosis and COVID-19. Unfortunately, this wasn’t what I encountered in practice. All those taken into custody at the jail undergo a medical screening. But it’s usually cursory and doesn’t include an offer to screen for hepatitis C.

AOL: Hepatitis C Treatment Ruling Adds to State Prison Health Tab
Florida may have to pay millions of dollars more in treatment costs for inmates infected with hepatitis C, following a federal judge’s ruling that said prison officials have been “deliberately indifferent” in caring for thousands of inmates infected with the virus. While the state was already mandated by the court to treat inmates with hepatitis C, the ruling by U.S. District Judge Mark Walker expanded the number of inmates who will receive care because it includes those who are at the early stages of the disease.

State & Territories Roundup

Alabama Political Reporter: Results of STD testing reveal new cases of Syphilis and HIV at ADOC facility
the results of a recent STD screening at an Alabama Department of Correction Facility (ADOC) revealed there were 62 new cases of syphilis and 10 cases HIV at the prison. The results are from a test of 1,227 incarcerated individuals at Staton Correctional Facility. The screening was conducted by the Alabama Department of Public Health at the request of ADOC at the end of February.

WGLT: Illinois prisons among worst in U.S. for mental health care
Mental health services in Illinois prisons are among the worst in the country, creating “abysmal and harmful” conditions for staff and inmates, with Pontiac Correctional Center fostering a “disgusting and neglected environment,” according to a consultant’s report on mental health care in Illinois facilities. In a separate report, Black inmates at Pontiac are five times more likely to be involved in use-of- force incidents with staff than other inmates. A total of 331 use-of-force interventions were reviewed at Pontiac and 324 at Menard in southern Illinois.

Maryland Matters: House committee advances correctional ombudsman bill
A House committee voted Monday to advance a correctional ombudsman bill, which some legislators and criminal justice reform advocates have pushed for at least three years. The ombudsman’s office would conduct independent reviews and assessments of various programs administered by the state Department of Public Safety and Correctional Services such as health and mental health services and educational and vocational programs, and resolve conflicts with a person incarcerated, an employee, or a contractor with the agency. The ombudsman’s office would also be allowed to interview correctional personnel, or a person incarcerated, and make unannounced visits and on-site inspections of facilities.

DL-Online: Jails desperately need help with inmates with acute mental illness
When the Minnesota Department of Corrections essentially shut down the Otter Tail County Jail recently, inmates were temporarily distributed to jails in Becker, Clay and Douglas counties. It's unclear when the inmates will return to the Otter Tail County Jail. The DOC gave the jail until mid-April to submit a correction plan. For now, the jail is not allowed to keep inmates longer than three days. Like other jails across the state, Otter Tail has been hit with an influx of inmates with serious mental illness, and the Becker County Jail is coping with the same problem, he said. (see last week's Editor's Note)

Medpage Today: Condemned Inmate Could Face 'Surgery Without Anesthesia,' Lawyers Say
Missouri's execution protocol allows for "surgery without anesthesia" if the typical process of finding a suitable vein to inject the lethal drug doesn't work, lawyers for a death row inmate said in an appeal aimed at sparing his life. A federal court appeal focuses on how Missouri injects the fatal dose of pentobarbital. The written protocol calls for insertion of primary and secondary intravenous lines. But it offers no guidance on how far the execution team can go to find a suitable vein, leaving open the possibility of an invasive "cutdown procedure."

New Jersey
Guardian: ‘He was a human being’: US prisoners are dying from treatable conditions
Jennifer Jasper-Thompson was shocked when she received a call from the New Jersey department of corrections (DOC). Her nephew Damien Jasper, who had been incarcerated at Northern state prison in Newark, was dead at just 32. His autopsy indicated that he had died from testicular cancer, considered one of the most treatable forms of cancer, even when caught in an advanced stage, with an overall five-year survival rate of 95%, according to the American Cancer Society. Despite having a visible tumor and complaining for many months about severe pain, Jasper never received a cancer diagnosis or any treatment.

