California is facing an overdose epidemic among former prison inmates

Michael Vera walked into a bedroom at a residential drug treatment program in Los Angeles in March to find its occupant collapsed on his bed and struggling to breathe, a homemade straw on the floor next to him and a piece of tin with what appeared to be drug residue underneath. body.

The 35-year-old overdose victim had been out of custody for less than 48 hours, in the midst of an often fatal danger zone: Individuals newly released from prison are 40 times more likely to die from opioid overdoses than the general population, he says. Researchers.

But he was one of the lucky ones, because Vera was among tens of thousands of California inmates given training in overdose prevention and resuscitation when he was released from state prison in 2020. He was given two doses of Narcan to take with him, part of it as California prisons try to weaponize every A departing guest with reverse overdose medication.

Vera and his roommate quickly summoned the staff. Medics administered two shakes of Narcan, a brand-name version of the drug naloxone. This stabilized the patient’s condition enough for him to be taken to the hospital, where he soon recovered.

More than 80% of prisoners released in California between April 2020 and June 2022 left with antidote kits and the training that came with them, according to a January study by corrections officials. Admissions continued to grow, with 95% of departing inmates agreeing to accept Narcan in July 2022, the latest month with data.

Corrections officials are now trying to determine whether these tools actually save lives by examining overdose rates among previously incarcerated people. They’re still collecting data and don’t have a timeline for results, though their report calls the evaluation effort a “crucial priority.” Officials are also looking into whether the program can help address issues of health inequality, since overdose death rates are higher in low-income areas, where freedmen often live, and they occur disproportionately among ethnic minorities and people with disabilities.

At the same time, California Gov. Gavin Newsom, a Democrat, is seeking to lower the cost and increase supply of opioids by having the state produce them itself. Currently, federal grants and legal settlements with opioid sellers fund most Narcan for the released prisoners, but officials said the state had to purchase 1,180 kits for $62.40 each.

“This is a very serious problem,” said Lynn Wenger of the nonprofit research institute RTI International. “As people get out of prison and incarceration, their tolerance to opioids is very low and their release pressure is high.”

Winger is the lead author of a 2019 study of a naloxone distribution program in San Francisco County Jail, in which nearly one-third of inmates prepped with the drug upon release reported reversing an overdose over a four-year period.

California officials estimate that about two-thirds of inmates in the state have a substance abuse problem, fueled by contraband. This statistic follows national estimates. A new program to administer anti-craving drugs such as methadone to incarcerated drug users has dramatically reduced inmate overdose deaths over the past several years.

But overdoses on parole remain a major problem.

Citing various studies, the California report says that people who have just been released from prison are 40 times more likely to die from an opioid overdose than people in the general population, though estimates vary. Massachusetts estimated the death toll to be 120 times higher, while a study using Washington state prison data estimated the risk to be 12.7 times higher in the first two weeks. Research in Georgia, Maryland, Michigan, New Mexico, North Carolina, and Cook County (Chicago) found significant connections.

Globally, overdoses are the leading cause of death among people recently released from custody.

“It’s very scary what’s going on here, and we’re seeing it,” said Mark Mallon, director of administration at Fred Brown Recovery Services, a 40-year-old nonprofit in the San Pedro neighborhood of Los Angeles. This is where Vera was receiving addiction treatment when he helped save an overdose victim.

Research shows that former incarcerated drug users are particularly at risk because their tolerance to opioids wanes while behind bars and their social networks and medical care are disrupted, and that often includes whatever drug treatment they were receiving in prison. And if they do take drugs once released, they often do so in isolation, as they are less likely to be found quickly if they overdose.

California provides departing inmates with a kit containing two doses of Narcan, along with instructions on how to recognize and prevent overdoses, perform CPR, and administer the antidote.

Demian Johnson, who served 35 years in prison for second-degree murder when he was 18 before his release in 2018, now helps formerly incarcerated people and others with substance abuse problems at Five Keys Schools and Programs, a San Francisco Bay Area . Nonprofit. He says two of his friends died shortly after their release from years in prison.

“It’s not hard for me to understand why so many succumb to these really effective drugs,” Johnson said, noting that what prisoners get in prison is likely to be less pure than what they’ll find outside.

One of Johnson’s comrades died alone of fentanyl within a year of leaving prison.

“He had no one to save him or bring him back or give him some Narcan,” Johnson said.

Wenger says the California program likely has benefits beyond helping those recently released: They could use Narcan to save others, too.

“They are often released to neighborhoods where they are likely to encounter someone with an opioid overdose who will have the tools to reverse the overdose,” she said in an email.

Such was the case with Vera, who said he was particularly happy to be able to help someone because he had lost his 21-year-old niece and 24-year-old nephew to overdoses at the time of his release.

Vera said the paramedics told him they were just in time. “If we hadn’t found him, they don’t know what the outcome would have been – but it would have been bad,” Vera said. “He has a second chance now.”

This article was produced by KFF Health Newsthat publish California HealthlineIt is an editorially independent service California Health Care Corporation.