California jails grapple with tragedy

California jails face crisis as overdoses skyrocket to alarming levels. Fentanyl flooding the system mainly to blame for the spike in deadly ODs. Early state numbers show at least 59 fatal overdoses last year - more than the prior two years put together.

Experts view the dramatic change as a setback following initial progress in enhancing addiction treatment and availability of the overdose rescue medication naloxone. Merely two years ago, a groundbreaking California initiative aimed at reducing overdoses in prisons received recognition nationwide as a blueprint for improvement. The rapid increase of fentanyl, a highly strong synthetic opioid, has surpassed numerous preventative initiatives.

With the total 2022 death tally likely even higher, overdoses probably killed the equivalent of a staggering 62 prisoners per 100,000 last year based on the current population. That surpasses the previous record set in 2019, giving California the nation's highest drug overdose death rate in state prisons at the time.

Attorney Don Specter asserted with confidence that the rise in drug use can be attributed mainly to the presence of fentanyl in the underground drug trade within jails.

In early 2020, California began offering medications like methadone and buprenorphine to help ease opioid withdrawal symptoms and decrease cravings for many jailed inmates dealing with addiction. Nevertheless, the campaign has struggled to match the swift rise of fentanyl in circulation, whether on the streets or in penal facilities. 

 Specter is confident that without these therapies, a significant number of convicts would have perished last year. He also advocates for greater expansion of these treatments.

Corrections officials declined requests to provide the total overdose death number for 2022, saying the data is still being verified ahead of an upcoming report. But Specter and other prisoner advocates said hospitalizations have also shot up sharply, according to internal state records they review.

Ike Dodson, a representative for California Correctional Health Care Services, highlighted a concerning rise in overdose deaths nationwide, mainly attributed to synthetic opioids, particularly fentanyl.

Dodson stated that officials are persistently assessing substance use disorder therapy to enhance the safety of individuals residing or working in a state correctional facility. But prisoner advocates argue the state must do much more to stop the flow of drugs and get inmates help.

"They need to move faster," said Dr. Brie Williams, a correctional health expert at the University of California, San Francisco, who previously helped spotlight California's early progress in a report last year.

Walter Jackson, aged 47, started heroin use during his adolescent years. He had overdosed four times by the end of last year following his release from the California Medical Facility prison in Vacaville.

The state had put Jackson on methadone treatment behind bars right before he got out in 2020. But he says no one coordinated additional care in the community. Within months, he relapsed.

"I managed to survive miraculously," Jackson noted.

Studies indicate that California's medication-assisted treatment program effectively reduces overdoses and rates of infectious diseases among participants. But it still only reaches a fraction of inmates who need it. Critics say treatment dollars have not kept pace with security expenditures even as drugs permeate prisons.

Officials attribute delays in expanding opioid agonist medications like methadone and buprenorphine to bureaucratic holdups and the nationwide shortage of prescribers. But other prison systems are making quicker progress. Rhode Island recently became the first state to offer all three FDA-approved opioid addiction medications in all of its jails and prisons.  

California corrections officials note they now carry more naloxone to reverse overdoses than most prison systems. But last fall, federal receiver J. Clark Kelso said he was weighing whether to use his oversight powers to obtain additional supplies for officers.  

"That's a good start," said attorney Steve Fama, who monitors prison substance use treatment, "but all officers should carry the medication, which should be administered as quickly as possible to be most effective."

State Senator Laura Murguia, who chairs the Committee on Public Safety, said California's prisons suffer from "critical deficiencies" in both drug treatment and interdiction. She intends to hold hearings this spring exploring a range of responses to the escalating crisis.

"We cannot continue to throw money at a problem plaguing both our streets and prisons without addressing the root causes," Murguia said. "Addiction," she emphasized, "is primarily a matter of public health, rather than criminal justice."

The recent rise in California prison overdose deaths is especially disheartening, given earlier successes. In 2020, inmate fatalities fell by over half, from 64 down to 23, as California rolled out its sweeping medication-assisted treatment program to curb substance use disorders.

But overdose deaths soon began creeping up again - a rebound experts blame squarely on the spread of fentanyl. Pressed by advocates, the state finally began offering naloxone for emergency use to more prisoners while making it more widely available to staff in housing units.  

Synthetic opioids like fentanyl - now frequently mixed with other street drugs - have driven an explosion in overdoses across the U.S. The drug's potency makes it especially dangerous for those who relapse after leaving treatment programs, experts say.  

Research shows that formerly incarcerated people face a vastly higher risk of overdosing in their first days and weeks after release. However, California's current relapse and post-release death rates remain unknown due to a lack of systemic tracking. Advocates say the data gap poses an unacceptable barrier to improving outcomes and accountability.

Last year's setback in prison overdose deaths is stirring urgent calls for California's corrections system to hire more substance use counselors, expand medically proven treatment, and adopt novel prevention strategies promoted by researchers.  

"There's a long way to go," said Dr. Steffanie Strathdee, a leading addiction expert at the University of California, San Diego. Strathdee wants California to consider establishing supervised injection sites and distributing test strips to identify deadly fentanyl contamination.

"Saving lives should trump moralistic attitudes about people who use drugs," she argued. "The status quo is clearly not working."

With overdose deaths again shattering records behind bars, experts hope the latest crisis spurs California prisons to rigorously expand addiction medications to far more inmates - and ensure adequate aftercare following release. Until then, the state's early leadership in the field remains constrained by funding challenges, bureaucratic inertia, and the ever-adaptable illegal drug trade.  

For Walter Jackson, every day now involves a continuing battle to maintain his recovery since leaving prison.

"It's an ongoing struggle," Jackson said. "But I'm just trying to take it one breath at a time."