New York
Washington Post: 6 inmates who sued New York over its prison lockdown order will get to view solar eclipse after all
Six inmates who sued New York’s corrections department over its decision to lock down prisons during the total solar eclipse will get to watch the celestial event after all. Lawyers for the six men incarcerated at the Woodbourne Correctional Facility in upstate New York said Thursday that they’ve reached a settlement with the state that will allow the men to view the solar eclipse “in accordance with their sincerely held religious beliefs.”

North Carolina
Spectrum News: North Carolina's formerly in­car­cerated at higher risk of suicide
A study published in the American Journal of Epidemiology found that North Carolina’s formerly incarcerated are twice as likely to die of suicide than those who never spent time behind bars. The Journal of Epidemiology found that the biggest risk of suicide comes in the two-week period after release. Freedom Fighting Missionaries provides housing and mental health resources.

NC Newsline: Experts: Lack of mental health services is spurring a ‘capacity crisis’ in NC jails
Across North Carolina, more than 200 people with serious mental illnesses are waiting in jail for a bed in a state psychiatric hospital before their criminal cases can proceed. “Many people do sit months and months, over a year, not getting the treatment that they need,” said Dr. Robert Cochrane, the statewide director of the Forensic Services Division of State-Operated Healthcare Facilities at the Department of Health and Human Services. “And the jails… just don’t have the resources. You know, they’re not hospitals, they’re not clinics.”

NC Health News: Prison reentry services. More crisis care beds. Better pay for health care workers. Where $835 million in new mental health money is being spent.
The first few years of the Formerly Incarcerated Transitions (FIT) Wellness program were limited to helping people in Wake County with mental illness who had recently been released from state prison. Now, due to new funding from last year’s state budget, FIT Wellness is poised to expand into Durham, Orange and New Hanover counties. The expansion was announced in January by Gov. Roy Cooper as part of a “whole-of-government approach” to help people re-enter society from the carceral system. The goal is to reduce overall state costs by reducing recidivism and connecting these folks to mental health care and other basic services.

NC Newsline: Prison job vacancy rates still high as prison population exceeds projections
About 39% of correctional officers jobs in North Carolina prisons are vacant, but officials are optimistic because the agency is hiring more people faster than employees are quitting. About 4,500 employees left the prison system in 2021, a turnover rate of 22%. That number includes retirees, those who left the state for personal reasons, and those who just hated the job and resigned. In 2023, about 2,070 left, a turnover rate just shy of 15%, a significant decrease from two years prior.

OPB: Analysis shows Klickitat County Jail owes considerable debt to local hospital
As Klickitat County officials discuss closing their local jail, talks have focused on making sure inmates are healthy and safe – concerns driven by a couple high-profile incidents. But a recent analysis shows the county may have financial interests in closing the facility, too. According to county staff, the jail has a growing stack of invoices from Klickitat Valley Health, the local hospital that treats inmates when they need medical attention.

Virgin Islands
Virgin Islands Daily News: Prison staffing shortages hindering mental health treatment, report says
Mental health treatment at the St. Croix prison has been lacking amid an ongoing staff shortage, and knives and other contraband are still being found inside the facility, according to the latest report by a team of court-appointed monitors. The John Bell Adult Correctional Facility, formerly known as Golden Grove prison, is under a federal consent decree that came about after the U.S. Justice Department began investigating the poor conditions of the prison in 1985. The territory will not be released from federal monitoring until officials can prove compliance with the requirements in the consent decree, and inmates are being held in constitutional conditions of confinement.

