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  • Elizabeth Brico from TalkPoverty

Jail Isn’t A Drug Treatment Center. Stop Promoting It As One.

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Carmen Mulholland, a nurse with Allied Resources, dispenses methadone to an inmate at the Penobscot County Jail. (Staff Photo by Gregory Rec/Staff Photographer)

Kathleen Cochran is no stranger to the term “enabling.” These days, she manages 11,000 acres of ranchland in the lush Santa Ynez Valley, just north of Los Angeles. Her daughter, who has struggled with heroin addiction for 15 years, is stable. But those 15 years were a tumultuous ride, riddled with harmful advice from fellow moms and accusations that she was “enabling” her child by preventing her from suffering the worst consequences of drug addiction. Some of the most prevalent advice Cochran was given was to call the police on her daughter, or otherwise allow her to become and remain incarcerated. Common refrains included a false belief that she was safer behind bars where she could not get drugs but would be provided three hot meals a day, or that people who do the crime deserve the time, and that it might give her the space to think critically about how she was living. What these families fail to understand is that incarceration leads to a host of problems for people struggling with drug addiction, both immediate and long-term.

“I understand the sheer panic of not knowing what to do, and you want to get your kid off the street because you really honestly believe they’re going to die,” said Cochran. “But I had a thought that, you know, if my daughter gets arrested, she’s gonna have a record.”

The concepts of “enabling,” “rock bottom,” and other punitive approaches toward addiction are mainstays of the 12 step programs that continue to dominate recovery culture despite a lack of scientific evidence backing their efficacy. It’s not uncommon for parents of people in the throes of addiction to feel compelled to call the police on their loved one, pray for their incarceration, or feel relief when their loved one gets locked up. Cochran still encounters the mentality frequently in “Moms for All Paths to Recovery,” an arm of her nonprofit “Heart of a Warrior Woman,” dedicated to disseminating the harm reduction tools and tenets she wished had been more available when she was desperate for ways to help her child.

“In that moment, [parents] say nothing else is working,” explained Cochran. “They need a reprieve and somehow they think no matter what anyone has told them, [their child’s incarceration] gives them a reprieve.”

Parents, however, are not the only people who uphold the myth that incarceration benefits people struggling with addiction. Many people in recovery credit incarceration with their turnaround. It’s not uncommon to hear people say they would never have stopped using if they hadn’t gotten locked up, or that detoxing felt psychologically easier in jail, where they knew they couldn’t get a hit. Amanda Mansur, a restaurant server and mother living in Massachusetts, told TalkPoverty over the phone that, in retrospect, being incarcerated was a “positive experience.”

“It taught me…about gratitude. You don’t realize how good you have it until you lose everything,” said Mansur.

But incarceration is highly traumatic and embedded with both short- and long-term negative consequences. In the long term, convictions, especially felonies, can follow people for years after their release from jail or prison. People with felony drug convictions face difficulties renting homes, gaining employment, and even accessing public benefits.

Most states no longer enforce a lifetime ban on public benefits like food assistance and cash benefits for families with children, but many still impose temporary bans or reinstatement requirements outside of their criminal sentence. That can mean drug testing, which is costly, invasive, and not always accurate; the more common, less expensive urine drug tests, for example, are prone to false positives, which can result from the use of over-the-counter medicines or even edible poppy seeds.

The negative consequences of incarceration are compounded for people of color. Members of Black and Latinx communities are more likely to be incarcerated for drugs, and one in nine Black children has an incarcerated parent, as opposed to one out of every 57 white children. One study conducted in New York City found that Black men with criminal backgrounds faced harsher employment discrimination than white men with similar convictions. One out of every 13 Black Americans will lose voting rights in their lifetime due to felony disenfranchisement. Over 250,000 immigrants have been deported as the result of drug charges since 2007, according to data compiled by the Drug Policy Alliance.

But all of these consequences hinge on the assumption that a person survives the ordeal of incarceration. For people who are addicted to drugs, survival is not guaranteed.

“Any time someone has to use drugs in a way that’s secret, that’s hidden, that’s rushed, that’s not around people, that’s not in a safe secure network where you can get help, you see increased harms,” said Kim Sue, the medical director of the Harm Reduction Coalition, who also performs clinical work at Rikers Island Correctional Facility and recently published a book titled “Getting Wrecked: Women, Incarceration, and the American Opioid Crisis,” that examines the use of methadone and buprenorphine within jails and prisons. Those harms can include increased rates of infections and diseases like HIV and Hep C that can result from sharing syringes and other equipment.

