Pubdate: Wed, 06 Aug 2014
Source: Providence Journal, The (RI)
Copyright: 2014 The Providence Journal Company
Contact:  http://www.providencejournal.com
Details: http://www.mapinc.org/media/352
Author: Lynn Arditi

ACI INMATES PREPARING TO RE-ENTER SOCIETY LEARN HOW TO HELP SURVIVE A 
DRUG OVERDOSE

CRANSTON, R.I. - Inside a cinderblock classroom at the Adult 
Correctional Institutions' medium-security facility, a group of 
inmates who are nearing their release dates get a lesson about how to 
say alive on the outside.

Their chances of dying from a bullet are nothing compared with the 
risk of a fatal drug overdose.

The men are told how to recognize the signs of an overdose: Pale or 
bluish skin. Faint pulse. Slow or labored breathing. "They may sound 
like they're snoring," Rebecca McGlodrick, a volunteer instructor, 
says, but when someone is overdosing the noises mean they're 
"struggling to take a breath."

The class run by PONI (Preventing Overdose and Naloxone Intervention) 
is intended to help prevent fatal drug overdoses among the population 
that is most vulnerable. Nearly 60 percent of those who died of drug 
overdoses in Rhode Island during the first four months of this year 
had spent time in prison.

But the medication that can reverse the effects of an overdose of 
prescription drugs or heroin - the opioid antidote naloxone, sold 
under the brand name Narcan - has not been widely available to 
distribute to inmates when they leave prison, largely due to a lack 
of funding. Meanwhile, as deaths from opioid overdoses have climbed - 
to 103 overdose fatalities so far this year as of early July - health 
officials are pressing to get more naloxone into the hands of 
community groups and law enforcement officials. But as demand for 
naloxone has spiked, so has the price. PONI paid $15 for a two-dose 
naloxone kit six years ago; today the same kit from Walgreens costs $45.

Now, Miriam Hospital and Brown University have agreed to supply the 
medication to the state Department of Corrections to distribute to 
prisoners at risk of overdose upon their release, A.T. Wall, 
corrections director, said this week.

The wide-scale distribution of naloxone to newly released prisoners - 
to be rolled out at the women's prisons, Wall said, within the next 
month - puts Rhode Island at the forefront nationally in overdose prevention.

Only a handful of communities around the country - including San 
Francisco, Seattle, and, more recently, Kent, Wash. - have programs 
in jails or prisons that distribute naloxone kits to prisoners upon 
release, according to the New York-based nonprofit Drug Policy Alliance.

Vermont passed a law last June to mandate the creation of a pilot 
project to train inmates that includes equipping those leaving prison 
with naloxone kits.

"Distribution at release is critical," said Dr. Traci C. Green, a 
research scientist at Rhode Island Hospital and assistant professor 
at Brown University who works with the PONI program. "Information 
only - education only - is necessary but utterly insufficient to 
reduce overdose mortality risk."

Inmates released from prison are more than twice as likely to die 
from a drug overdose than a homicide, according to a study reported 
in the 2012 issue of Addiction Science and Clinical Practice.

"There's nothing that comes close to overdose death," said Dr. Josiah 
D. "Jody" Rich, a professor of medicine and epidemiology at Brown 
University Medical School and Miriam Hospital.

PONI's training classes at the ACI are rooted in a more than 
decade-long effort that began when Dr. Rich, an infectious disease 
specialist, and Michelle McKenzie, an epidemiologist at Miriam 
Hospital, began a federally funded research project to screen 500 
inmates and former inmates for enrollment in methadone treatment when 
they were released.

But once they left prison, McKenzie said, about 40 percent didn't 
show up for their first methadone clinic appointments. Some of them 
had already died of an overdose. "It opened my eyes," she said.

In 2011, Rich and Green received a federal grant for a pilot program 
at the ACI to train 107 inmates who were a month from their release 
date to use naloxone and then supply them with their own kits to take home.

The funds also were used to produce a 20-minute video, "Staying Alive 
on the Outside," released in 2012.

During the recent Friday afternoon training at the ACI's John J. 
Moran Facility, the pair of overdose prevention instructors pressed a 
button to start the video for the 14 inmates seated at school-style desks.

The room fell quiet except for the voices on the TV screen: a mother 
who lost two sons to overdose; a former inmate who lost a friend. 
Unlike the "just say no" approach of drug prevention, this training 
is based on a harm reduction model that acknowledges that for many 
addicts relapse is not only possible but probable. One addict in 
long-term recovery offers frank advice to those who relapse about how 
not to die. Never do drugs alone. Always carry Narcan...

When the video ends, the instructors, McGoldrick, 24, and Jared 
Moffat, 23, both Brown graduates, talk about the varying strengths of 
prescription painkillers to what to do if someone is overdosing and 
you're afraid to call 911 because you're on probation.

McGoldrick uses a dummy to instruct the men in how to perform rescue breathing.

"The reason we're here," she tells the men, "is because there's a 
crisis and people are dropping."
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MAP posted-by: Jay Bergstrom