Rikers Island

New York Times: New York City Set to Pay a Record $28 Million to Settle Rikers Island Suit
New York City has agreed to pay more than $28 million to settle a lawsuit filed by the family of Nicholas Feliciano, who suffered severe brain damage after he attempted to hang himself in a Rikers Island jail cell as more than half a dozen correction officers stood by. If approved by a judge, it will be among the largest pretrial settlements ever to be awarded to a single plaintiff in a civil rights case in New York City. When he tried to hang himself, guards watched as he flailed his arms but did not intervene even after he became limp

Provider Experience

KevinMD: Unlocking compassion: lessons from a prison clinic
A physician who had experience in treating patients at Louisiana State Penitentiary, Angola was initially intimidated by incarcerated people but found common ground through vulnerability and empathy during medical interactions. These interactions underscored for the provider the profound human connection these encounters fostered.

Prison Contractors

Yahoo: Prison-Phone Firm ViaPath in Talks to Refinance $1.4 Billion of Debt
ViaPath Technologies, a company that provides phone services to prisoners, hired Texas Capital Bank to help it refinance about $1.4 billion of debt, according to people with knowledge of the matter. The American Securities-backed business has been exploring several avenues to handle debt maturing in 2025. Some new lenders have been hesitant to offer money as the regulatory risk and perceived social impact of investing in businesses that profit off prisoners and their families has been called into question. ViaPath’s competitor, Aventiv Technologies, which is owned by Tom Gores’ Platinum Equity, also struggled to refinance its debt, forcing it to reach a tentative deal with lenders that calls for the company to sell itself next year. “ViaPath is committed to breaking the cycle of incarceration through transformative technology and services,” the company said in an emailed statement.

MPR: Lawsuits allege jail phone-call kickback schemes in Genesee, St. Clair counties
Genesee and St. Clair counties have been accused in separate lawsuits of ending family visitation to jails as a part of a “quid pro quo kickback scheme” with a pair of companies that specialize in inmate prison communications. ViaPath Technologies and Securus Technologies are accused of profiting off of exclusive deals with the counties, which the plaintiffs say receive kickback money. The companies are accused of conspiring to deprive families of in-person visits.

Correctional Health Care Vendors

Santa Barbara Independent: Deficits and Benefits of Mental-Health Care in Santa Barbara County Jails
The Sheriff’s Office has also implemented mandatory Crisis Intervention Training for all custody deputies, where they learn about de-escalation tactics without the use of force, suicide prevention, and behavioral illnesses. More than 40 deputies have taken part in the 40-hour course since 2021. Advocates from the Clergy and Laity United for Economic Justice (CLUE), identified by the sea of red scarves, were loud in their calls for more mental-health and drug-focused treatment options and overall contract compliance from Wellpath.

KTVU: Longshoreman with schizophrenia sues Santa Rita Jail after attempted suicide
A man who suffers from schizophrenia is suing Santa Rita Jail saying that he wouldn't have tried to die by suicide if he had received the proper medication. Julian Martinez, a former longshoreman and father of three who also suffers from bipolar disorder and addiction, filed a federal suit against Alameda County, Wellpath – the company that provides medical care at the jail – and the city of Fremont, as officers are accused of not properly notifying the jail of his condition. This case illuminates "yet another failure of defendants Alameda County and Wellpath to provide anything resembling adequate medical care to detainees at Santa Rita Jail," Clarke and colleagues Patrick Buelna and Adante Pointer wrote in their March 29 suit filed in U.S. District Court.

Charlotte Observer: Mecklenburg County jail will get new health care provider after contract ends early
People jailed at the Mecklenburg County Detention Center will get their health care from a new company next month. Kansas-based VitalCore Health Strategies will care for people starting May 19, the sheriff’s office said in a news release Monday. The jail’s current medical provider, Wellpath, recently terminated a $10.66 million contract to work in the jail. VitalCore is being sued in federal court by the Delaware ACLU. A court complaint alleges that staff have provided poor medical care in the state’s prisons since July, when they took over there. The Charlotte Observer reported how Wellpath has a history of being sued by families of people who died or were hurt in North Carolina facilities. Wellpath often ends those lawsuits by settling them