After what can only be described as a bizarre wave of incidents over the last few months in which prison staff were sickened by alleged exposure to a drug, on Aug. 29 the Pennsylvania Department of Corrections declared a statewide lockdown. When the lockdown was lifted, a new policy was put in place as a part of the "drug-elimination efforts" of the DOC — friends, families, and volunteer groups are no longer allowed to send books to people incarcerated in Pennsylvania state prisons, because the DOC argues that books were used to smuggle in drugs.
The changes are going to cost Pennsylvania taxpayers $15 million even though many experts believe that mass hysteria is a more likely explanation than actual poisoning — in one incident at SCI Mercer, six "exposed" staffers experienced seizures and became unresponsive even though toxicology testing confirmed they were not exposed to a controlled substance.
Aside from being an attack on the humanity of people in prison and their ability to connect with the world outside the prison walls, the ban on books attempts to solve the wrong problem.
The issue is not how people are smuggling substances into prisons but why they do it in the first place. By definition, addiction manifests in drug-seeking behaviors despite harmful consequences. Without access to effective addiction treatment, which includes medications that are not accessible in Pennsylvania prisons, people in addiction turn to drastic measures such as smuggling drugs and risk more years in prison and losing visitation privileges. Sometimes, the drugs smuggled are actually medications for the treatment of addiction.
The DOC took to social media to explain its book ban. In one tweet, the department posted a picture of "a Bible shipped from a major bookseller containing multiple strips of the drug suboxone."
Suboxone is not a drug, it is a medication.
Suboxone is the brand name of a mix of two medications — buprenorphine and naloxone. The first, buprenorphine, is actually an opioid that is long-acting and prevents craving. Like methadone, it is one of the medications that are often referred to as MAT — medication-assisted treatment. There is a large body of evidence that shows people in opioid addiction who receive buprenorphine are less likely to relapse or overdose than those who do not. Naloxone, the other component of Suboxone, is an opioid-overdose reversal medication, and is in the medication to prevent abuse by making people who inject Suboxone sick.
Dr. David O'Gurek, an associate professor of family and community medicine at Temple who runs a buprenorphine program out of his family medicine practice, explains that "one of the big issues with any substance-use disorder is not the actual use. It is sort of what happens between uses." The harmful behavior that is associated with addiction comes from the worry that people in addiction have about being well — by using again — once the levels of drugs in their body start to drop. By taking Suboxone which does not lead to euphoria but satisfies the physical craving for opioids, O'Gurek explains, a person in addiction "avoids that cycle of developing euphoria and falling into that fear state that you are going to get sick, or what is going to happen if you get sick, that you need to use to get better."
A spokesperson for the Pennsylvania Department of Health says that the state does not track buprenorphine in the blood of people who died of overdose, but that the chemical composition of Suboxone — the existence of naloxone — makes it " very difficult to overdose on."
There are close to 50,000 people in Pennsylvania state prisons. According to the DOC, about 65 percent — more than 32,000 people — need some level of "alcohol and other drug treatment." Not a single person of those 32,000 is treated with Suboxone. Only pregnant women are treated with methadone. Anyone else suffering from an opioid-use disorder will not get the evidence-based gold standard of addiction treatment.
Currently, the state prisons provide only Vivitrol, which is, in essence, a long-lasting opioid-reversal medication that is injected once a month, but the treatment is used only upon release from prison and back to the community — about 1,000 people receive it currently. The DOC is going to start a buprenorphine pilot in the next couple of months with an injectable form.
Steven Seitchik, the MAT statewide coordinator at the DOC, says the current situation is unacceptable: "If you're on methadone, if you're on buprenorphine, and you have to go to jail, there is no reason in the world that you should not be afforded the ability to continue those medications while you are incarcerated." In fact, the situation that Seitchik describes is not only unacceptable but might be illegal.
The American Civil Liberties Union of Massachusetts filed a lawsuit this week against a county jail in Massachusetts on behalf of a man who used methadone to treat his addiction for two years and then was incarcerated in a county jail which, like Pennsylvania prisons, does not provide methadone (or buprenorphine). According to the lawsuit, denying the treatment forces people to undergo painful withdrawal, which constitutes a cruel and unusual punishment — a violation of the Eighth Amendment. Further, barring treatment might be a violation of the American with Disabilities Act, which prohibits discrimination based on disabilities including chronic illnesses such as addiction. Similar lawsuits have been filed in Maine and Washington state.
Seitchik's goal is to have medication available for people during their time of incarceration in all Pennsylvania prisons but says it will take time to get to that point.
Meanwhile, if there are no treatment options, all incarcerated people in addiction have left is to try to practice self-care. A recent study published in the Journal of Addiction Medicine found that in Rhode Island, the main motivations for people in addiction to buy diverted Suboxone — i.e., Suboxone that was not prescribed by a physician — were the "management of withdrawal symptoms" and "self-treatment of opioid-use disorder." The researchers conclude that the use of diverted Suboxone "indicates a shortage in treatment capacity and inaccessibility of existing services."
The exact same dynamic happens in Pennsylvania prisons.
For Seitchik, the solutions to diversion of Suboxone in state prisons are simple, "if you would treat individuals for their substance-use disorder, you would likely reduce the black market."