Los Angeles jails limit opiate treatment as fatal overdoses continue

from Kayla MichalovichCalMatters

This story was originally published by CalMatters. Sign up for their newsletters.

Los Angeles County jails have restricted access to life-saving equipment opioid addiction treatment this fall during one of the system’s deadliest years, according to records obtained by CalMatters and interviews with staff.

The policy change came a week after Attorney General Rob Bonta sued the county over “inhumane” conditions in the prison system, citing a “shocking death rate,” including overdoses.

In interviews with CalMatters, two Correctional Health Services doctors expressed concern about the reductions, saying even the slightest delay in treatment is “wildly dangerous” and could lead to more fatal overdoses.

“Patients are asking me for help,” said a doctor who spoke to CalMatters on condition of anonymity for fear of professional retaliation. “I’m on edge, waiting to see if someone dies.”

The reduction in treatment also comes as jails hold about 700 more people each day as a result of a tough-on-crime measure approved by voters last year. Proposition 36 extended sentences for certain drug and theft offenses, causing prison populations to grow and strain county resources, according to a Sept. 10 memo from Correctional Health Services to the Board of Supervisors.

Los Angeles County allocates approximately $25 million annually to the treatment program. County supervisors this year gave the program an additional $8 million from opioid court settlements. That amount ultimately did not increase funding for treatment because the department uses the money for various needs, according to a statement from the Los Angeles County Department of Health.

“Total funding for the (medication-assisted treatment) program remained the same” despite the additional money the department received, the statement said.

In a Sept. 16 memo obtained by CalMatters, Chief Medical Officer Sean Henderson said Correctional Health Services “will pause in primary care when ordering buprenorphine.” The drug reduces appetite and prevents overdose.

The new mandate limits how quickly and widely correctional health services doctors can prescribe the drug. Priority will be given to people when they first enter the prison system — California’s largest — which houses roughly 13,000 people in nine major facilities. Everyone else who wants medication will be put on a waiting list.

“It’s misleading because we just put people on that list and then they stay on the list,” said a doctor.

That means if someone doesn’t accept treatment upon arrival, they won’t have access to it for the rest of their incarceration, even if they change their mind, said both doctors who spoke to CalMatters.

Legal experts and doctors say there can be a myriad of reasons why people refuse treatment when they are first arrested and incarcerated. For example, a person may not be fit to make medical decisions if they are in active withdrawal.

The waiting list for opioid treatment has grown

Between 2,350 and 2,650 incarcerated people in Los Angeles County receive drug treatment each day, the Los Angeles County Department of Health said in an email to CalMatters.

As of Sept. 15 — just one day before the rule change took effect — 363 people were on the waiting list for treatment, the department said.

But that number jumped to 835 people as of October 31. The total includes 471 newcomers who have never participated in the program; the rest are people who have asked to re-enroll after dropping out. As of October, the average waiting time was 25 days, the department said. The department refused to answer how long the person waiting the longest has been in line for treatment.

In a statement to CalMatters, the Los Angeles County Department of Health said the policy change is intended to “help maximize the reach of (its) jail-based treatment program by utilizing existing medical staff at the (Inmate Intake Center) where patient traffic is constant.”

The department maintains that drug treatment is “still available to all inmates, including those who may have refused treatment when they first arrived.”

“The length of incarceration varies for each inmate, from just a few days for some to many months for others; whether an individual will access (medication-assisted treatment) while incarcerated is based on their personal choice, unique case, and length of time they will remain incarcerated,” the department wrote.

Melissa Camacho, senior staff attorney at the ACLU of Southern California, said the reduction in treatment is “staggering” in a year of record deaths.

“I would like to know how many people who died of overdoses were on the waiting list,” she said. “Having a waiting list doesn’t matter if the waiting list is too long to get treatment.”

More money for prison health care in Los Angeles

Medication-assisted treatment combines counseling with FDA-approved medications, including buprenorphine, methadone, and naltrexone to treat certain substance use disorders. A 2021 report by the National Commission on Correctional Health found that drug and alcohol overdoses are the third leading cause of death in prisons, after illness and suicide.

Los Angeles County was the first to adopt medication-assisted treatment in its jails. Since the program began in 2021, approximately 25,000 inmates have been treated with Suboxone, an oral form of buprenorphine administered daily by medical professionals. But relying on Suboxone alone has proven challenging due to staffing limitations, the Los Angeles County Department of Health said in an email to CalMatters.

That’s why, according to Correctional Health Services doctors, the current regime allows someone to have access to Suboxone for only 30 days when they first arrive at the detention center. They can then receive a long-acting injectable form of buprenorphine that is given once a month.

Since July 2022, nearly 40,000 doses of injectable buprenorphine — which cost roughly $1,600 per shot — have been administered to incarcerated people, according to the Los Angeles County Department of Health.

In a Sept. 10 memorandum to the Board of Supervisors, Correctional Health Services Director Christina Galli said overdose deaths accounted for at least 28 percent of deaths this year. This is a sharp increase from 2016, when they accounted for 9% of deaths in custody.

“Of all the medical care we provide in the prison, opioid use disorder treatment is definitely the most life-saving measure we provide,” said a second doctor, who spoke to CalMatters on condition of anonymity for fear of professional retaliation. “It seems paramount to protect these services.”

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.