Prisoners favor new anti-addiction drug

by Joseph Gresser

copyright the Chronicle  5-15-13

NEWPORT — Some inmates at Northern State Correctional Facility here are exploring new frontiers in prison contraband.  In the past month or so, several people have appeared in the Orleans Criminal Division of Superior Court and admitted trying to smuggle buprenorphine strips into the prison.

Buprenorphine is an opiate that was developed to treat opiate addiction.  It is used like methadone, but is believed to be less addicting itself.

While it may appear that prisoners are trying to smuggle in drugs to treat their own addictions, “our experience is that people who use it tend not to use it the way it was intended to be used,” said Pam Bushey, program services director for the state Department of Corrections.

Although most of those who are incarcerated have substance abuse problems, Ms. Bushey said, “We generally do not continue medically assisted treatment past 60 days.”

People who are incarcerated for fewer than 60 days and who have valid prescriptions for a drug like methadone will receive their medications, she said.  (The methadone clinic in Newport does not dispense buprenorphine.)  But those who have longer sentences have their dosages tapered off and no longer receive substance abuse medications after two months.

Ms. Bushey said that substance abuse treatment, as such, is not a major focus of the corrections system.

“Even though we are the Department of Corrections and part of the Agency of Human Services,” she said, “our main focus is on risk reduction.”

Risk reduction, Ms. Bushey explained, means reduction of risk to the general public from released inmates.

“Generally what the research says is while 75 to 80 percent of the incarcerated population may have a substance abuse diagnosis, the larger issues are antisocial thinking and antisocial personality traits,” said Ms. Bushey.

 Drug resembles Listerine strips

Buprenorphine is produced as a tablet or in the form of a strip of film that can be dissolved by placing it under the tongue.

Dominic Damato, interim director of facility operations for the Department of Corrections (DOC), said what he calls “bupe strips” look like Listerine breath freshening strips, but are orange in color.

According to the manufacturer of the films, sold under the trade name Suboxone, the drug works by binding to the same receptor in the brain that is used by heroin or other opiates.

Suboxone combines buprenorphine with another drug, naloxone, which blocks the same receptors.  The combination is intended to produce immediate withdrawal symptoms if a person tries to abuse the drug by injecting it.

Because the effects of buprenorphine seem to plateau at a relatively low dosage, taking more of the drug will not produce an increased effect, according to the label information.

DOC officials offered several possible answers to the question of why someone would risk arrest to get a drug that was designed to be difficult to abuse into the hands of inmates.

“Science lags behind the experience of abusers,” Ms. Bushey said dryly.

“You have to understand, many of our inmates who have a lifetime of substance abuse just chase the high.  They’d take sugar pills,” said Mr. Damato.

He suggested that the buprenorphine strips, which are easily concealed, might also be valuable as an item in prison commerce.

In at least three cases over the past month, people have admitted trying to pass slugs, containers wrapped in electrical tape containing contraband including buprenorphine strips, through the fence at the prison.  In each case the plans were broken up by police who were alerted to the smuggling plot by prison officials.

According to court files, the smuggling plots were hatched over phone lines monitored by prison guards.  Mr. Damato said that every phone call between inmates and the outside world is preceded by a taped message that both the caller and the person receiving the call can hear warning that the call may be monitored.

“The criminal mind is willing to take that risk,” he said.

Mr. Damato said that buprenorphine smuggling does not appear to be a national trend yet.  In fact, he said, officials at out-of-state prisons which house Vermonters were caught by surprise when the drug turned up in their facilities.

He said inmates have devised a variety of ways of trying to get hold of buprenorphine in both of its forms.  In addition to passing slugs through the wire, attempts to smuggle the drug in by leaving it in a bathroom have been foiled and resulted in court charges.

Other methods of trying to get the drugs to inmates include crushing tablets and placing them under stamps or stickers on letters to inmates, concealing them in documents or newspapers, and even using dissolved strips to paint on children’s drawings.

Mr. Damato said the DOC is pretty good at stopping these attempts.

“We have a pretty good security process, but it’s not foolproof,” he said.

It is too bad, Mr. Damato added, that prisoners can’t have drawings from their kids, just because some try to take advantage of sentiment.  He said the DOC is working on an e-mail system to allow more contact between inmates and their families.

Much of the problem, in Mr. Damato’s view, comes from doctors who write what he termed “frivolous prescriptions.”  The result is a large amount of medically unnecessary buprenorphine at large in the community, he said.

Behind jail walls, the drug becomes part of a prison economy in which anything of value can be used as currency to buy anything from snacks to contraband from other inmates.

“That’s one reason that we have uniforms.  It takes the value of clothing away, so inmates won’t change Michael Jordans for contraband,” Mr. Damato explained.

He compared commerce behind the walls to life on a desert island.  “Coconuts would be valuable there,” he said, “if you had them and someone else didn’t.”

 Discovery program seeks risk reduction

In its pursuit of risk reduction, Ms. Bushey said, over the past two years the DOC has instituted a new way of working with inmates to help them learn how to act in a way that will not return them to prison.

The program, called Discovery, is designed to teach inmates “to avoid rule-breaking behavior,” Ms. Bushey said.

Ms. Bushey said it is too early to have firm data on the success of the program — judged by the number of people who have gone back to prison within three years of their release — but, she said, anecdotal evidence suggests that the program is achieving its goals.

The curriculum for the Discovery program is based on principles of cognitive behavior therapy, which seeks to change people’s actions by giving them new ways to deal with impulses that might lead to trouble, Ms. Bushey said.

Earlier programs, she said, “were doing a lot of cognitive work, but not doing a lot of behavioral work.”  The behavioral aspect of the program is intended to give inmates new ways to deal with the impulses that the cognitive portion of the program brings to their attention.

One of these strategies, she said, is called urge surfing.  Its premise is that an urge to do something, such as use drugs, may be intense, but if it is not acted on goes away quickly, she said.

The urge surfing technique encourages people not to concentrate on the desire to take drugs, or to fight it.  Instead a person is taught to pay attention to particulars of the urge, such as where in the body it is felt, and to notice how it builds in intensity and then drops off, Ms. Bushey said.

She said that inmates are also helped to see what sort of situations provoke urges and, if possible, to avoid these situations.  If a person with an alcohol problem — and alcohol is by far the substance most abused by inmates — finds that he faces a strong temptation to drink when he plays cards with his buddies, it might be best for him to skip the game.

Unlike earlier attempts to help inmates, the Discovery program demands a great deal of work from participants, Ms. Bushey said.  She refers to more intensive classes as an “increase in dosage.”

Completing the Discovery program requires 200 hours of class time, she said, and at least 14 weeks.  When inmates’ work schedules are taken into consideration, that represents a major commitment of time and energy, Ms. Bushey said.

Another change is that the program is no longer filled primarily by people who volunteered to participate.  Instead, Ms. Bushey said, inmates with a high or moderate risk of offending are picked.

In addition to working on dealing with impulses that might lead to illegal behavior, inmates are taught social skills, Ms. Bushey said.  Among them she listed active listening, giving feedback, dealing with negative feedback from others, negotiating and problem solving.

Ms. Bushey is optimistic about the new program, which she said has already been tried with success in Oregon, Ohio and Washington institutions.

If she is correct the question of smuggling could be lessened as inmates learn to avoid the kind of behaviors that lead to that kind of trouble.

contact Joseph Gresser at [email protected]

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