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Thousands of California Inmates Waiting for Access to Addiction Treatment

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Prisons confine inmates during group therapy in metal cages, also known as therapeutic modules, at California State Prison in Sacramento. (Julie Small/KQED)

More than 6,000 California prison inmates are awaiting the doctor's appointments they need to receive addiction-treatment medication, according to a prisoner advocacy group.

Attorneys with the Berkeley-based Prison Law Office say many of them have faced months of delays, including one man who had an appointment rescheduled three times over multiple months after being found unconscious in his cell from an apparent opioid overdose.

“He needed the services, needed them urgently,” said Steven Fama, a senior staff attorney with the group, which is representing plaintiffs in a longstanding lawsuit over medical care in the state prison system. “When you don't have treatment and you have an opioid use disorder, many are going to turn to the underground economy and obtain drugs, which are unfortunately widely available in prison.”

Delays in treatment for addiction can also have fatal consequences. Recent research has shown that opioid-related overdoses are among the leading causes of death among people released from jails or prisons. That factor is particularly pertinent now as thousands of jail and prison inmates have been granted early release in an effort to curb the spread of COVID-19 in crowded prisons.

Fama said he has requested monthly reports from prison officials to determine whether additional doctor’s appointments are being offered to those seeking addiction medication. The next report is expected in January.

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“They understand our concerns and recognize there is a substantial backlog,” he said. “What's not clear yet is how quickly the backlog can be reduced.”

Despite concern about delays, Fama also acknowledged that California’s prisons are ahead of the curve in terms of addiction treatment. In fact, some addiction policy experts say that the state’s prisons are still doing far more than those elsewhere in the country, many of which don't provide any kind of medication for substance-abuse disorders.

California's sweeping treatment program was launched in response to years of rising opioid-related overdoses in its prisons. A 2017 analysis of inmate deaths found that the fatality rate from drug overdoses in California prisons was three times higher than in any other prison system in the country.

Ike Dodson, a spokesman for the California Department of Corrections and Rehabilitation, said in a statement that state prisons began offering a comprehensive drug rehabilitation program at the start of this year. There has been “tremendous interest from the inmate population” he said, noting that over 6,600 inmates in 35 state prisons currently receive medication-assisted treatment.

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In response to claims about the backlog, Dodson said that prison officials are "working every day to grow one of the world's largest treatment programs involving [medication-assisted treatment] in a correctional setting. It's happening during a global pandemic, with rising cases in both communities and within our system."

Donna Strugar-Fritsch, a correctional health consultant with Health Management Associates, said she's not surprised by the backlog, particularly because Buprenorphine, a medication used to ease the pain of opioid withdrawal and reduce cravings, can only be prescribed by a physician with special waivers and training. The handful of other states with medication-assisted treatment programs inside prisons, like Connecticut and New Hampshire, have dealt with similar hurdles, despite having much smaller inmate populations, she said.

“It's kind of what we call a pig in a python. There's a great demand at first because no one's ever had access to the treatment before,” Strugar-Fritsch said. “Some of it is artificial and needs to be culled out. Some of it is there are more people in the prison system that had cravings for years and still do and would like some relief from that.”

Strugar-Fritsch said it’s significant that jails and prisons in California have continued to provide medication-assisted treatment at all during the pandemic, given the string of major COVID-19 outbreaks in multiple facilities.

“A lot of prisons and jails basically said, ‘No one is getting health care anymore unless it's an emergency because we can't take people out of their cells,’ ” she said.

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