Washington Corrections Center (WCC) is one of the Substance Abuse Treatment Facilities in the Washington State Department of Corrections (WDOC) system. For several years, it’s been known as one of the few WDOC prisons to offer even limited access to Suboxone, one of the two FDA-approved opioid use disorder (OUD) medications shown to reduce risk of overdose. WCC prisoners in the final six months of their sentence could get a prescription for it, in preparation for re-entry. Now, that Suboxone has been replaced with merely a referral for Suboxone.
Three people less than six months out from their release dates, all of whom have served previous sentences at WDOC prisons, told Filter that this time around they were not offered Suboxone. Instead, all three were given referrals to local outpatient providers.
A fourth prisoner, who was released in January and has since been reincarcerated, told Filter that he had been offered the six-month Suboxone regimen (as well as Narcan on his way out the door). If a policy change has been implemented, it appears to have taken place sometime between January and March. WDOC did not respond to Filter’s request for comment.
Lucas has filed three grievances requesting Suboxone, and received three denials.
Todd Lucas, currently incarcerated in WCC, has spent a total of 30 years in WDOC facilities since 1987. All his interactions with the criminal-legal system have stemmed from his OUD, including nine drug-related infractions in the past 10 years.
Earlier in the COVID-19 pandemic, Lucas was at Monroe Correctional Complex, and struggling in a way he never had before. The pandemic had taken away every opportunity and resource: Alcoholics Anonymous, Narcotics Anonymous (NA), educational programming, recreational programming, chapel services. Medical services were severely delayed. Contraband flooded the prison. Guards were either not there physically, or mentally checked out. Alone and with no other way to pass the time besides using drugs, Lucas sank deeper and deeper into the life he knew he did not want for himself.
Lucas has been diagnosed with opioid use disorder by both WDOC and outside providers. When he was previously back on the streets between sentences, he was enrolled in methadone program and found it a stabilizing, positive part of his life.
But because he is not being released in the next six months, WDOC will not allow him access to Suboxone while incarcerated. (Litigating for access to OUD medication is easier—relatively speaking—if someone was already on it and stable at the time of their incarceration. This isn’t how most people, including Lucas, come into the prison system.)
He’s filed three grievances requesting Suboxone, and received three denials. He tries to stick with NA and whatever programming is available, but he is in crisis and desperately wants not to be. He doesn’t want to be using drugs at all.
There is an extremely powerful consensus among staff that Suboxone is always diverted.
In order for someone to get Suboxone in the final six months of their sentence—and now, in order to get what appears to have been reduced to just a referral—they need to be diagnosed with OUD by WDOC, even if they’ve previously been diagnosed in the free world.
The factors that determine who gets the diagnosis and who doesn’t often have little to do with the severity of the person’s condition. To even get in front of the doctor with the authority to diagnose you, you first have convince three nurses you have OUD. Do all of them have compassionate, harm reduction-based views on substance use? Are all of them in a good mood that day?
A prisoner perceived by staff as friendly, articulate and generally non-threatening will likely get the diagnosis they need. A prisoner who has lots of tattoos, who is visibly mentally ill or otherwise disabled, who triggers internal biases staff have about race, gender, sexuality, “lifestyle”—they will be dismissed as a scammer. Both, it seems, would now be leaving prison without Suboxone regardless, but only one would even be leaving with the referral.
This culture is reinforced in the WDOC Health Plan, a handbook intended to guide providers in the quick decisions they need to make under our triage model of care. Under “Factors Considered In Decision Making,” the plan explicitly prioritizes “cost minimization and cost effectiveness,” as well as “patient’s likely cooperation with, and adherence to, care and after-care.”
Many WDOC medical and correctional staff will outwardly express their belief that people who use drugs are inherently noncompliant. As such, they are of course at fault for any medical and legal complications related to their use.
We need to treat more than withdrawal.
The only other time WDOC prisoners have had access to Suboxone is at intake, if they’re beginning a sentence of six months or longer—but only as part of a tapering program, which lasts a maximum of nine days. The program is described as one where prisoners get 8 mg Suboxone three times per day, but in reality all three doses are dispensed at the same time, in the evening.
There is an extremely powerful consensus among WDOC staff that Suboxone is always diverted, that it allows for too much autonomy and doesn’t require enough accountability.
Earlier in the pandemic, many people incarcerated at WCC were released early to mitigate COVID transmission. Because this increased the number of prisoners with under six months left here, so many people were eligible for Suboxone that they had to gather everyone in the chow hall to dispense it. They made everyone sit on their hands.
That prisoners are nearing their release dates without the opportunity to acclimate to Suboxone is alarming. But even the six-month program was never anywhere near adequate, nor is the nine-day taper offered at intake. We need to treat more than withdrawal.
The final six months of someone’s sentence is a transitional period, full of preparations to get back on the streets. Someone who spends years in crisis during their incarceration, never really finding stability, doesn’t have the chance to make Suboxone a part of their regular routine—integrating it into their daily life as they go to their work detail, their classes, their medical appointments. No chance to get in the frame of mind they need to be to find and maintain stability once back on the streets.
Everyone reached by Filter expressed that being unable to find stability due to chaotic drug use contributes to the cycle of recidivism. To break it, they need access to Suboxone during the whole course of their sentence, not just the final six months. They certainly need more than a referral.
Photograph via Cumberland County, Pernnsylvania