Will jails let inmates access medically assisted treatment for drug addiction?

This story was published in partnership with New York Focus. 

In September 2020, Paul Fontana, 34, was doing better than he had in years. He had been released on parole for grand larceny that he committed in 2016. He was back in college and was living with his mother in Delhi, New York, a rural town of about 5,000 in New York’s Southern Tier region. 

Most importantly, he was successfully battling his addiction to heroin, having been prescribed Suboxone, a medication that allows people addicted to opioids to stop using without going through painful withdrawal. 

“I’d finally found the proper mixture of medication,” Fontana said in an interview. “It made me feel like a normal human being; allowed me to function like a normal human being. It stopped the depression, and the anxiety, and the uneasiness, and the temptation of just wanting to use.” 

Then he missed a meeting with his parole officer. The officer put out a warrant for his arrest, and Fontana turned himself in. At the hearing, the judge remanded Fontana to prison to serve the one to three years remaining in his sentence, and he was taken to Delaware County Jail to await his transfer to state prison. 

 Back in jail, Fontana’s access to Suboxone disappeared overnight. He entered into Suboxone withdrawal, the effects of which can be similar to heroin withdrawal.

 “You’re completely by yourself,” Fontana said, describing his experience. “You’ve got nothing and nobody there to talk to, nobody there to comfort you. They keep it very cold in that jail, and you’re not even allowed to be under your covers during the daytime, so you’re just literally like sitting there on your bed just shaking and sweating and puking, and having bowel problems. It’s really toture.”

 The extent of medical attention that Fontana received was periodic checks of his vital signs.  “They didn’t give me anything. They didn’t do anything,” Fontana said. “Their advice was if you’re not feeling well, drink lots of water. You’ll be okay if you drink lots of water.”

After about a week, Alexis Pleus, executive director of the opioid harm reduction advocacy organization Truth Pharm, was able to persuade Delaware County Sheriff Craig DuMond to provide Fontana with Suboxone, which Dumond said is now available to all incarcerated persons approved for such treatment by the jail’s physician. 

Fontana’s story is a common one in New York, where few prisons or jails offer medically assisted treatment (MAT) for opioid addiction, in which methadone or Suboxone, also known by its generic name buprenorphine, are prescribed. Both are legal prescription drugs, and both have been found to be effective at reducing fatal overdoses and fighting addiction.

New York City’s detention complex on Rikers Island has offered medically assisted treatment since 1987, and some upstate counties have started MAT programs in recent years. But as of 2019, only 18 of the state’s 62 counties provided Suboxone to jail populations, and only 15 counties provided methadone. MAT in prisons is even rarer – asked at a recent legislative hearing, the state prison department’s commissioner said that “about 7 or 8” of the state’s 52 prisons currently offer MAT.

Beyond causing painful withdrawal, the lack of access to MAT leaves incarcerated individuals at far higher risk of overdosing after release, public health experts say. The human body’s tolerance for opioids decreases when forced to be abstinent. An individual who resumes a drug habit after release at the level they were using before incarceration is therefore highly likely to overdose.

Outside of New York, few states currently offer medically assisted treatment to significant percentages of incarcerated persons. But more have been taking steps to do so in recent years. In 2016, Rhode Island became the first state to make the treatment available to all incarcerated persons. After the program was instituted, the state saw an over 60% reduction in overdose deaths among individuals recently released from incarceration, according to a study published in the Journal of American Medicine.

A bill introduced in 2017, cosponsored by state Sen. Jamaal Bailey, a Bronx Democrat, and Assembly Member Linda Rosenthal, a Democrat from Manhattan, would mandate that New York’s prisons and jails provide medically assisted treatment to incarcerated persons with drug addiction issues.

“While individuals are incarcerated, that might be the best time for them to be able to receive necessary treatment for their prior addictions,” Bailey said, adding that the lack of MAT in jails is a “gaping hole” in addiction treatment in New York.

“The level of MAT in prisons and jails is paltry and pitiful. To deprive people who are incarcerated of a proven tool is cruel. It leads to premature death, it leads to suffering, and it’s totally unnecessary,” Rosenthal said.

