Rikers: Island of Harm Reduction in State of ‘Forced Detox’

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Rikers: Aerial view of complex on island.

U.S. Geological Survey

Rikers Island

Waiting to be taken to Dutchess County Jail for the last time, Matthew Herring knew from experience he needed something that would ease the pain to come. The 24-year-old from Fishkill, N.Y., anticipated an excruciating detox from heroin. So he grabbed a handful of Suboxone pills. 

Herring was facing prison time in October 2016 for violating probation from a case that started when he was 18. Then, a Dutchess County drug force raided his mother’s house and found his stash of Ecstasy and steroids, she said. Now, during his intake at the jail, north of New York City, a county correction officer found on him an opioid medication that’s prescribed for addiction recovery. 

ny bureau“He was caught, and he was put in solitary confinement for three or four days — no treatment, no medication,” said his mother, Trish Herring, 51. “That’s where he detoxed.” 

Col. Michael Walters, administrator of the jail, confirmed that Matthew Herring spent days in segregation as a result of bringing contraband into the facility.

Matthew was then transferred to Altona Correctional Facility in Altona, N.Y., near the Canadian border, and after five months there was released in June 2017. Back in Fishkill, he failed three urine tests with his parole officer and was placed in a 21-day rehab at Richard C. Ward, a state addiction treatment center in Middletown. 

In the nine days that followed the stint in rehab, he stayed at his grandparents’ house and at his father’s in nearby Wappingers Falls. 

On Aug. 24, Matthew’s father went to the wake of a friend who had died of a drug overdose. In the evening, his mother visited Matthew at his father’s. 

“I knew he was high as a kite,” she said. “He denied it. I laughed.” 

The next morning, at about 6 a.m., Trish Herring’s phone rang while she was with her daughter, waiting in line in Manhattan for the “Today” show. It was her ex-husband. 

Matthew’s girlfriend had found him cold, with no pulse, in his father’s lower-level bathroom. He had overdosed and died. 

Trish Herring said if her son had violated parole in New York City in 2016 rather than Fishkill, he might still be alive today. Rikers Island, where he would have been taken, has a medically assisted treatment (MAT) program for detainees who are addicted to opioids, providing buprenorphine (of which Suboxone is a major brand) or methadone. 

“I would think that if Matthew would’ve been given MAT in jail and prison that it would’ve prolonged his life and eventually led him to live a life of sobriety,” she said. 

‘Forced detox’ is dreaded

For many locked up there, a Rikers Island jail is only a way station before a trip upstate to prison. But now, over 30 years after its KEEP treatment program began, only six other correctional facilities in New York offer pilot opioid treatment programs, which are available only to limited segments of their respective populations. 

Dr. Jonathan Giftos, clinical director of substance use treatment at Rikers Island, said he oversees the intake of 500 people a month there with opioid use disorder. At any one time, the jail complex houses over 7,500 detainees awaiting trial or serving sentences of up to a year. 

Rikers Island has had its methadone program since 1987, making it a pioneer in the treatment of opioid use disorder. The facility’s Correctional Health Services is now administered under the city’s Health & Hospitals department, which oversees all public hospitals. Those who are identified upon intake as facing withdrawal from opioids are eligible to receive daily doses of  methadone or buprenorphine. 

But even if Matthew Herring had found himself on Rikers Island pretrial and awaiting sentencing, taking medication in the form of methadone or buprenorphine, eventually he would have been tapered off his dose, assuming he was to serve out a prison sentence of more than two years in a state correctional facility. 

Reform advocates call this tapering “forced detox.” Many of those who have experienced or witnessed it describe it in a vocabulary reserved for violence. 

Rikers: Smiling woman with blond hair, long earrings, sweatshirt.

Trevor Boyer

Marilyn Reyes underwent “forced detox” from methadone at Rikers Island in 1995 and found the process so traumatic she never again used opioids of any type.

