Calif. prison doctors fear drug treatment program could create new addicts

The doctors said they support medication-assisted treatment for inmates, but they have concerns over CDCR's implementation


By Wes Venteicher
The Sacramento Bee
        
SACRAMENTO — More than a third of California state prison doctors are objecting to a new corrections department requirement that they prescribe an opioid treatment drug, saying the prisons aren't taking enough precautions to prevent its abuse.

The 138 doctors' objections, outlined in a petition drafted by the Union of American Physicians and Dentists, come as the Department of Corrections and Rehabilitation continues its rapid rollout of the largest prison drug treatment program in the country.

Launched in January 2020, the program makes available to prisoners the three most effective opioid medications available. The corrections department launched the program to try to curb an alarming rise in prison overdoses: 64 California prisoners died of overdoses in 2019, according to the most recent data.

Three doctors said prisoners often hide pieces of Suboxone film instead of ingesting them and sell them to other inmates for as much as $200. Inmates have also been smoking or dissolving and injecting them.
Three doctors said prisoners often hide pieces of Suboxone film instead of ingesting them and sell them to other inmates for as much as $200. Inmates have also been smoking or dissolving and injecting them. (Photo/Wikimedia Commons)

The doctors said they support medication-assisted treatment for inmates, but they have concerns over the department's directives for prescribing Suboxone, a brand-name drug that combines the addictive opioid buprenorphine with overdose-reversal drug naloxone.

The prisons administer the drug in soluble pieces of film the size of a Band-aid patch. In interviews, three doctors said prisoners often hide the pieces of film instead of ingesting them and sell them to other inmates for as much as $200, often at the direction of gang leaders.

Prisoners have been smoking the pieces of film in cigarettes and dissolving and injecting them, leading to overdoses and hospitalizations, said Dr. Steven Sabo, who works at the California Men's Colony in San Luis Obispo and spoke with The Sacramento Bee on behalf of the physicians union's policy committee.

Sabo said he is most concerned about abuse by prisoners with no history of opioid use.

"I feel like we're adding to the problem, not taking away from the problem," Sabo said.

Prison overdoses

To prescribe buprenorphine, the doctors have to take a training course and sign a Drug Enforcement Administration waiver certifying they are prescribing the drug according to federal standards.

The doctors, who said they have been told they must sign the waivers by June 30 or face discipline, said they aren't convinced the prisons are meeting requirements for counseling and safe prescribing.

Elizabeth Gransee, a California Correctional Health Care Services spokeswoman, said in an email that the prisons check inmates' urine frequently to make sure they are using the drugs according to treatment plans, which Gransee said is "almost always the case."

About 10,400 inmates are receiving treatment across the 35 prisons run by the state, Gransee said in the email. About 97,000 people are in corrections department custody, according to the latest population report.

"We are committed to providing necessary services to those within our system and will continue to implement safe, sustainable processes to expand treatment," Gransee said in the email.

She didn't respond to a request to interview an official in charge of the program.

J. Clark Kelso, a federal receiver overseeing prison health care in California, described the system's approach to drug treatment in 2019 as "go bold, go big," in testimony before a state legislative committee.

At that time, correctional health care system data showed 40 inmates had died from overdoses in 2017, up from 19 two years earlier. The deaths climbed to 62 in 2018 and 64 in 2019, according to updated data.

The Legislature and the Governor's Office rejected proposals two years ago to slow the program down. The systemwide rollout, estimated to cost about $129 million in the coming fiscal year, is on schedule, according to Gransee's email.

Gransee said in her email that preliminary data from 2020 suggest a "very significant reduction" in overdose deaths following the program's implementation. She didn't provide the data.

'Don't discontinue this'

Dr. Stuart Bussey, the physicians union president, said the union has filed an unfair labor practice complaint with the Public Employment Relations Board over the way the corrections department has rolled out the program.

The petition, signed by 138 of the 358 doctors who work for the corrections department, seeks "concrete reforms and improvements" to the substance abuse treatment program.

"You have to at least consider the possibility that with so much Suboxone being widely available and not being used by the patients it is prescribed to, you worry that you're even creating new addicts and new problems that were not there before," said Jen Villa, a California Correctional Center doctor who spoke with The Bee on behalf of the physicians union's policy committee.

Among the ideas supported by the doctors is injecting buprenorphine instead of handing out the film strips, to prevent the doses from being diverted. They also said they want the prison's psychiatrists to be involved and they want increased counseling support. And they want to be able to stop prescriptions when inmates abuse the drugs, which they say they can't do now.

The doctors said that due to pressure from superiors, they have little discretion to make regular treatment decisions for their patients.

For example, when urine screens show that patients with Suboxone prescriptions aren't taking the drug — suggesting they're selling it instead — doctors haven't been able to halt the prescriptions, the three doctors said.

Sabo said he told an inmate he was going to discontinue Suboxone when the man tested negative for the drug after picking up doses from a nurse at a counter for 10 days.

The inmate laughed at him and told him he would get the prescription back the next day, Sabo said.

"He was right; they re-started it," he said. "Then I got an email saying, 'don't discontinue this, he could go into withdrawal.'"

Dr. Pierrette Lenoir, who provides telemedicine for San Quentin State Prison and also spoke with The Bee on behalf of the physicians union's policy committee, said she got a phone call from the department after she raised objections to signing the waiver.

Lenoir said she finally signed the waiver, but wrote next to her signature that she was signing under protest.

"I should be able to start it, stop it, manage it, but I can't," she said.
    
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