Those harms can also manifest as death due to withdrawal. Although opioid withdrawal is not conventionally considered fatal among otherwise healthy adults, a number of people have been found dead in cells across the country. In 2017, Mother Jones reported that although nobody is tracking how many of these deaths are taking place, 20 lawsuits were filed against United States correctional facilities between 2014 and 2016 in response to alleged opioid withdrawal-related deaths. Withdrawal-related dehydration is often cited as a primary factor in these deaths. In more than one of these cases, distressed inmates reported concerns for their life to family members over the phone, or begged staff for water and medical care in earshot of their cellmates. Surveillance cameras caught the excruciating withdrawal and death of a 32-year old Michigan man who was in addiction treatment when he was arrested and sentenced to 30 days in jail for failing to pay a driving ticket.

“If you’re doing a lot of vomiting or a lot of diarrhea…[that] can lead to different electrolyte disturbances which can affect cardiac function, leading to cardiac arrest,” explained Sue, who also noted that many times, medically untrained guards are the only people available to assist incarcerated people in withdrawal. She added that even when inmates are transferred to medical units, most facilities do not have doctors on site full time.

There is a growing awareness among criminal justice authorities that medications used to treat opioid use disorder, like methadone and buprenorphine, are essential for people struggling with opioid addiction. Often prompted by lawsuits, several facilities have begun inducting incoming inmates who are addicted to opioids, or allowing people already prescribed the medications to continue taking them. Regardless, the majority of facilities do not allow the use of these medications, except for people who are pregnant (even then, patients are typically tapered off after pregnancy, sometimes while still recovering from childbirth).

This means that most people who are incarcerated while addicted to opioids will undergo forcible detox. In some cases, even when people are given methadone or buprenorphine as a withdrawal aid or for maintenance while inside, they are not given adequate referrals on the outside. In some areas of the country, these medications are difficult to access or too expensive to pay for out of pocket. For people addicted to opioids, being forcibly detoxed without adequate access to evidence-based treatment like methadone or buprenorphine can be dangerous upon release because it leaves them at risk of relapse, but without their former tolerance. Opioid-addicted people who have been released from incarceration are at significantly heightened risk of overdose in their first several weeks back in the community.

Even in facilities where evidence-based treatment is offered, the risk of trauma remains ever-present. “[People who are incarcerated] get killed by staff, they get killed by other inmates…they get raped, they get sodomized,” said Dinah Ortiz, a vocal harm reductionist and parent advocate at a New York defense firm. “You don’t know how many rapes I saw, you don’t know how many women I saw sodomized during my little six months in Rikers.”

“If you’re the kind of person who needs to take a walk when you’re feeling stressed, you cannot do that [while incarcerated]. If you’re anxious around other people who are loud or fighting, you can’t avoid that. The environment is not therapeutic,” said Jonathan Giftos, who worked as the clinical director of substance use treatment for the Division of Correctional Health Services at Rikers Island. “A lot of the health side works hard to mitigate the harms of the environment, but you can only do so much.”

Even when formerly incarcerated people praise their experience behind bars, they also often share stories of trauma and relapse that didn’t end with jail or prison, but with evidence-based care that they accessed in the community. Mansur, for example, admitted that she relapsed shortly after her release, and continued using for three years before achieving sobriety with the help of a self-referred buprenorphine prescription. She detailed that she’s had difficulty renting apartments because of her conviction, which was for theft that she committed in order to pay for drugs. She’s also unable to work in the medical field or with vulnerable populations like children or the elderly, which she finds disappointing because she had studied psychology in college.

“Maybe if I had been introduced to medication-assisted treatment previously from going to jail, maybe that would have prevented [the need to be arrested],” Mansur stated, before acknowledging that her addiction became “much worse” after she was released from jail.

“If your [child] is out of control there are ways to go about [helping them] that do not involve incarceration,” advised Ortiz. “If you have that mentality that I prefer they be in jail, then that’s the mentality that they are going to have, too.”—a project of the Center for American Progress—is dedicated to covering poverty in America by lifting up the voices of advocates, policymakers, and people struggling to make ends meet.

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