SCOTT SIMON, HOST:
Overdose deaths are rising dramatically in state prisons. Data from the Bureau of Justice Statistics show that while all unnatural deaths are increasing, drug- and alcohol-related deaths have seen the most extraordinary rise - up 600%. The increase is leading to calls for prisons to change their entire approach to drug addiction. Jimmy Jenkins from member station KJZZ reports.
JIMMY JENKINS, BYLINE: Enrique Alan Olivares-Pelayo started using heroin at a young age, but he didn't experience an overdose until years later, when he went to prison in Douglas, Ariz.
ENRIQUE ALAN OLIVARES-PELAYO: On a minimum unit, actually - and I was cared for by my friends because, like, we could be unobserved by officers for extended periods of time.
JENKINS: He says heroin overdoses were common, and his cellmates were practiced in preventing loss of consciousness.
OLIVARES-PELAYO: They put me on a bed, and they gave me a little bit of crystal methamphetamine.
JENKINS: Essentially treating one illicit drug with another - not the way doctors would have treated him, but Olivares-Pelayo credits his friends with saving his life. That was in 2010. But access to illegal drugs in prisons continues with more dire consequences as powerful drugs like fentanyl have taken over, and the cost can be seen in the prison mortality rate. The nonpartisan advocacy group Prison Policy Initiative recently reviewed federal data collected from 2001 to 2018. They focused on unnatural deaths. That includes homicide, suicide and those caused by drug and alcohol abuse. Suicides have been increasing rapidly, but one category really stood out.
WANDA BERTRAM: There's been a 600% rise in drug and alcohol intoxication deaths over the last 20 years.
JENKINS: Wanda Bertram is with the initiative. She says the new federal data does not include information about what drugs people are using behind bars. To get a better sense, KJZZ and The Marshall Project examined death analysis information from California's prison system, among the country's largest. We also interviewed prison employees and currently and formerly incarcerated people in five states. We found that opioids, synthetic marijuana and methamphetamine are, by far, the most prevalent.
APRELLE MCCARTY: Meth - meth was a huge thing.
JENKINS: Aprelle McCarty retired in 2019 after 14 years as a correctional officer in the Alaska prison system, where overdose rates are among the highest in the nation. She says the drugs would come in waves.
MCCARTY: We definitely had COs, kitchen stewards, maintenance people that brought it in.
JENKINS: She says it was frustrating to watch prisoners she worked with going through programming, making progress.
MCCARTY: And then someone would get them some meth, and they would go crazy.
JENKINS: As prisons cycle through periods of drug supply and scarcity, those using the drugs experience a dangerous buildup and sudden loss of tolerance, which can lead to more overdoses, according to Dr. Jody Rich, an infectious disease and addiction expert who works with incarcerated populations.
JODY RICH: People, if they use opiates on a daily basis, can develop tolerance. And that tolerance can be quite high and can develop very quickly in days to weeks, but it also goes away in days to weeks.
JENKINS: He says as long as there is a demand in the prisons, the drugs will find a way. And that's a problem because they're not addressing addictions.
RICH: We should be treating them.
JENKINS: With proven medications like Methadone, Suboxone and Vivitrol - without proper treatment and powerful drugs like fentanyl readily available in prisons, Rich says there's never been a more dangerous time for incarcerated people who use illicit drugs. And prisons need to change their response.
RICH: The first tangible evidence of this I saw clinically was a young man who was in his late 20s.
JENKINS: He was in a minimum-security prison, buying what he thought was cocaine.
RICH: About a half a grain of rice worth of powder - white powder.
JENKINS: He snorted it, but it was fentanyl, and he passed out. Rich said it took four doses of naloxone to bring him back around. Rich's research found fentanyl-related overdoses appear to be increasing in prisons, but the numbers are still hard to quantify. To address the overdose crisis behind bars, the California prison system says it uses robust drug and contraband detection and interdiction efforts at state prisons. The state also recently began rolling out a comprehensive treatment program, which includes Suboxone and Methadone.
Arizona prison officials say staff are now carrying Narcan, which has helped lower the number of overdoses in recent years. And the department is currently running a medication-assisted treatment pilot program. Enrique Alan Olivares-Pelayo is now a graduate student and community organizer in Tucson, but he keeps in touch with people in state prisons. And he believes overdoses are much more common than we know because the nature of prison culture keeps many of the incidents hidden.
OLIVARES-PELAYO: Because if you self-report an overdose or you go and seek help for the fact that you took drugs, everyone else pays consequences for that.
JENKINS: Visitations are closed. Phone calls are monitored more closely. Drug dogs are sent into living areas, and cells are tossed as COs search for contraband.
OLIVARES-PELAYO: So the standing code of conduct is that they would never self-report an overdose that's happening.
JENKINS: He says until more prisons change the way they approach drug addiction, overdose deaths will continue to rise.
For NPR News, I'm Jimmy Jenkins in Phoenix.
SIMON: Beth Schwartzapfel of The Marshall Project also contributed to that report. Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.