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A Chance To Save Inmates From Opioid Addiction

In this Friday, March 15, 2019 photo, Laura Levine prepares to stock sterile supplies at the syringe exchange at Vocal NY, an organization that works with addicts. New York state -- and now Connecticut -- are considering providing medication-assisted treatment to all prison and jail inmates struggling with opioid addiction. (Bebeto Matthews/AP)

Connecticut’s rate of opioid deaths is nearly double the national average, and still much that is lost to the epidemic goes uncounted. Among the official casualties, nearly half belong to Connecticut residents with histories of incarceration. Among the unacknowledged casualties are the lifetimes lost to grief and sorrow, by their family members and loved-ones.

As a physician, an attorney and a member of the Connecticut State Medical Society’s Opioid Committee, I am painfully aware of both Connecticut’s mortality data and how our opioid deaths are concentrated in our most vulnerable communities. As the brother of a sibling who lost his life to heroin, I am even more painfully aware of the sorrow lived by those left behind.

But there can be hope, even where it seems hopeless. The state legislature is currently considering House Bill 7395, a bill that would reach the incarcerated population with the care that they need.

Currently, Connecticut prisoners receive no medication-assisted therapy for opioid use disorder. Rather, those who suffer from addiction are cut loose to reenter the same social situations and use patterns that brought them into prison, without the protections of either tolerance or medicine.

Predictably, this too often ends in grief. It is grief that transcends the overdose and lingers in the survivors. It is grief of which I was recently reminded by a 12-year-old girl named Abigail. In many ways, this grief is her story.

When I met Abigail, on the adolescent ward of Yale Psychiatric Hospital, she had already lived far more than her 12 years might suggest. Early abuse, neglect and violence had overtaxed her fragile psyche, leading to a daily struggle against overwhelming hopelessness. She sought relief by cutting her arms in neat razor-bladed rows of self-mutilation, and repeatedly contemplating suicide. She came to me just a few days removed from an emergency hospitalization for drinking bleach.

As Abby relayed her story to me, in a soft voice made softer by the caustic burns around her lips, I heard the same themes that I often hear in these cases: She lived with depression, and on this backdrop a new injury had pushed her beyond her 12-year-old limits.

Abby explained that her suicide attempt and hospital admission coincided with the 1-year anniversary of her mother’s passing. She explained that her mom had been in and out of Abby’s life, nearly since birth, often landing in jail for property crimes committed to sustain her substance use.

Following her last release from York Correctional, Abby’s mother was picked up in the prison parking lot by an old boyfriend, and the two began a celebration that ended her life. Time in prison had deconditioned her system such that she was no longer tolerant to the drugs that her body still craved. And so inevitably, the same patterns of use that prompted her incarceration proved too much for her body to withstand. Just as hundreds of her fellow former inmates do, every year, Abby’s mother succumbed to an opioid overdose.

Abby admitted that she and her mother had never had the luxury of living close with one another, but that didn’t make her mother any less her mother. It was this guttural loss that drove Abby, a slight, 12-year-old girl with a sad smile, plain hair, and shelter clothing, beyond her reserves.

In many ways, the tragedy of Abby’s story owes to collapsing systems: frayed social supports, crumbling safety nets, a shattered family. But in one very real way — in the way most important to Abby — it owes to a broken policy that prevented her mother from receiving the care that could have saved her life.

Time in prison left Abby’s mom vulnerable to the stream of evermore potent opioids flooding Connecticut’s communities, and without the protection of medication-assisted therapy, she stood little chance in the days after her release. Abby lost her mother, and it will take every ounce of her 12-year-old resiliency to regain any sense of a normal life.

But the sorrow of Abby’s story does not have to be the rule. House Bill 7395 would provide Connecticut’s incarcerated population with the opportunity for a happier ending. Linking inmates to medication-assisted therapy while in prison is not only the correct medical intervention, but it makes possible outcomes whereby Connecticut families and communities have the chance to heal, to progress, to strengthen those same systems that failed Abby.

Certainly, there will be some who question the wisdom of replacing one drug with another. Regrettably, there will likely be a hardened few who will even question the provision of “extra” care to the incarcerated. To these, I can only say that it is our mission in Connecticut to create a state where every 12-year-old, regardless of background, has an opportunity at happiness.

Will Rutland is a psychiatry resident at the Yale School of Medicine.

This article was taken from the Hartford Courant.



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