Prison drug overdoses surge again after initial treatment success
SACRAMENTO >> Drug overdose deaths in California state prisons rebounded to near record levels last year even as corrections officials touted the state's intervention methods as a model for prisons and jails across the United States.
At least 59 prisoners died of overdoses last year, according to a KFF Health News analysis of deaths in custody data the California Department of Corrections and Rehabilitation is required to report under a new state law. That's more than double the number who died of overdoses in each of 2020 (23) and 2021 (24).
Prison officials would not provide the number of overdose deaths in 2022, saying they are still being analyzed for a report to be released later this year. But attorneys representing prisoners said they believe there were substantially more fatal overdoses in 2022 than in the previous two years.
The new numbers are a big setback for state officials, who poured resources into overdose prevention efforts after a record 64 overdose deaths in 2019 gave California prisons the highest drug overdose death rate of any state correctional system in the United States.
With nearly 94,000 state prisoners, California is one of the nation's largest providers of medication-assisted drug treatment. The prisoners' attorneys still support California's pioneering program, saying there would be even more deaths without it.
“Fentanyl. That's I think probably the main cause from what I hear,” said Don Specter, a lead attorney in the major class-action lawsuit over poor medical care of California prisoners, referring to the synthetic opioid at the heart of the nation's overdose crisis. “Nothing else has really changed too much. It's very pervasive.”
With a lower prison population than in previous years, California's 2023 numbers represent a record high overdose death rate of at least 62 per 100,000 prisoners — and the numbers are likely to rise further as the cause of death is determined in some cases.
“National data has shown an alarming increase of overdose deaths across the country, largely driven by synthetic opioids (primarily fentanyl),” Ike Dodson, a spokesperson for California Correctional Health Care Services, said in an email.
He added that prison officials “continue to evaluate substance use disorder treatment to improve the safety and well-being of all who live or work in a state correctional facility, including plans to broadly expand access to Narcan,” an overdose reversal device.
Until now, California's increasingly comprehensive drug intervention program had been an apparent success story.
In January 2020, when the prison population was about 124,000, the state began using buprenorphine, naltrexone, and methadone to lessen drug users' cravings and the crash of withdrawal symptoms while helping them stay away from dangerous opioids. The new program's focus on medication-assisted treatment appeared to be working after deaths fell to 23 that year.
The medication-assisted treatment is one of five core components of the prison system's approach: screening every arriving prisoner for substance abuse; use of medication where needed; therapy; supportive housing in prisons; and pre-release planning and post-release assistance. Officials say all five have begun to varying degrees, at a cost of $270 million for the fiscal year starting July 1.
By 2021, the prisons' reported overdose death rate fell to 25 per 100,000, less than half the rate before the program began and well below the overall national average.
There also was a nearly onethird drop in drug-related hospitalizations and emergency room visits among California prisoners receiving the medication-assisted treatment, researchers for the program said in a progress report last year.
In promoting the approach, corrections experts last year cited California's “immediate and significant” progress in reducing deaths, emergency hospitalizations and drug abuse-related infections. While the use of medications to help keep prisoners from using opioids is rapidly expanding, it remains underused nationally in other prison and jail systems, the report said.
But last year's preliminary overdose death toll in the state's prisons was close to the record numbers of 2018 and 2019. Overdoses likely caused 11 deaths in October, according to attorneys representing prisoners — the most they had seen in a month.
Drug-related hospitalizations also have seen a more re
cent surge, attorneys representing prisoners said, citing the state's data in a December court filing.
Efforts to crack down on the smuggling of drugs and other contraband into prisons have had limited effect.
Corrections spokesperson Alia Cruz said the department favors a “multilayered approach” that couples prison security with deterring smuggling and disrupting gangs and other drug distributors.
There were 236 smuggling arrests last calendar year, up significantly from the 2020-21 and 202122 fiscal years and similar to 2019-20 but about one-third fewer than in 2018-19. “Miscellaneous” seizures, which include fentanyl and other opioids, were up about 14% through the first nine months of 2023, the last data available, over the same period a year earlier.