‘We don’t want them to die’: As drug deaths double, inmates get overdose training

Several times a month, a team of health professionals comes to inmates at the New Orleans jail and questions them about signs of overdose.

On a recent afternoon, Dontrace Young, 24, nodded as the group talked about the slow, shallow breathing that precedes a drug death. Two of his cousins ​​died of opioid use in their 20s. He refers to the addicts in his life: his mother, grandmother, aunts and uncles.

“That’s what’s stuck with me my whole life,” said Young, who was born in the 7th District and raised in the West Bank. “I’ve always lived in that environment. There’s never been a time when I haven’t lived it.”

At the end of the training, the inmates left knowing how to use Narcan, a nasal spray that blocks the effects of opioids on the brain. But Young also left a phone number. When he gets out, he’ll get a call from the transition clinic for ex-offenders. He needs help with his mental health.

“I never attempted suicide directly,” said Young, who was charged with assault with a firearm. “But I took a lot of risks, knowing that I could die.”

Dr. Anjali Niyogi, founder of the Formerly Incarcerated Transitions Clinic, knows that overdose education can save lives once inmates reenter society. But she also hopes the session, conducted with community health workers who have been incarcerated themselves, will pave the way for a better life for a community that has seen drug-related deaths more than double in the past four years. Overdose education is the first step.

“While people are trying to figure out how to get better … we just don’t want them to die,” said Niyogi, who is also an internal medicine physician at University Medical Center.

Overdoses on the rise

Drug use in lethal amounts is increasingly the most serious health problem for people released from prison. According to a 2007 study in the New England Journal of Medicine, the risk of overdose is 129 times higher upon release.

In New Orleans, overdose deaths have more than doubled in just a few years, from 241 in 2019 to 523 in 2023.

More and more people are being involved in Narcan overdose reversal cases.

According to the New Orleans Health Department, between 2019 and 2023, bystander use of Narcan increased nearly 1,000 percent, from just 22 to 253. Most Narcan, also known as naloxone, is administered by emergency medical services.

Health workers at the FIT clinic have seen about 175 people in custody at the Orleans Justice Center and 170 other correctional officers, who are often on assignment in places like the French Quarter where overdoses are more concentrated, Niyogi said.

Overdose rates increase among inmates right after they’re released because tolerance wanes in prison, said Dr. Kasha Bornstein, speaking to a group of inmates in the common area of ​​a two-story cell block.

It also has to do with how fentanyl has infiltrated the drug supply.

“Heroin is a bygone era,” said Bornstein, who was a paramedic for 10 years before becoming a doctor. “This is all fentanyl.”

Bornstain told inmates how he had met people who had fatally overdosed, often in the library or McDonald’s bathroom, and how he had experienced the stigma that leads people to use drugs alone.

At the beginning of the presentation, about 12 inmates were listening. By the end, their number had increased to 18. Thirty minutes into the presentation, an inmate interrupted the presentation.

“I like you,” he said. “You know what, I really like you.”

Gain someone’s trust

Another day at the prison, in a room containing a large easel with grammar tips and a portable baptismal tub on the floor, Niyogi pointed to a poster on the wall with the number for the FIT clinic.

“He will connect to Mr. Haki or Ms. Danielle, and they will talk with you and figure out what you need,” Niyogi said.

Haki Sekou and Danielle Metz are community health workers at the FIT clinic. Sekou spent 41 years at Angola. Metz was incarcerated for 23 years before her sentence was commuted by President Barack Obama in 2016. Both know firsthand the many challenges of reintegration.

The clinic provides primary health care, as well as coordination and referral to specialized services for illnesses that may have worsened in prison, such as HIV, hepatitis, and lung and heart disease. But it also serves as a bridge for people who are deeply distrustful after experiencing unpredictable health care in the prison system.

“They think the doctors are going to use them as guinea pigs,” Sekou said. “That’s one of the words they commonly use.”

Sekou explains to them what they need, from transportation to getting a new ID card or a cell phone. Often, he is the reason they agree to see a doctor.

A middle-aged patient was in desperate need of heart surgery upon his discharge, but his own mother failed to convince him to stay in the hospital. He told Sekou he planned to overdose and die on his own terms.

Because they had spent time together in Angola, Sekou was able to convince him to have the operation, explaining that the doctors wanted to see him healthy.

Lately, he keeps hearing the same thing from people who suffer from mental health issues but can’t say it out loud.

“They just say, ‘I need help,’” Sekou said. “They really can’t tell you what they want.”

‘I need help’

As Niyogi unpacked the Narcan, one inmate recalled the moment he woke up after an overdose. He still struggles with a constant urge to use.

“It’s not like we can stop it or stop it,” he said. “I need help.”

Prisons are uniquely positioned to initiate treatment for substance use disorders. Prescription medications like methadone and buprenorphine, or Suboxone, have been shown to quell the brain’s opioid cravings and reduce the risk of overdose by 50 percent.

Drug use has also spilled over into the New Orleans jail. The Orleans Parish Sheriff’s Office declined to provide the number of overdoses in recent years, but a federal monitor has repeatedly flagged the problem. Last year, an inmate died of an overdose after being hospitalized twice before.

Substance use disorders are much more common in prisons than in the general population, with some estimates putting them at around 60 percent, said Dr. Benjamin Springgate, an addiction specialist often referred by the FIT clinic.

“There’s a connection between the people there,” Springgate said. “There’s over 1,000 people there every night, a lot of them on drugs.”

A new health care provider, Wexford Health Services, started at the prison in June. Medication-assisted therapy is part of the contract. Wexford, a medical provider for more than 100 prisons and jails across the country, has been sued for failing to provide treatment to inmates for substance use disorders.

The prison is currently treating 51 inmates with the drug buprenorphine. About 100 more are waiting for treatment, which is due to a cut in funding for the program, according to a prison spokesperson.

“We are working with OPSO on plans to secure staff and funding to expand this program over the course of our partnership,” read a statement from Wexford sent by an OPSO spokesperson.

At the end of the presentation, Niyogi asked if anyone wanted more information about medication-assisted treatment for opioid use disorder upon discharge.

Seven out of ten raised their hands.