“Prisons are sites that inflict trauma and punishment. And that forced detoxification is probably part of that,” said Dr. Kimberly Sue, medical director for the Harm Reduction Coalition in New York. “My medical opinion is that no one should be tapered who doesn’t want to be tapered.” 

Tapering only for those facing at least a two-year sentence is, in fact, a recent victory for treatment advocates. On June 20, Correctional Health Services announced a partnership with the state’s Department of Corrections and Community Supervision. The new policy means methadone treatment can continue in state prisons for those who received it in New York City jails and have less than two years left on a sentence or parole violation.

Bill fails in Albany

But the day after that gain, disappointment followed for advocates. They had been pushing for a bill that would require opioid treatment within all state prisons and county jails, such as the one in Poughkeepsie where Herring detoxed in solitary. 

The State Senate passed the bill but it fell short in the State Assembly. While the Democratic majority there had the votes, Republicans asked to debate the bill. The 2019 session was a busy one for Democrats, who had been waiting years for unified control, and even an hour for that debate wasn’t in the offing.

The legislative session expired after an overnight marathon that ended the morning of June 21. No “MAT in Corrections” bill would reach the desk of Gov. Andrew Cuomo in 2019.  The Assembly simply ran out of time.

“We got close. It’s unfortunate that it did not get all the way. It’s heartbreaking because you know people are going to suffer,” said Dionna King, a policy manager with the Drug Policy Alliance in New York who had advocated for the bill.

If the bill had passed, New York’s state prisons and county jails all would have needed to adopt MAT programs. Instead, detainees struggling with opioid use disorder will have to wait at least until January before the policy of immediate detox ends at all county jails in New York and the practice of pre-sentence tapering ends on Rikers.

The Assembly will likely take up the bill again in January, said Assemblyman David Weprin, a Democrat, chair of the Corrections Committee and a sponsor of the bill.

A spokesperson from the state Department of Corrections and Community Supervision (DOCCS) said the agency cannot comment on pending legislation. But statements from DOCCS officials suggested the agency was looking beyond the status quo, under which medically assisted treatment for opioid use disorder is extremely rare outside Rikers Island. 

“This department’s pilot programs at six correctional facilities, providing methadone- and naltrexone-based MAT, is providing the much-needed experience to help plot a path forward to the expansion of these treatment programs at other facilities throughout New York,” acting DOCCS Commissioner Anthony Annucci said last November at a public hearing on the bill. 

Detox as trauma

When Marilyn Reyes was using heroin, she knew people were watching her. She was conscious of their revulsion. What onlookers to her heroin use would not have known is that she did not use drugs until after surviving a brutal attack. 

When she was a young mother, she was staying with her children in a shelter hotel in Harlem. Another resident raped her at gunpoint in front of her children. 

“That took me over the hill,” she said. “I started turning into using heroin, and it helped me medicate my pain.” 

Reyes, 57, served a sentence of less than a year on Rikers in the mid-’90s while taking methadone in the KEEP Program, the MAT treatment program that has been around since the 1980s. But upon her release she went straight to the “cop man” in her South Bronx neighborhood, she said. 

“I didn’t have a plan, so I went back to what I knew,” she said. “And I fell right away. I knew where to go. Everything was still going on. Nothing changed.” 

Having children to care for didn’t stop her from using. Reyes ended up in Rikers again the next year, in 1995, again in the KEEP Program. But this time she faced a felony charge and a sentence in state prison. 

That meant weeks of tapering off the medication down to zero, described as an excruciating experience by those who have experienced it, from the 1980s until recently. 

“It stays with you, it’s not like something that I’ve ever erased. It’s like, just as yesterday. It was that traumatic for me,” Reyes said. “And I’d already been through trauma.” 

Reyes, now a harm reduction advocate and co-chair of the Peer Network of New York, said she slept under her cot at Rikers to feel the cool of the floor while she was being tapered from methadone. 

“I can remember pulling my hair out,” she said. “I was in agony. I had chills, diarrhea. You know, all the symptoms that come with withdrawal.” 

