The Media Does Not Understand or Appreciate the Complexity and Strengths of the Prison Department’s Program to Prevent Overdoses

The Philadelphia Inquirer ran an article recently "Drug deaths and overdoses plague Philly jails, raising concerns about plans to step up Kensington arrests"in which the reporter alluded to flaws in how prison systems' are addressing the overdose crisis, including our system.

The reporter made some valid points about the many challenges prisons face across the country -mostly due to understaffing, however, it failed to help the newspaper's readers truly understand the processes and measures utilized by the Philadelphia Department of Prisons to ensure the safety of all persons struggling with addiction who are held in our custody. We were surprised and disappointed since we made our prison medical services administrator, Bruce Herdman, recognized throughout the country as a leading expert, available as a professional resource but also to spend time explaining our programs and process.

The federal Substance Abuse and Mental Health Administration (SAMHSA) and the federal Department of Justice (DOJ) cite the drug treatment programs of Philadelphia's jails as best practices that should be replicated nationwide.The Inquirer did acknowledge that the Philadelphia Department of Prisons, "is known as a leader in providing medications for opioid use disorder," but did not give the credit to our staff that is well-deserved. Consisting of 325 full-time, licensed clinical and medical personnel, our staff has devoted their careers to helping Philadelphia residents incarcerated in the city's jails, providing, annually:

• 75,000 healthcare visits

• 80,000 laboratory tests

• 120,000 medication prescriptions: psychiatric and physical health inpatient care

• a full range of specialist care, dental care, eyeglasses, and many other services for citizens in need.

Every incarcerated person who suffers from substance abuse disorder is offered treatment (nationally, only 11% of incarcerated individuals receive treatment). The rate of overdose deaths in the jails is the same as the citywide rate, despite that the incarcerated population is 8 times more likely to be addicted to opioids than the citywide population.

It's worth noting that there were almost 1,400 overdose deaths in Philadelphia in 2022 (the last year for which citywide data is available); four were in our jails.

We feel it is important that Philadelphia residents know about the ways our experienced and dedicated staff assist those struggling with substance addiction. We're proud of our staff and know we are leaders in the field. In this blog post, we will elaborate on our well-respected process and success since the Inquirerneglected to provide the details needed to tell the full story - a story that should be told.

Phase 1: Intake Care

The City's process for addressing substance use disorders of arrested individuals is comprehensive. It starts in the Police Administration Building and Police District Offices, where newly arrested individuals are screened for withdrawal symptoms. Those experiencing significant symptoms are transported immediately to the nearest hospital. If an arrested individual is sent to our jail, they are screened again at the front door for withdrawal symptoms.

At the jail, the severity of opioid withdrawal is measured using the nationally recognized Clinical Opioid Withdrawal Scale, also known as the "COWS scale." The very lowest number on that scale is used to start treatment in the Intake area using Subutex, a form of Buprenorphine (aka, Bupe)that almost instantly decreases, if not eliminates, withdrawal symptoms. This medication, which is not used in many jails nationwide, is much more effective than the "comfort medications," used in many other prison systems throughout the country to lessen the severe and sometimes life-threatening symptoms of withdrawal.

While Methadone, Suboxone, and Vivitrol are all medications proven to decrease cravings and significantly contribute to an individual's ability to remain clean after release from jail, Suboxone has been proven to significantly decrease the chances of overdose death soon after release from jail by over 60%. All three medications are administered in the jail (Methadone for over 20 years; Suboxone and Vivitrol since 2018).

Phase 2: Care During Detainment & Post-Release

The next step in our process is to provide daily Methadone and Suboxone maintenance dosing to individuals who are receiving these medications in the community or to start and maintain opioid use disorder patients on Suboxone. Each year, more than 850 individuals who are receiving care in the community are maintained on Methadone or Suboxone during their incarcerations and are linked to their community providers upon release.

We initiate Suboxone treatment for nearly 1,700 individuals annually. Suboxone patients then select and are linked to community providers shortly after arrival at the jail. We provide each Suboxone patient with five days of medication at the time of release to prevent cravings while each patient secures treatment and medication in the community. We also provide patients with Naloxone, a nasal medication sold under the brand name Narcan that can reverse an opioid overdose and prevent death. All inmates are trained about the risk of opioid overdose deaths, how to recognize an overdose, and how to use Naloxone to prevent death.

Our Suboxone program may prevent as many as 120 deaths after release each year and get thousands of Philadelphia residents started on ongoing treatments that can lead to a drug-free life.

It's important to know, the City of Philadelphia treats drug abuse as a brain disorder, not as criminality. We are committed to improving substance use disorder treatments and have done so by:

• substituting Subutex comfort medications to decrease suffering during withdrawal (since last quarter).

• securing funding to allow the jail to administer long-lasting injectable forms of Suboxone to assure medication compliance within the jail and after release.

• adding cognitive behavioral therapy group sessions to treatment protocols (3rdquarter 2024).

We also plan to start issuing municipal photo identification cards to inmates on release because the absence of a photo ID often interferes with access to care after release. We are doing this through the City's Municipal ID Program.

Most citizens incarcerated in Philadelphia do not have regular care providers in the community, so the jail helps those with chronic illnesses choose a community provider to go to after release, sends a referral to that provider and a discharge summary when the citizen is released, and reactivates (or activates) Medical Assistance insurance coverage for almost all individuals upon release so that they know what care they need, where to get it, and can pay for that care when they return to the community.

We are painfully aware that there is a lot of work to be done to restore jail programs to pre-COVID levels, and we're always looking for ways to improve and expand when funding allows. We've also greatly increased our recruitment efforts over the last several months since staffing clearly is an issue.

Even though there is much to be done to continue to improve, we hope more people know that many of our programs are exemplary, and that jail staff are working very hard to make all jail services excellent.

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