We've been hearing a lot lately about heroin overdoses and drugs to combat them like Naloxone, which can reverse an opiate overdose instantly. Police and fire departments are equipping their officers and EMTs with the drug antidote to help save lives across America. Statistics show that the rate of accidental overdose deaths has been on a steady climb in the United States in the last ten years, and Naloxone has been a game-changer.
But as heroin use surges among the general public, the drug has become a mainstay in the American prison system, where Naloxone is still hard to come by.
According to the US Bureau of Prisons, "Substance use disorders are highly prevalent among inmate populations, affecting an estimated 30 to 60 percent of inmates." With plenty of time to kill and nothing better to do, prisoners get high. It's just a matter of getting the drug in and making a homemade syringe.
"There's nothing better than shooting up some brown tar or—better yet, China White—when you're doing a bid," a prisoner we'll call Chance tells me. Chance is from Pittsburgh, 36 years old, and a three-time loser. He's in on a 20-year sentence for selling cocaine and is a member of a prison-based gang. He is heavily involved in the drug scene, using, abusing and smuggling heroin with frequency.
"I always make sure heroin is available in whatever prison I'm at," Chance says. "It takes the edge off and just makes the days go by."
For inmates who are addicts, overdosing is a constant threat, and they don't have Naloxone as a safety net. While the Bureau of Prisons National Formulary lists Naloxone as an available drug, it limits use for detox purposes only. "It is on our formulary," BOP spokesman Chris Burke told me. "The formulary is a list of drugs that have been pre-approved."
Perhaps Naloxone will be used to treat prison drug overdoses in the future, but until that day comes, prisoners will continue to combat overdoses the old-fashioned way. With the federal Narcotic Treatment Act of 1974 restricting the use of methadone for opiate dependence, there are no good options.
"I've seen many dudes OD in here," Chance says. "All you can do is get some ice and pack it on their balls and hope for the best." Notifying the correctional officers (COs) or medical staff that a prisoner is ODing is frowned upon by convicts and can quickly get the good Samaritan labeled as a rat or snitch.
"In prison the only thing lower than a rat or snitch is a chomo (child molester)." Chance says. "One time my homeboy and me shot up some junk with a binky and my homeboy nodded off. He laid down on the bunk, and next thing I knew he was turning blue. I ran to the ice machine and got some ice, put it in a towel and went back and packed it on his balls. I mean, what else could I do? I couldn't call the CO. I was high as a kite."
When prisoners shoot up heroin, they're begging for trouble. Not only are they susceptible to an overdose with no viable treatment available, but they also are likely to share needles, as syringes are scarce. (In case you're wondering, there is no needle exchange program in prison.)
"We just make a binky with a pen tube and guitar string," Chance says. "They aren't that hard to make. And if someone has heroin and you got the binky, then they got to kick down to use the needle. It doesn't matter about sharing needles because we are trying to get high. When you are doing time you just don't give a fuck." This leads to addicts in prison catching diseases like AIDS and Hep C.
Luckily, in the case of Chance's homeboy, death didn't rear its ugly head. The guy came out of it and was able to stand up, vomit, and walk it off. But prisoners under the influence often panic and leave their fellow user by the wayside as they seek to get the hell away from a possible crime scene.
"Man, that shit was messed up," Chance says. "Dude was in my cell. If he died in there, I woulda had a hell of a time explaining that. It woulda been a serious situation and beaucoup drama for me." Drug addiction is a health problem, of course, but in a security-conscious environment like a prison, it becomes a custody concern, too. With the no-snitching code in full effect, most inmates would rather exit the area then call for help.
And without a drug like Naloxone within arm's reach, it would be too late to revive the prisoner even if medical staff were notified. With heroin widely available, an overdose is a daily threat. That's just the reality of shooting dope in prison.
"I've seen dudes die. I've seen them swallow balloons and they burst," Chance says. "No one is gonna say anything because ain't no one trying to catch another case." Safety takes a back seat to maintaining order of the institution. Prison is a reactive environment, not a proactive one.
"If the balloons burst in someone's stomach, that's it. He's fucked up," Chance says. "It's up to him to get himself to medical. We do what we can for people, but that's the code, everyone knows what the deal is. Ain't no one trying to see someone die, but when it comes down to you or me, I'm going with me."
The convict code is the law of the jungle—survival of the fittest at all times. It's a see-no-evil, hear-no-evil and speak-no-evil mentality, and this leads to tragedy.
The problem is compounded by the lack of effective medical services in most prisons. Stephen C. Richards, professor at the University of Wisconsin and author of The Marion Experiment: Long-Term Solitary Confinement and the Supermax Movement, told me: "Most prisons have very limited medical services. One large prison with 2,000 prisoners might have one or two part-time nurses that come to the institution once or twice a week. Prison systems have limited health care budgets, and few medical professionals want to work inside prisons."
Richards wonders if "maybe prison administrators don't care if a few junkie convicts expire."
Surprisingly often, prisoners don't care all that much either.
"Some dudes want to die. They are doing life and 20 and 30 years and they just don't care." Chance says. "All they want to do is get slammed so they don't have to think about all the time they gotta do. I can attest to that. I am a perfect example. If I'm not getting high, I'm trying to find some or figuring out a way to get some in. That's just how I do my time."
Packing ice on an overdosing addict's testicles is not a viable treatment, so let's hope the Bureau of Prisons gets it together on Naloxone sooner than later.