In These State Prisons, Addiction Treatment Is Out of Reach

Stark disparities in access to life-saving medication for opioid addiction persist between facilities — and racial groups.

Spencer Norris   ·   March 22, 2024
Historical photo of the Ray Brook State Sanatorium, now Adirondack Correctional Facility. | Photo: United States Library of Congress | Illustration: Maia Hibbett

Speaking in Albany last month, New York’s commissioner for addiction said that all of the state’s jails and prisons were providing the “gold standard” for treating opioid addiction.

“I am very proud to report that all 44 prisons and all 58 jails are implementing all forms of medication treatment for substance use disorders,” said Chinazo Cunningham, commissioner of the Office of Addiction Services and Supports, or OASAS, during a joint legislative hearing on February 13.

Many prisons appear to be doing well: Across facilities, 91 percent of applications reviewed were granted, suggesting that the people who requested the medication are, for the most part, receiving it. But internal data from the Department of Corrections and Community Supervision, which runs the state prison system, show that stark disparities in access persist. Some facilities have made the life-saving treatment less widely available than Cunningham indicated.

The state has required prisons to provide the medication since October 2022. But a December report DOCCS prepared for the state legislature, intended to show compliance with the law, shows a stark racial divide in treatment access: Half of all incarcerated people in New York state prisons are Black, but only a tenth of prison program recipients are.

And the data, which New York Focus received via a public records request, reveal that over two years, five facilities started providing treatment for single-digit numbers of people. (The data only reflect enrollment rates among applications that prison officials reviewed; they do not note how many were received in total in each facility.)

Proportion of treatment program applications rejected and initiated by facility.

The Adirondack Correctional Facility in Ray Brook, which housed 123 people as of January 1, had only inducted one person on medication to treat opioid addiction from January 2022 to December 2023. During the same time period, the facility rejected 14 other applications for treatment.

One facility didn’t admit anyone. Queensboro Correctional Facility, a minimum security prison in Long Island City, only reviewed three applications for treatment, all of which were rejected. Three people were being offered the medication as of January 1, but according to the data, none were inducted at the facility. (Prisoners who start on medication elsewhere can be transferred between locations.)

The need is likely extreme: The National Institute on Drug Abuse estimates that up to 65 percent of the national prison population suffers from a substance use disorder. And people who have been imprisoned are far more likely to die of an overdose than those who have not. One study found that formerly incarcerated people are nearly 13 times more likely to die in the two weeks following release than the general population, most commonly from an overdose.

In response to New York Focus’s findings, state Senator Julia Salazar, chair of the corrections committee, said that her office would look into the disparities.

“I’m disturbed that racial disparities mark program participation statewide and that participation in some DOCCS facilities is far lower than what we know is the need for treatment,” Salazar said in a statement. “Inequities in substance abuse treatment are unacceptable, and I’m reaching out to DOCCS to ensure remedies are in place as soon as possible.”

DOCCS has generally been proactive about offering the medications. Memos obtained from the records requests show officials discussing the MAT program as early as January 2022, nine months before New York’s legal mandate to provide it went into effect. From January 2022 to December 2023, 3,075 state prisoners were admitted to the program — roughly 10 percent of the population under custody at any given time. Ten facilities had programs with acceptance rates over 99 percent, enrolling hundreds of people.

But that doesn’t mean that all facilities are providing the same level of care. With limited state oversight and intervention, conditions between facilities can vary widely — and shortages among health staff have plagued New York prisons, making it harder to implement new health programs.

The data obtained from DOCCS also shows that different facilities are using different blends of medications, each with their own advantages and drawbacks.

Despite being one of the most effective forms of MAT, eight facilities did not have anyone enrolled on methadone, based on a snapshot of the prison population on January 1. Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates, said that there were issues with the initial plans to provide methadone, slowing the rollout. “The [request for proposals] was frankly just a mess,” she said.

In response to questions, DOCCS spokesperson Thomas Mailey said that all 44 DOCCS facilities are contracted with an opioid treatment program to provide the medication.

A number of facilities also rely on Sublocade, an injectable form of the oral medication buprenorphine. While medications for opioid use disorder aren’t one-size-fits-all, DOCCS has considered using the injectable as a workaround to prevent prisoners from illicitly sharing medications, according to OASAS spokesperson Evan Frost. “The use of injectable medications is something that can mitigate diversion concerns,” he said.

“Commissioner Cunningham said that MAT was up and running successfully in every single DOCCS correctional facility and every county jail,” said Megan French-Marcelin, senior director of New York state policy at the advocacy non-profit Legal Action Center. “That doesn’t align with what we’ve been hearing.”

OASAS spokesperson Evan Frost told New York Focus that OASAS provides technical assistance to the state’s prison system, but doesn’t have an oversight role. “We are working closely with DOCCS and NYS Commission of Correction to implement these services and provide technical assistance when needed, in order to help as many individuals as possible access this treatment,” he wrote.

Asked about the gap between facilities, DOCCS spokesperson Thomas Mailey attributed the divergences among prisons to a mix of factors.

“Medical and mental health complexities, age, polypharmacy concerns, and diagnosis of opioid use disorder are all considered when a provider decides whether to enroll a patient into the MAT Program upon the patient’s request,” Mailey wrote. “Populations in all DOCCS facilities do not have equal proportions of patients that request and meet criteria for the MAT program.”

Other disparities are even more startling.

Just one in 10 MAT recipients in the state’s prisons are Black, despite the fact that Black people account for half of the state’s prison population — and have the highest overdose rate of any racial demographic in New York.

“The data is kind of shocking actually in terms of the racial disparity,” said Christine Khaikin, senior health policy attorney at the Legal Action Center.

Outside prison, access to MAT is already an issue for Black people with opioid addictions, Khaikin said. Black Medicaid enrollees with an opioid use disorder are less likely to receive MAT than white enrollees. “Seeing that kind of play out in the carceral system is just really, really upsetting,” Khaikin said.

Myra Mathis, a Rochester-based psychiatrist specializing in addiction medicine who frequently works with incarcerated people, said that many Black prisoners may fear retaliation for disclosing an opioid addiction or requesting an evaluation.

“Given the history of interactions between carceral systems and Black populations, the degree of distrust is quite high,” Mathis said. “It’s not the same as sharing confidential clinical information with your physician.”

While significant disparities remain, the overall 91 percent admission rate has impressed some observers.

“I would say that they have done an extraordinary thing in implementing this evidence-based public health intervention in an environment that has been very unfriendly,” to people with substance use disorders, said Jennifer Scaife, executive director of the Correctional Association of New York.

“Ten percent of the population in prison now is receiving meds that they couldn’t have received a couple of years ago,” Scaife noted. “I think that’s helpful.”

Spencer Norris is an investigative reporter covering homelessness for New York Focus and ProPublica’s Local Reporting Network. He has exposed deficiencies in opioid treatment in New York’s jails and prisons, as well as a treatment desert spanning most of upstate. Spencer previously worked… more
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