Prison can be the worst place to be for a person struggling with addiction, but the devastation of mass imprisonment and the burden of drugs are inseparable today, as the two scourges pervade the same communities. In New York, where a massive prison population intersects with an exploding opioid crisis, authorities hope to turn a place of crisis into a seedbed for rescue. A new pilot project aims to equip incarcerated people with tools and skills to act as emergency responders for overdose victims. The hope is that they will return to their neighborhoods to help people in their communities stay safe, while they stay free.
Though the opioid epidemic swelling across the country is typically associated with white rural regions, it has permeated both cities and suburbs in New York. Opioid-related overdoses hit thousands of people each year (statewide, deaths linked to opioids rose from about 1,600 to 2,100 annually from 2013 to 2015), including those related to prescription medication and others from heroin or its even more deadly cousin fentanyl. Additionally, thousands of overdoses lead to hospitalizations annually. The lucky ones will be saved by emergency doses of naloxone, a medication that alleviates overdoses rapidly and can be administered by anyone with simple training and equipment. Since the fatality risk in an overdose situation may depend on the seconds it takes to get medical aid, public-health authorities have been bringing the emergency response straight into the most affected communities, and, not surprisingly, the same populations at risk of overdose are also besieged by the criminal-justice system.
In an effort to combat the crisis, state correctional and public-health authorities have begun collaborating on a unique harm-reduction initiative to equip people released from state prisons with naloxone kits. After undergoing voluntary training and education on their rights as “Good Samaritans,” the formerly incarcerated, many of them out on parole or conditional release, are positioned to intervene when they encounter an overdose in their family or neighborhood.
So far, according to research by the Vera Institute of Justice, the trainees have more than risen to the challenge. While the state works to expand naloxone-distribution programs in communities, the formerly incarcerated population is a unique experimental group because they are often so close to the opioid epidemic. Some might even have struggled with addiction themselves. And many come from impoverished areas isolated from public-health institutions.
The program also provides training to corrections staff and the families of formerly incarcerated people, in order to ensure the widest impact and promote a sense of engagement for the whole community. The program—modeled on harm-reduction principles and community-based overdose-prevention programs—could be a key ingredient in the state’s prevention and treatment strategy, as it turns a massive population into a corps of grassroots volunteer medics.
For people struggling with opioid addiction, both the health-care and the criminal-justice systems are failing them. Even when courts assign treatment as an alternative to incarceration for drug offenders, the sentence can be counterproductive, Vera researcher Leah Pope says, because “they primarily relied on abstinence-based treatment options that require the cessation of all drug use to achieve recovery.” Naloxone’s only objective is preventing death; the individual is left to make their own choices afterward. For the volunteers, including staff and the incarcerated individuals, many of those interviewed “still emphasize the importance of abstinence,” but, based on their experiences, “understand drug use to be complex and encompass a continuum of behaviors.”
Corrections staff who received the training reported gaining insight into both the complexities of the epidemic and the hardships the formerly incarcerated face following release. Moreover, if they are living in communities where drugs and incarceration act as reinforcing crises, helping the formerly incarcerated become change agents in a local health program encourages rehabilitation for both survivor and rescuer, socially and medically. One staffer described becoming conscious of the importance of harm reduction as a critical public-health measure: “There’s no point of telling them no, they can’t do it, it’s illegal…but maybe we can inform them to where they make proper decisions about what they do.”
Meanwhile, those who opted not to take the kit expressed rational fears that, despite Good Samaritan laws that purport to shield them from legal risk, they might somehow end up punished if they acted to intervene: “How are they gonna apply it?… If it’s being used the same way courts use regular criminal activity, then I don’t trust it.”
But other formerly incarcerated volunteers opted for the kit from an ethical viewpoint. As one participant explained, “I would feel less than a man knowing that I had an opportunity to be able to do something constructive and not take the chance. Nah, I can’t see [myself] doing that. Plus, me, I’m just different now.”
The virtuous cycle of the program (which is also open to people convicted of drug-related offenses, though on the whole they participated less) may even extend to combating recidivism. According to Pope, “By empowering people to save lives, the program humanizes incarcerated people and allows them to be seen—both by prison staff, and themselves—as valuable members of the communities to which they belong.” Because the program was deliberately inclusive of families as well as open to those convicted of drug charges, the training provided a neutral space to discuss the risks of drugs in a non-judgmental way. It thereby “offered a number of opportunities for incarcerated people to strengthen relationships with loved ones at home, an important ingredient for successful reentry.” Moving from an idle existence behind bars to the front lines of a rescue mission in their home communities, “people feel not only a sense of pride in helping others but a sense if being back in control of their lives.”
Of course, people at risk of overdose and those leaving prison need more than a medical kit to cope with cross-cutting health and social crises. Safe-injection sites, long-term health-care access, and expanded rehabilitation and social programs are all key interventions for the formerly incarcerated as well as for drug-afflicted families. But a naloxone kit in the hands of someone who just left a cell might upend the cycle of suffering in two ways: Staying out of jail is even more vital when someone else’s life depends upon whether you can be at their side when they need you.