When Pennsylvania's prisons come off a statewide lockdown begun Aug. 29, inmates will be greeted by a number of radically tightened security measures: high-tech body-scanners for visitors, drone-detection equipment, and the digital delivery of all mail, which will be scanned and forwarded via a Florida-based contractor. In total, they will cost taxpayers $15 million.
The improvements come after the Department of Corrections reported 57 staff were sickened in 28 incidents at prisons in central and Western Pennsylvania. Corrections Secretary John Wetzel announced the lockdown after linking the illnesses with exposure to synthetic cannabinoids — the drugs have, by official and inmate accounts, flooded prisons across the state in recent years — but also cited concern over a reported mass exposure to fentanyl at an Ohio prison the very same day the lockdown was announced.
"Pennsylvania's corrections officers put themselves in harm's way to make our commonwealth safer, and it is up to us to provide them protection from harm," Gov. Wolf told reporters. "I want to assure them that their concerns are valid."
But, what if their concerns are actually misplaced?
That's a question raised by toxicologists, who say one likely diagnosis for the staff illnesses may be "mass psychogenic illness" — that is, a sort of contagious hysteria fueled by fears of dangerous exposure.
"There is some great concern that it's psychogenic," said Jeanmarie Perrone, director of medical toxicology at the University of Pennsylvania's Perelman School of Medicine.
"Mass psychogenic illness happens all the time. We see it all the time with law enforcement," Perrone said. "Police pull someone over and find an unknown substance. Suddenly their heart's racing, they're nauseated and sweaty. They say, 'I'm sick. I'm gonna pass out.' That is your normal physiological response to potential danger."
Although seven prison staff were administered naloxone, the drug used to reverse opioid overdoses, experts said that was probably unnecessary. Unlike the guards — who reported symptoms including elevated heart rate and blood pressure, light-headedness, dizziness, and headaches — an overdose victim would be unresponsive, Perrone said. "If they are speaking, they don't need naloxone."
The American College of Medical Toxicology released a position paper on fentanyl last year noting that the risk of exposure for emergency responders is "extremely low." They noted that it cannot be absorbed through the skin in a powder form, and it's unlikely, if it were aerosolized, that it would be concentrated enough to sicken responders.
Synthetic cannabinoids — laboratory-made compounds also known as K2 or Spice — are more complicated, because they can be made up of any number of compounds, and their makeup can vary wildly from one batch to the next. Some versions even include rat poison. Prison officials say K2 is frequently soaked in paper, which can be easily sent through the mail and then smoked.
But experts said merely touching K2 should not have caused the guards' symptoms.
"In a word, it's implausible," said Dr. Lewis Nelson, chair of emergency medicine at Rutgers New Jersey Medical School and a past president of the American College of Medical Toxicology. "One thing we know about [synthetic cannabinoids] is that they don't cause the effects these folks are having, and certainly not by the route that they're being exposed. … The symptoms are much more consistent with anxiety."
Jason Bloom, president of the Pennsylvania State Correctional Officers Association, described that theory as "asinine. There's no other way to put it. Maybe moronic."
"If that were the case," he added, "then why such a strong reaction from the Department of Corrections?"
He described the dangers of K2 as including not only sickness from incidental exposure, but also contact with inmates who become violent on the drug.
One thing that is not in dispute is that K2 and other drugs have become ubiquitous in the state's prison system.
"I find it quite troubling that it seemed to never be an issue with the DOC on how prisoners were harming themselves with these synthetic drugs," Cintron said. " … It is now a problem because it is affecting the DOC staff and officers, allegedly."
Wetzel said that the goal now is not to reduce drug traffic into the prisons but to altogether eliminate it.
"The safety and security of staff and inmates is paramount to the Department of Corrections," Wetzel said in a statement announcing security measures.
Among them: The prisons will shift to e-books and digital magazines, and double staff in the visiting rooms. And, all incoming mail must be sent to a company called Smart Communications in Seminole, Fla., which will scan and forward it at a cost of $4 million annually. The state will pay an additional $1.9 million per year for copy machines and paper to manage legal mail, which will be photocopied by staff wearing protective clothing.
Also on the horizon: $6 million on new machines to scan visitors for contraband, and $2.2 million for drone detection at each prison.
Nelson said those efforts may well be necessary to keep drugs out of the institutions. But if the goal is to keep staff safe from incidental exposure, he said, "It borders on the irrational. It's panic mode."
Medical experts pointed out that they frequently treat patients who are on synthetic cannabinoids without wearing gloves or other protective gear.
"As chemists, we don't even wear face masks," agreed Sherri Kacinko, a toxicologist at Willow Grove's NMS Labs who studies substances like K2. "The risk is very low."
All acknowledged that the drug compounds in K2 are constantly evolving. David Vearrier, a Hahnemann University Hospital emergency doctor, said that makes it hard to know the truth.
"Some of the newer synthetic cannabinoids you see on the street are really potent, and … have been associated with symptoms in law enforcement personnel," he noted, referencing a study of federal agents who handled K2 after raiding a drug lab and were later found to have the drug in their system. (However, the study also described the agents eating and drinking while cataloging the evidence, and noted that most of them did not consistently wear gloves.)
To Vearrier, it's not implausible that a correctional officer could run into a similar situation. On the other hand, he said, "Just feeling anxious about it could cause them to have some of these symptoms. There's also a possibility that they want to get an afternoon off work."
Edward Boyer, a Harvard Medical School professor and Brigham and Women's emergency doctor, reviewed the prisons' incident logs and responded with an audible shrug. "We have no biological testing confirming exposure actually happened, and we have a large number of individuals with complaints of vague, subjective conditions," he said.
He and others said they'd want to confirm the exposure through blood or urine tests. The only results the Department of Corrections have released are lab and field tests of the substances found in the prisons.
Without that confirmation, Boyer said the most likely cause is something even doctors can relate to: "We treat people who come to the [emergency department] with lice all the time. Everyone begins to itch."