ARI SHAPIRO, HOST:
More than a hundred Americans die from opioid overdoses every day. From 2015 to 2016, opioid overdose deaths in the U.S. went up by 28 percent. A few years ago, Rhode Island's governor asked some experts to look for ways to address this problem. And when they took a close look at who was dying from overdoses, they realized that one place offered a huge opportunity for an intervention.
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UNIDENTIFIED PERSON #1: (Unintelligible).
SHAPIRO: Prison. Dr. Jody Rich of Brown University was on the task force.
JODY RICH: I mean, it's just ludicrous that we have a whole population of people who are by and large being incarcerated, caught up in the criminal justice system because of their disease. And we have an effective medication treatment for this disease, and we don't give it to them.
SHAPIRO: Many prisoners wind up behind bars for crimes that feed their addiction like burglary or drug possession. When they get out of prison, they often relapse without the same opioid tolerance they had before.
RICH: And if you relapse back to the same level that you were using, you're set up for overdose and death.
SHAPIRO: At the John J. Moran Medium Security Facility in Cranston, R.I., inmates are playing basketball in the yard on a sunny afternoon. Everyone who enters the correctional system in Rhode Island is screened for opioid addiction. And everyone who has an addiction is offered medication-assisted treatment, meds like methadone, Suboxone and Vivitrol that can reduce cravings and help people stop abusing. This is considered the most effective form of treatment for opioid addiction, but the vast majority of Americans with this disorder don't get these medications. At this prison, about 10 percent of the inmates are on one of the therapy drugs.
UNIDENTIFIED PERSON #2: I brought some footnotes.
UNIDENTIFIED PERSON #3: You came prepared.
SHAPIRO: Group therapy is part of the program, too, and we sat in on a session in a classroom. We're only using the inmates' first names so they can speak frankly about illegal behavior. A goateed 23-year-old named Ray is here for robbery. He describes his experience arriving here a few years ago before this treatment program existed.
RAY: It was a rough detox in a cell. I was sick for a good 30 days - you know, the physical aspect. The mental aspect - I mean, I didn't get a good night's sleep for at least six months. There was no counseling when I came in. There was really nothing - three in a cell and told you to go to chow and everything.
SHAPIRO: That's pretty typical of American prisons. A 39-year-old-man named Josh has a history of drug offenses and prison time going back years.
JOSH: Time wasted from my kids, time wasted from my family, time wasted from my life all because of drugs. Pretty much every time I got out of here, I overdosed repeatedly.
SHAPIRO: You know, one real fear is that people will die of an overdose because their resistance goes down when they're incarcerated. Do you know people who've lost their lives that way?
UNIDENTIFIED PERSON #4: Friends.
KEVIN: Very good friends. I had two very good friends.
SHAPIRO: That's Kevin, a man with a salt-and-pepper beard. He's serving time for shoplifting. Josh says he's seen the same thing.
JOSH: I had a close friend die right in the other room. Yeah, just a lot of people. I had quite a few right in my hands. It's a horrible thing.
SHAPIRO: And does it seem to you like an avoidable thing? Like, if there had been programs for these people...
JOSH: Yeah, absolutely, absolutely.
SHAPIRO: This program in Rhode Island costs $2 million a year. That's money the state could have used to improve schools or roads. So I asked Patricia Coyne-Fague, the acting director of Rhode Island's Department of Corrections, what she says to skeptical politicians when they ask why this program is worth the money.
PATRICIA COYNE-FAGUE: It saves people's lives. Sometimes there can be a negative attitude about whose lives we're saving. But, you know, everybody belongs to somebody. And so while they may have committed crime and deserve to be incarcerated, they're still human beings. And if we can keep people from dying, that's a good thing.
SHAPIRO: And early evidence shows that this program is keeping people from dying. In the first six months of last year, researchers saw a significant drop in overdose deaths among people recently released from prison. The prison system's medical director, Dr. Jennifer Clarke, believes this will actually save money in the long run. She says, look at who tends to die from overdoses.
