In February, high on heroin, Daniel S. robbed a bank near his Sayville apartment. Unarmed, he handed a teller a note demanding money, but there was a GPS locator in the cash and he was quickly arrested and jailed. Again.
Daniel, 43, asked that we not use his last name because he does not want to further embarrass family members. In an interview at the Suffolk County jail in Riverhead, he said he had a stable upbringing in Elmont. He had a trade as a union ironworker, and although he struggled with alcohol early, he mostly kept it together until he hurt his back in a motorcycle accident in 2011 and was prescribed painkillers. He became dependent on the pills, and when the doctor cut off his prescriptions, he switched to heroin, and quickly spun out of control.
In 2012, Daniel was arrested two hours after he broke into a business in Bay Shore and stole a laptop, for which he was sentenced to 18 to 36 months. After his release, he stayed sober for 18 months, then relapsed. Then came the bank. Now he’ll serve 1 to 3 years. He says he plans to work a 12-step program and stay sober when he gets out. But he also fantasizes about scoring heroin as soon as he is released.
Putting Daniel and other addicted inmates on the right path and keeping them on it is the challenge facing jails and prisons everywhere. They are mostly failing — at a tremendous cost.
Daniel sent Newsday an impassioned, handwritten letter in April after reading two editorials on the opiate crisis. He wanted to share his view of addiction from jail. He described cell blocks full of drug addicts, many unaware they have problems, and days full of boredom, with far too few drug rehabilitation services that might help prisoners stay out of trouble once they’re free.
About two-thirds of the nation’s 2.3 million inmates are addicted to drugs or alcohol. Many of the most troubled opiate addicts in the country are in penal institutions, with time on their hands. Every possible attempt to enhance their chances at recovery should be seized. More services are needed in local jails and state and federal prisons, and for prisoners upon release. But perhaps just as important, more data are needed on what works.
Opiate rehabilitation basically consists of 12-step programs, behavior-modification therapies and medication-assisted therapies, or MAT. MAT includes methadone, a traditional long-term treatment using an opiate that allows addicts to function and controls cravings. Also included are Suboxone, a newer drug that functions much the same way, and Vivitrol, a once-a-month injection that blocks the high of opiates.
Correctional facilities have too little of all of this, according to prisoners, experts and corrections officials. There are too few counselors and meetings. But the biggest problem is that there are far too few MAT programs, which have been shown to halve the chances of relapse and overdose. Of the 5,000 correctional facilities in the nation, it’s estimated fewer than 100 offer MAT programs.
The Nassau County jail has three 12-step meetings a day in cell blocks devoted to recovery. Suffolk County is staging a pilot Vivitrol program, as is the state prison system. Nassau tries to set up departing inmates with rehabilitation programs on the outside. Suffolk is trying some innovative anti-recidivism programs with its youngest inmates.
Everyone’s trying. But jail and law enforcement officials need more funding for treatment, more volunteer help from outside, and more facts.
There are practically no data to show which methods are best to treat opiate addiction and prevent relapse, for whom or in which combinations — not in the corrections world or outside it. Addressing this lack of data is a top priority. That means funding studies that track the outcomes of different programs, and loosening state and federal privacy laws that make it hard to track such outcomes. If five or 10 years from now we still don’t know what works, it will be a disaster.
In addition to adding services in jails, the biggest change that would give addicted inmates a chance at long-term recovery is immediate help when they get out. A path toward that is under consideration. In April, Gov. Andrew M. Cuomo made New York the first state to apply to the federal government for permission to enroll jail and prison inmates in Medicaid 30 days before they are released, giving them access to the services they need and a continuity of care upon discharge, a move Daniel said could make a big difference for him and fellow inmates. Washington needs to approve this change for New York, track the results, and expand it nationally if it curbs relapses and recidivism.
Daniel and most of the other opiate addicts he’s doing time with are going to get out. What happens after that depends on their choices, but those choices partly depend on the treatment they get.
If their addictions lead them back to crime, we will all suffer.