This November marks the beginning of the largest prisoner release in this country's history. Just over the first weekend, the federal prison system discharged over 6,000 inmates who saw their drug-related sentences reduced as a result of recent reforms. An estimated 40,000 additional federal prisoners will be eligible for early release in the coming months. This is just one part of a broader drive to slash senselessly harsh sentences for drug crimes, reduce prison overcrowding, and generally move away from mass incarceration and the War on Drugs.
Although generally positive (and long overdue) for the inmates, their families, and the taxpayer, this monumental de-incarceration effort is also a source of grave risk. Few will be surprised to hear that the U.S. is in the midst of an overdose crisis, but there is little recognition that re-entering individuals are nearly 130 times more likely to die of an overdose in the first two weeks after their release than the population as a whole. Multiple factors drive this astronomical risk, including low tolerance after a period of abstinence, use of drugs from unfamiliar sources and of unknown strength, mixing multiple substances, and the disorienting chaos inherent to the reentry process.
It is easy to cast post-incarceration substance use -- and consequent overdose -- as the individual's character weakness and recklessness. But we know that relapse is a foreseeable consequence of the chronic nature of addiction. The good news is that science provides clear guidance on how these post-release deaths can be prevented; the bad news is that we are doing almost nothing to avert them.
Targeted overdose education, resuscitation training, and distribution of naloxone -- the opioid antagonist -- are highly effective in curbing overdose fatalities. Research from the U.S. and abroad suggest that brief overdose prevention efforts are easily integrated into existing pre-release programming, drastically cutting reentry overdose risk. Yet, only a handful of U.S. programs are currently providing such training to inmates before they re-enter the community; none cover federal prisoners.
Medication-assisted treatment (MAT) and other evidence-driven care behind bars have also shown to cut overdose risk upon re-entry, especially when released individuals continue with their treatment in community-based settings. We know that upwards of 80 percent of incarcerated individuals are estimated to require such treatment, but only a small percentage receive any help with their substance use issues. Although there are some federal and state efforts to remedy this, access to science-based MAT behind bars remains dismally rare. Once on the outside, former inmates face a barrage of barriers to community-based MAT and other services, including the need to re-enroll in health insurance coverage and long wait lists plaguing our byzantine drug treatment sector. The Affordable Care Act (a.k.a. Obamacare) includes several provisions that may help address these issues.
Transitioning into community after time behind bars is disorienting and stressful, so overdose prevention must also be incorporated into other support programs already in place. Instead, many institutions supposed to facilitate re-entry may inadvertently aggravate overdose risk. For instance, most halfway houses offer zero overdose education, while some transitional housing organizations espouse ill-informed policies prohibiting MAT. Community supervision officers are optimally situated to assess -- and reduce -- overdose risk among people on probation or parole, but there is currently almost no effort to engage them in this vital work.
After years of stubborn inaction, federal sentencing reform and other de-incarceration efforts are finally gaining momentum. In adapting to this paradigm shift, criminal justice institutions need to take ownership of the overdose risk facing inmates after they leave custody and the opportunities to address it. Tragically, this potential goes almost completely unrealized. As we celebrate progress, we must demand that the criminal justice system do more to ensure that spending time behind bars does not translate to a death sentence for so many.
This post was based on an article "Fatal Re-Entry: Legal and Programmatic Opportunities to Curb Opioid Overdose Among Individuals Newly Released from Incarceration" published in the Northeastern University Law Journal and co-authored with Lindsay LaSalle, Michelle Newman, Janine M. Paré, James S. Tam and Alyssa B. Tochka.