As Overdose Deaths Mount in New York Prisons, Treatment Program Crawls

While overdose deaths in New York reach new records each year, the state prison agency does not track them within its custody. Instead, prison staff record fatal overdoses under causes of death like “accident,” “natural,” or “unknown.”

New York Focus was able to quantify overdose deaths in the state’s prisons over time, using documents obtained from the State Commission of Correction and the attorney general’s office. In the year before Rodkey’s death, 18 people died of overdoses in New York state prisons. Over five years, while the prison population declined by half, the incarcerated overdose death rate nearly tripled.

As deaths have climbed, medical neglect in prisons has remained rampant, and a law that seeks to provide drug treatment in prisons has struggled to get off the ground.

“There is a crisis in regards to the accessibility of healthcare in the state’s prisons right now,” said Sumeet Sharma, policy director at the Correctional Association of New York. That crisis is making it difficult to get addiction care to everyone who needs it.

Though the prison system doesn’t log overdose deaths, it does keep track of how many people receive medication assisted treatment, or MAT, like Suboxone. The Department of Corrections and Community Supervision told New York Focus that 3,216 people in the prison system were on MAT as of late July — about 10 percent of all people it incarcerates. According to the federal Substance Abuse and Mental Health Services Administration, it’s estimated that 17 percent of state prisoners nationally have opioid use disorder.

DOCCS’s numbers also suggest an acute racial disparity: As of November, the department reported nearly half of state prisoners as African American. But Black people made up just 10 percent of MAT recipients in July 2023.

Inadequacies in prison healthcare aren’t limited to opioid use disorder. In a 2019 Correctional Association survey of the state’s prisons, 73 percent of incarcerated people said they were unable to see a medical professional when they needed to in the last year. Prison officials struggle to fill healthcare jobs, with over a third of the department’s physician and nurse positions currently vacant.

“It just didn’t seem like people were getting seen enough,” said Leslie Strickland, a doctor and former medical director at Upstate and Riverview correctional facilities. “It was not adequate care at all.”

Handling medical care within DOCCS isn’t the only option: The department outsources treatment for some life-threatening conditions — HIV and Hepatitis C — to the state Department of Health. The DOH runs support sessions with patients and oversees prison policies on treatment for both conditions, which lawmakers have argued leads to better care outcomes than treating them in the prison system alone.

A DOCCS spokesperson told New York Focus that “the Department is committed to providing medical care to the community standard for those in its custody.”

But federal regulation can make MAT difficult to provide in prison. Methadone, the most restricted, has noticeable side effects and can cause an overdose if someone takes too much, so federal law requires extensive training to administer it. Buprenorphine-based medications, like the Suboxone Rodkey was on, have fewer side effects and will make patients severely ill if they use other opioids. When Rodkey died, federal law required that doctors obtain a special certification to prescribe buprenorphine, something most DOCCS doctors did not have before the state law was passed. Newly certified doctors could only prescribe the drug to 30 patients at a time. In December 2022, those requirements were lifted.

When New York’s law went into effect, DOCCS contracted with opioid treatment providers to supply medication to every prison in the state. With more than 3,200 incarcerated people receiving treatment as of late July, according to the department, just 358 are on methadone.

“That’s a big step forward,” said Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates, an organization of clinics that provide addiction medication. “It’s an enormously beneficial change.”

For people who enter prison with an MAT prescription, the department is now able to continue their treatment. But for prisoners seeking addiction care for the first time, entering the program is proving difficult, according to Sharma, the Correctional Association policy director.

At Green Haven Correctional Facility, Sharma said, people needing treatment knew about the program but faced a long waitlist to see a doctor and get assessed. He encountered a similar situation at Marcy Correctional Facility: While staff said they expect the program to grow from its current size of 25 people to over 200, incarcerated people requesting to participate in the program said they had yet to be seen by a doctor.

“People we spoke to at Marcy expressed frustration at being unable to access the medication” they would get from the MAT program, said Sharma. “They’re hoping to be eligible for the program and be on a track to prevent substance use in the future.”

In some cases, the prison agency brings in outside help. The health department has been running support and education sessions for incarcerated HIV and Hepatitis C patients since the 1990s. Those sessions, Sharma said, have helped educate people on the importance of treatment while getting around some of the mistrust that characterizes prison healthcare.

In 2009, the state legislature gave the health department authority over DOCCS policies on those diseases. Lawmakers attribute high HIV and Hep C treatment rates behind bars to that oversight — even as other medical issues go unaddressed. So does the Correctional Association. It has for years pushed the state to tap the health department to oversee all healthcare in prisons and jails. It is currently backing a state Senate bill that would establish that authority.

Strickland said lack of trust was a barrier to quality care in the prisons she staffed.

Among some of her incarcerated patients, “the thinking was, ‘You’re not here to help me. You don’t care, so why should I tell you anything?’” The fear was often well founded, she said: Some of her coworkers seemed to believe that incarcerated people did not deserve care.

“They would say, ‘Well, they’re here for a reason,’” she said. “It was a battle every single day advocating for patients.”

According to Rosenthal, that attitude went to the highest levels of the department.

She said Governor Kathy Hochul’s office proposed a DOCCS-backed change that would allow the department to discipline MAT patients if they tested positive for any drugs outside of the three used for the program.