Imagine a house that’s infested with termites. No matter how many times you try to fix it, the termites keep devouring the wood and causing damage. That’s similar to what’s happening in prisons across the US, where the drug crisis is swelling and overdose deaths are on the rise. The penal system has long been used as a solution to address drug addiction, but it hasn’t led to a decrease in drug use or overdoses. Instead, there has been a surge in overdose deaths behind bars. The need for alternative solutions that prioritize treatment over punishment is becoming more evident. Research from the Pew Research Center shows that the alcohol and drug overdose death rate in prisons increased fivefold from 2009 to 2019, outpacing the national drug overdose rate. These shocking statistics emphasize the urgent need for comprehensive addiction treatment programs that address both substance use disorders and underlying mental health issues.

Annissa Holland should be excited her son is coming home from prison after four long years of incarceration. Instead, she’s researching rehab centers to send him to as soon as he walks out the gate.

She doesn’t know the person who’s coming home — the person who she said has been doing every drug he can get his hands on inside the Alabama prison system. She can hear it in the 34-year-old’s voice when he calls her on the prison phone.

Her son is one of almost 20,000 inmates in the Alabama prison system living in conditions the U.S. Department of Justice has called inhumane. In two investigations, it found that the rampant use of drugs causes sexual abuse and “severe” violence in the state’s prisons. The department has sued Alabama, alleging conditions in its prisons violate inmates’ civil rights. According to the Alabama Department of Corrections’ own report, almost 60 pounds of illicit drugs were confiscated from its prisons in the first three months of this year.

Even if Alabama’s prisons and jails are especially overrun by drugs, death, and violence, their problems are not unique in the U.S. Within three weeks this spring, incarcerated people died of overdoses in Illinois, Oklahoma, New York, and the District of Columbia.

The alcohol and drug overdose death rate increased fivefold in prisons from 2009 through 2019, according to a recent study from the Pew Research Center — a surge that outpaced the national drug overdose rate, which tripled in the same period.

As the opioid crisis ravages America, overdose deaths are sweeping through every corner of the nation, including jails and prisons. Criminal justice experts suggest that decades of using the legal system instead of community-based addiction treatment to address drug use have not led to a drop in drug use or overdoses. Instead, the rate of drug deaths behind bars in supposedly secure facilities has increased.

This rise comes amid the decriminalization of cannabis in many parts of the country and a drop in the overall number of people incarcerated for drug crimes, according to the Pew report.

“It certainly points to the need for alternative solutions that rely less on the criminal justice system to help people who are struggling with substance use disorders,” said Tracy Velázquez, senior manager for safety and justice programs at the Pew Charitable Trusts.

For decades, drug use in America has mainly been addressed through the penal system — 1 in 5 people behind bars are there for a drug offense. Drug crimes were behind 30% of new admissions to Alabama prisons in March. Nationally, they were the leading cause of arrest, and almost 90% of arrests were for possession of drugs, not sale or manufacturing, according to the Pew study. The researchers also found that fewer than 8% of arrested people with a drug dependency received treatment while incarcerated.

Velázquez said a lot of drug use is spurred by people with mental health issues attempting to self-medicate. Almost 40% of people in prisons and 44% in jails have a history of mental illness, according to the Bureau of Justice Statistics.

Holland said her son was diagnosed with schizophrenia and PTSD six years ago after struggling with drug use since his teens. The son, who asked that his name not be published for fear his comments could jeopardize his release from prison or subsequent parole, said a schizophrenic episode in 2017 led him to break into a house during a hurricane. He said he didn’t realize people were in the house until after he ate a sandwich, got a Coke from the fridge, and looked for dry clothes. They called the police. He was sent to prison on a charge of burglary.

“They don’t put the mental health patients where they should be; they put them in prison,” Holland said.

She’s not only frustrated by the lack of medical care and treatment her son has received, but also horrified at the access to drugs and the abuse she said her son has suffered in the overcrowded, understaffed Alabama prison system.

He told KHN he’s been raped and beaten because of drug debts and put on suicide watch more than a dozen times. He said he turned back to using heroin, meth, and the synthetic drug flakka while incarcerated.

“We need to really focus on not assuming that putting someone in jail or prison is going to make them abstinent from drug use,” Velázquez said. “We really need to provide treatment that not only addresses the chemical, substance use disorder, but also addresses some of the underlying issues.”

Beth Shelburne, who works with the American Civil Liberties Union, logged 19 drug-related deaths in Alabama prisons in 2021, the most she has seen since she started tracking them in 2018.

She said those numbers are just a snapshot of what is going on inside Alabama’s prisons. The Justice Department found the state corrections department failed to accurately report deaths in its facilities.

“A lot of the people that are dying, I would argue, don’t belong in prison,” Shelburne said. “What’s so disgusting about all this is we are sentencing people who are drug-addicted to time in these ‘correctional facilities,’ when we’re really just throwing them into drug dens.”

The corrections department’s reports reveal at least seven overdose deaths in 2021, three of which officials classified as natural deaths. It reported 97 deaths in the first three months of this year that have yet to be fully classified.

Though Republican Gov. Kay Ivey recently announced a grant of more than $500,000 for a program to help incarcerated people address drug use disorders, the number of graduates of drug treatment programs in the state’s prison system has plummeted in the past decade to record lows. About 3% of prisoners completed a treatment program in 2021, down from 14% in 2009.

In contrast, California reported a 60% reduction in overdose deaths in its prisons in 2020, which state officials attributed to the start of a substance use treatment program and the widespread availability of medication-assisted therapy.

Alabama’s system is developing a medication-assisted treatment plan with its health contractor, said Alabama Department of Corrections spokesperson Kelly Betts. Before 2019, medications that curb drug cravings or mute highs were given only to those who could be separated from the general prison population, according to Deborah Crook, the department’s health services deputy commissioner.

“The science has changed considerably and there are more medication options that are safer to prescribe — even in general population,” she wrote in a statement.

Though prison officials have long blamed visitors for bringing in drugs, the ban on visitation during the pandemic did not lead to a drop in drug use inside. Multiple officers were arrested in Alabama last year and accused of bringing drugs into jails and prisons, and the Department of Justice’s 2019 report found dozens of officers arrested in the previous two years on charges related to drug trafficking and other misconduct.

Illegal drugs are “a challenge faced by correctional systems across the country,” Betts wrote in an email. “The ADOC is committed to enforcing our zero-tolerance policy on contraband and works very hard to eradicate it from our facilities.”

Betts did not specify how these policies are enforced. The department also refused to respond to a detailed list of questions about drug use and overdoses in its prisons, citing the litigation with the Justice Department.

Holland doesn’t know what will happen when her son gets out. He said he hopes he can restart his business as an electrician and provide for his family. But the four years of his so-called rehabilitation have been a nightmare for both of them.

“They’re released messed-up, hurt, and deeply dysfunctional. What do you do with someone that’s been through all that?” Holland said. “That’s not rehabilitation. It’s not.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.USE OUR CONTENTThis story can be republished for free (details).

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