The State Worker

California prison overdoses are soaring. Gavin Newsom has a $160 million plan to curb them.

The history of Folsom State Prison in about 2 minutes

Opened in 1880, Folsom is the state's second-oldest prison, after San Quentin, and the first in the United States to have electricity. Folsom, near Sacramento, CA, was also one of the first maximum security prisons.
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Opened in 1880, Folsom is the state's second-oldest prison, after San Quentin, and the first in the United States to have electricity. Folsom, near Sacramento, CA, was also one of the first maximum security prisons.

Gov. Gavin Newsom wants to launch a drug and alcohol treatment program for California prison inmates that would be by far the largest and most complex of its kind, and he wants to get it up and running in two years.

The $160 million-per-year proposal, which calls for hiring 280 people next year and 150 the year after that, would make California the third state to provide comprehensive treatment in prisons, along with Rhode Island and Massachusetts.

“I think I can fairly describe our approach here as go bold, go big,” said J. Clark Kelso, a federal receiver overseeing prison health care in California. Kelso spoke in favor of Newsom’s proposal at a state Senate subcommittee hearing on May 14.

Some California lawmakers aren’t sure they’re ready to “go big” with Newsom.

Leaders from the Senate and Assembly this week are writing a final state budget, and one version on the table would scale down the drug treatment program to about a third of the size of the Newsom proposal. The slower approach would start with seven prisons rather than the 35 that Newsom would fund.

The two chambers and the governor’s office face a June 15 budget deadline to hash out differences. Newsom at a press conference this week insisted his plan was the right one, arguing the full program is necessary to address a climbing number of overdoses in state prisons.

The rate of overdose deaths in California prisons is higher than the rate in any other state’s system, and triple the national average, Kelso told the subcommittee last month. On top of that, 800 inmates were treated for non-fatal overdoses last year, he said.

Forty California inmates died from an overdose in 2017, up from 19 two years earlier, according to California Correctional Healthcare System data. The trend tracks with a national pattern to an extent. Nationally, in the general population, overdose deaths increased 16 percent per year from 2014 to 2017, when deaths reached 70,237.

“Our nation has seen an unfortunate increase in drug overdoses, hospitalizations and deaths due to opioids in recent years and the California state prison system is no exception,” California Department of Corrections and Rehabilitation spokeswoman Vicky Waters said in a statement.

Kelso said the problem in California is driven by a steady flow of drugs into prisons despite former Gov. Jerry Brown’s efforts to ramp up screening.

“They’re being mailed in, they’re being brought in by visitors, they’re being brought in by staff, both custody and health care,” Kelso said. “They’re being dropped over the fence in drones, and in some of the more dangerous recent formulations — fentanyl, for example — tiny specks is all you need to get into the facility.”

He said the prisons need to try reducing demand inside the prisons.

Newsom’s proposal would make California the third state to provide all three of the drugs the FDA has approved for opioid dependence: methadone, buprenorphine and naltrexone. The program would focus on new inmates who were receiving treatment before they entered prison, those at high risk of an overdose in prison and those scheduled to be released in 15 to 18 months, according to his budget proposal.

In addition to medical and administrative staff, the proposal calls for hiring 126 new correctional officers in the program’s first six months, who the budget proposal says would provide security in program areas and escort inmates to treatment. The proposal calls for adding staff training focused on reducing stigmas around addiction.

Rhode Island was the first state to provide as broad a treatment program in 2016. A study published in JAMA Psychiatry showed early success.

Rhode Island’s prison system is much smaller and more consolidated than California’s. Staffers of the Assembly subcommittee questioned whether the California Department of Corrections and Rehabilitation could implement a program of the size and scope proposed by Newsom within his cost and time estimates.

CDCR in recent years has faced “demanding challenges that have caused them to fall critically short of meeting laudable goals,” Assembly staff said in an analysis for a May 20 hearing.

Assembly subcommittee staffers balked at the the rapid hires the proposal calls for, and questioned whether the prisons would be able to establish the community connections needed to achieve the “warm handoffs” contemplated in the proposal. The handoffs aim to ensure recently incarcerated people get treatment after release, when they are 42 times more likely than the general population to die of an overdose, according to the subcommittee’s analysis.

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