Intriguing article from journalist Beth Schwartzapfel discusses federal prisons punish prisoners for using addiction medication. The article was published in partnership with The Marshall Project, who spoke to more than 20 people struggling with addictions in federal prison. They described the dire consequences of being unable to safely access a treatment that Congress has instructed prisons to provide.
Last year, the Bureau of Prisons disciplined more than 500 people for using Suboxone without a prescription. When prescribed, Suboxone typically comes as a strip of film that patients dissolve under the tongue. On the illegal market behind bars, a strip is cut into 16 or 32 pieces, each of which sells for $20.
Some prisoners have overdosed. Many have gotten involved in dangerous and illicit money-making schemes to pay for Suboxone. The medication costs about $20 for a small fraction of a daily dose on the illegal market, several prisoners said. Many have lost phone or visiting privileges or been sent to solitary confinement because they were caught taking the medication.
“Believe me, 100% I recognize the irony there,” said a bureau administrator familiar with the agency’s addiction treatment programs, who spoke on the condition of anonymity because they are not authorized to speak to the press. “It’s maddening.”
THE “FIRST STEP” ACT
Congress passed the First Step Act four years ago, requiring, among other things, that the Bureau of Prisons offer more prisoners addiction medications, the most common of which is Suboxone. The medications can quiet opioid cravings and reduce the risk of relapse and overdose.
Yet the federal prisons are treating only a fraction — less than 10% — of the roughly 15,000 prisoners who need it, according to the bureau’s estimates.
At the end of October, 21 prisons were not offering any prisoners addiction medication, and another 59 were treating 10 or fewer people — in many cases, just one person, according to bureau data obtained through a Freedom of Information Act request. The rest of the 121 facilities nationwide were each treating a few dozen people at most.
THE CHALLENGES OF PRESCRIBING MEDICATIONS TO PRISONERS
According to the article, the Bureau of Prisons (BOP) is treating increasingly more people since it launched its opioid medication program. In 2019, 41 people were receiving addiction medications. As of October, that had risen to 1,035 people; more than 80% of them are receiving Suboxone. This is good progress.
However, the BOP has fought in court to prevent people entering the system from staying on the addiction medications they were prescribed by doctors in the community. That began to change in 2018, when the First Step Act was passed and prisons and jails across the country began losing lawsuits from prisoners who argued it was cruel and unusual to deny them the addiction medicine they’d been taking before they were incarcerated.
Presently, prisoners need to overcome several administrative hurdles before they can begin medication. They must also obtain clearance from psychological services, then health services, before seeing a prescriber. This process naturally involves extended wait times. Some say the issues stem from a culture at the BOP that is skeptical of addiction medication and pits staff against prisoners.
Federal law treats use of any narcotics without a prescription in federal prison — including Suboxone — as a “greatest severity level prohibited act.” This infraction allows officials to punish prisoners by delaying their release date, confiscating their property. It also allows officials to withdraw visiting or phone privileges and hold prisoners for up to six months in solitary confinement. Experts say even a few days in solitary can exacerbate the mental illness that is often the cause of, or closely linked to, drug addiction.
According to the article, the lack of Suboxone treatment comes amid a rise in drug-related deaths behind bars. A variety of substances are routinely smuggled into prisons and jails through mail, drone drops, visitors or corrections officers and other staff. In the last two decades, federal data shows that fatal overdoses increased by more than 600% inside prisons and more than 200% inside jails.
Forty-seven incarcerated people died of overdoses in federal prison from 2019 through 2021, according to internal bureau data released via a public records request. The data does not specify how many of these overdose deaths were caused by opioids and could have been prevented by medications like Suboxone. However, other BOP data offers some clue: During the same period, correctional staff administered Narcan — a drug that reverses opioid overdoses — almost 600 times in federal prisons.
Prison is an awful experience. Serving a prison sentence while needing a prescription medication is even more challenging. Please contact my office if you, a friend or family member are charged with a crime. Hiring an effective and competent defense attorney is the first and best step toward justice.