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

The prison department doesn’t track overdose deaths in its custody. A New York Focus analysis found that the overdose death rate has tripled.

Jake Neenan   ·   November 9, 2023
DOCCS records point to an acute racial disparity in its MAT program. They don't reflect overdose deaths at all. | Illustration: Maia Hibbett

Before he went to prison, Tyler Rodkey had a heroin addiction, the result of his years-long struggle to self-medicate his schizophrenia. He’d had some success managing it with Suboxone, a drug that helps people to stay off of opioids without the usual gut-wrenching withdrawal. According to Rodkey’s mother, Michele, “he said Suboxone kept him alive.”

The medications Rodkey took — for both his opioid use and psychiatric disorders — became harder to come by during the pandemic. In 2021, he had a psychotic episode and stabbed his girlfriend. He went to the Tompkins County Jail, where he was able to access Suboxone, and then to the state prison in Elmira, where he was not. Five months into his sentence, in July 2022, he overdosed on contraband fentanyl and died.

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.

Prison overdose deaths are infrequent enough that the yearly totals can rise and fall by chance. But statistical tests show this is unlikely to be the case in New York. Deadly overdoses are becoming more common.

The data used comes from investigations of individual deaths from the State Commission of Correction and assessments from the state attorney general. In the attorney general’s report, some deaths were classified as “potential overdoses,” pending the completion of assessments. New York Focus confirmed with the attorney general’s office that those assessments are closed and the cases are listed as overdose deaths.

For comparison of overdose death rates, overdose deaths from September 2021 through August 2022 were compared to overdose deaths from September 2016 through August 2017. The former time period came from the attorney general report and the latter came from individual State Commission of Correction reports. The populations from December 2021 and 2016 were used, respectively.

Confidence intervals were calculated at 90 percent.

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.”

Four months after Tyler Rodkey’s death, a new law went into effect mandating that prisons and jails provide MAT, widely acknowledged as the most effective method of treating opioid addiction.

It’s part of a shift in how both state and federal lawmakers are working to address the opioid crisis. Recent legislation emphasizes harm reduction, treatments that have been proven to reduce overall overdoses and deaths, rather than promoting individual abstinence.

“For people in prison who want it and need it, they should have absolute access to it,” said Assemblymember Linda Rosenthal, one of the bill’s lead sponsors.

“It just didn’t seem like people were getting seen enough.”

—Leslie Strickland, former prison doctor

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.”

People with opioid use disorder may need different medications depending on the stage of their addiction. Though riskier than some treatments, methadone can be more effective for people with severe addiction or who used recently: It can be used in high doses and doesn’t require a person’s system to be free of opioids. Buprenorphine, considered the gold standard for opioid addiction treatment, is best for people trying to stay off heroin permanently. Another option, the monthly-injected Naltrexone, is effective for people on long-term treatment plans who want to taper off buprenorphine-based medications, but doesn’t work as well for people who have recently stopped using opioids.

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.”

Administering daily mat doses for Marcy’s 25-person program takes about an hour and a half, Sharma told New York Focus in August. Expanding it will require a serious lift: The same rate would put the full-capacity program at an approximately 12-hour daily commitment for Marcy medical staff.

In many prisons, rampant understaffing plagues healthcare. DOCCS has vacancies in 19 percent of its healthcare positions — and 35 percent among physicians and nurses. At Upstate, Strickland said she was only able to see 10 patients per week in a facility of over 1,200 people.

Administrative work and lengthy security procedures kept that number even lower most weeks, she said. But “even if I had been able to see people every day,” she said, “it wouldn’t have been enough.”

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.

“It reflects a total lack of understanding of the nature of substance use disorder. You don’t punish someone because they relapsed,” said Rosenthal. “That was very, very disturbing.”

In response to questions from New York Focus, a DOCCS spokesperson said the department had pushed for the governor’s proposed change. Hochul’s office did not respond to New York Focus’s request for comment.

Rosenthal and the legislature were able to block the rule change. They also stopped proposals that would have mandated only that injectables could be offered behind bars and made it easier for the department to deny addiction medication outright.

Tyler Rodkey’s parents said they have no doubt Suboxone would have kept their son alive in Elmira, like it did for the 15 years before he went there. Instead, he was left to choose between opioid withdrawal, which can itself be fatal, or using heroin that had been smuggled inside.

“Why would you think that any other outcome would have happened?” said Rodkey’s father, David. “Other than death?”

Jake Neenan is a reporter covering internet access in the US at Broadband Breakfast. His work has appeared in the Boston Globe. He’s also devoted cat parent.
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