Erie County, home of Buffalo, has no MAT program in its jail. Keith Mleczko, 50, suffered forced withdrawal while incarcerated there in late 2019 after being remanded to the jail on a parole violation and losing access to Suboxone.

Upon reincarceration, Mleczko was placed in the jail’s detox unit. “They take your blood pressure like every half hour, and check your vitals, but they don’t really give you anything for withdrawal,” he said. 

Corrections staff “don’t really seem to care about it (withdrawal), is the vibe that you get,” Mleczko said. “Their big thing with the detox unit is they have this Gatorade, like on the football sidelines. ‘You gotta keep hydrated’—that’s the detox unit. And then they take it away at night. It was hell.”

Mleczko was able to buy contraband Suboxone that had been smuggled into the jail a few times, a practice that he said is common in Erie County Jail, but received no other medical treatment. The Erie County Sheriff’s office, which administers the jail, did not respond to multiple requests for comment.

 In 2019, Erie county legislators budgeted $1 million to create an MAT program in the county’s jails. But Sheriff Tim Howard declined to use the grant or to apply for state funds to create a program. "Offering government resources to continue with an addiction does not strike me as the best approach,” Howard said in 2019. “We've gone from drug prevention efforts to supplying drugs for the individual that has chosen to continue to live a life of drug addiction. And I just don't think that's justice.”

When Mleczko was released in April 2020, he was able to continue taking Suboxone. But others weren’t as lucky. “I heard some tough stories about that,” he said.

Recently incarcerated people are at the highest risk of any population of suffering fatal overdose, with an overdose mortality rate at least 40 times higher than that of the general population. A 2019 study found that overdoses were the leading cause of death among people released from incarceration.

Matthew Herring died of an overdose in August 2017, at the age of 24, in Wappingers Falls, Dutchess County, shortly after being released from jail. He had spent the past eight years fighting addiction, during which he was in and out of jail, according to his mother Patricia Herring. “He was never offered any MAT, no counseling, no therapy, nothing,” Herring said, despite going through forced withdrawal multiple times during different stints in jail. 

After her son’s death, Herring became an advocate for MAT in prisons and jails and was successful in pushing Dutchess County Jail to begin administering MAT in 2019, too late to save her own son, but not too late for others.

Rosenthal and Bailey’s bill would mandate the adoption of such programs in all incarceration facilities statewide and require that all incarcerated individuals be able to access MAT. The bill would also provide prisoners with a one-week supply of medication and a referral to MAT providers upon release.

The bill is not without opponents. The New York State Sheriff’s Association opposes the bill due to concerns over funding and the potential for medications used for MAT to become contraband goods in jails and prisons, Association counsel Alex Wilson said.

State Sen. Patrick Gallivan, a Republican representing a rural and suburban district stretching nearly from Buffalo to Rochester, said that he supports MAT access for incarcerated individuals but opposes the bill on grounds of cost. “At this time, with the economic problems brought on by the pandemic, it’s wrong for the state to impose this upon the counties,” he said.

Assembly Speaker Carl Heastie, Senate Majority Leader Andrea Stewart-Cousins, and Gov. Andrew Cuomo’s office did not respond to inquiries about whether the bill will be brought to a vote in this session.

In 2019, the bill passed the Senate but the session ended before it could be voted on in the Assembly. Supporters hope to see it passed this year, though some acknowledge that the state’s budget crunch will make it difficult.

“It will absolutely save lives,” said Jasmine Budnella, drug policy coordinator for VOCAL-NY, a grassroots lobbying organization that advocates for more lenient drug policy. “But it’s unclear where the bill will land this year given that we are in a fiscal crisis and this bill costs money.”

While no precise estimate exists, Rosenthal thinks the annual cost would be in the tens of millions of dollars. The cost of the status quo is higher, she said.

“There’s the measure of lives lost, and you can’t really put a price on that,” she said. “People in prison deserve healthcare, and this is healthcare.” 

Correction: Keith Mleczko's name was originally misspelled in this article. 

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