JENNIFER CLARKE: They are typically young. Many of them are young parents. So it's not just the life of the individual. It's the whole family. It's a whole community that's affected. So all analyses that have been done have really shown that the money we spend on treating people - you save money in other areas of society.
SHAPIRO: When you look at the impact that this program has had in the last couple years, do you think it's something that every prison in every state all over the United States ought to do?
CLARKE: Yes, definitely, without a doubt.
SHAPIRO: And a lot of other states are interested. Corrections officials from around the country regularly come here to see how the program works. One big piece of advice the Rhode Island staff gives - get the prison guards on board. Lauranne Howard is the substance abuse coordinator here, and she's had to work closely with the security staff.
LAURANNE HOWARD: The reaction was, why are you going to bring in a medication that we're working real hard to keep out?
SHAPIRO: So how did you overcome that?
HOWARD: And that's a legitimate concern. We had to have meetings. We did a lot of talking. We did a lot of education.
SHAPIRO: See; a drug like Suboxone is itself an opioid, so inmates might take a pill that's intended for treatment and sell it or give it to someone else. They've tweaked the program to deal with those concerns, switching from pills to strips that dissolve faster.
HOWARD: We talked about all of the benefits of...
SHAPIRO: Lauranne Howard helps run the therapy sessions. And on the day we dropped in, two of the men had a very specific fear. Twenty-three-year-old Ray and 50-year-old Kevin are both getting out soon.
KEVIN: It feels good, but it's like I'm nervous. I'm nervous. I always get nervous.
SHAPIRO: Kevin knows what he has to do when he gets out to make sure he doesn't relapse again.
KEVIN: My feet - when they hit the pavement outside of here, I have to get busy immediately. So I need to get a job, like, right away.
SHAPIRO: Ray is bracing for re-entry, too.
RAY: I already have it lined up. I already have counseling appointments lined up, doctor's appointments lined up.
SHAPIRO: It helps that the substance abuse organization running the program inside the prison also has centers on the outside all over the state. It's a group called CODAC. Lauranne Howard reminds Kevin and Ray that they won't be on their own when they leave here.
HOWARD: You can get your medication the day that you leave. And then the very next day, you can go into a CODAC program and get your medication again.
SHAPIRO: We asked to meet someone who has already been released, and the staff introduced us to Michael Manfredi in an office building near the prison. He's been out for a few years and works in construction now.
MICHAEL MANFREDI: I started at 10 years old smoking marijuana. And I became a heroin addict at 15 years old. And it just progressed, and numerous incarcerations due to my drug addiction.
SHAPIRO: He's 55. The last time he got locked up, he got on Vivitrol as part of an earlier, smaller program.
Does it seem strange that the program that finally helped you escape this was a program that you had to be incarcerated (laughter) to get access to?
MANFREDI: It was the best thing for me to do to get incarcerated because either I was going to die, or I was going to hurt somebody and never come out again. So the best thing that happened to me - and it's not a nice thing to say, but incarceration was the only alternative for me.
SHAPIRO: And how does it feel after so many years of addiction and incarceration to be living this, quote, unquote, "normal life?"
MANFREDI: I still don't believe it's happening, but it is. I'm up at 4 o'clock in the morning, out the door by quarter of 6. I put 10-hour days in. I go to a meeting sometimes five, six times a week. If not, I stay home, and I watch TV, and I play with my grandkids in the yard.
SHAPIRO: When you were in the depths of your addiction, did you ever imagine you could have that kind of a life?
MANFREDI: No. I didn't think it existed. Never thought it would exist - never. Never.
SHAPIRO: So far, Rhode Island is the only state in the country with this comprehensive of a program. Last year, while opioid overdose deaths went up nationally, Rhode Island was one of just a handful of states that reported the numbers went down.
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