For Reyes, once was enough. She never again used street drugs — or opioid-based medications such as methadone — after that experience of detoxing. That’s one measure of how painful the weeks of tapering are.

Eddie, 56, of the Lower East Side of Manhattan, said he’s undergone the process seven times since 1985. 

“A lot of people were on high dosages and they were getting detoxed,” he said. “They would put you in a house where everybody uses. People in there would be sick, and they’d be throwing up everywhere. People would be diarrheaing everywhere. It was madness.” 

Brooklyn resident Luis Torres, 45, experienced the tapering from methadone in 2012 before a transfer to Washington Correctional Facility in Comstock, N.Y., near the Vermont state line, to serve 16 months of a sentence. 

“The process was very fucked up,” he said. “Oh my God, you’re not sleeping for maybe six or eight months.” 

Rikers treatment

When Torres underwent the detox, the clinic would cut his dose by 10 milligrams every three days until he was taking nothing. The clinic at Rikers has since extended the later part of the detox so that once the patient hits 40 milligrams, the dosage is cut by only 5 milligrams every three days. 

“While these tapers are specific at the beginning, they can always be adjusted based on individual patient needs,” said a spokesperson with Correctional Health Services. 

Also, Rikers has changed its rules regarding those facing felony charges. Until September 2017, detainees would be detoxed immediately if they were charged with a felony, but now that applies only if a conviction will place them in a prison with no medically assisted treatment program. And as of June, only those facing a state sentence of two years or longer will need to detox from opioid treatment. 

“If you do get a felony and a [longer] state sentence, those patients are as humanely as possible slowly tapered off their maintenance medication,” Dr. Giftos said.  

In 2016, Giftos’ office found that half of those admitted to Rikers with opioid use disorder were facing felony arraignment charges. But of that half, only 28% ended up in a state prison. The other 72% either served out a sentence of a year or less on the Island or were released. 

For those fortunate enough, medically speaking, to spend their incarceration time on Rikers Island, leaving poses a challenge in the form of maintaining their opioid treatment in a less regimented environment. 

Rough reentry

Reentry is another focus of the bill that failed to pass the State Assembly in June. The bill called for facilities to provide information on housing, employment and the location of treatment facilities to all inmates in MAT programs, and it required jails and prisons to help enroll patients in Medicaid before their release. 

For more information on Re-entry, go to JJIE Resource Hub | Re-entry

In mandating these offerings from state facilities, the legislation seems to follow the findings of recent scholarship. Those released from prisons are less likely to return if they participate in reentry programs, according to a 2015 study. And according to a 2016 study, those who receive methadone treatment while incarcerated have lower recidivism rates than those who undergo detox on the inside. 

Reentry is a precarious time, especially for those with opioid use disorder. An American Journal of Public Health study of people recently released from North Carolina jails and prisons from 2000 to 2015 showed that in the first two weeks after their release, they were 40 times more likely than the general population to die from an opioid overdose. A study by Massachusetts’ health and human services office pegged that risk multiplier at 120 for those leaving Massachusetts jails and prisons from 2011 to 2015. 

Rikers: Clasped hands.

Trevor Boyer

Eddie, 56, underwent “forced detox” from methadone seven times at Rikers Island.

“Their tolerance is on minus 100. They haven’t been using,” said Hector Mata, care coordination manager with VOCAL NY, a harm reduction nonprofit based in Brooklyn. 

As of September 2018, the epidemic of drug overdose deaths had not abated enough in New York City to show that it peaked. Deaths due to overdose in the Bronx, Manhattan and Staten Island in the first nine months of 2018 remained at record highs. Across the state, 80% of overdose deaths involve opioids. 

“Having MAT throughout the entire state, that will have a significant impact on the overdose rate that we’re seeing in our state right now,” Mata said.

The Rikers model

Especially in recent years, Rikers Island has stayed in the crosshairs of civil rights advocates and activists pushing to reform incarceration in the U.S. New York Mayor Bill de Blasio has committed to shutting it down over several years, replacing it with a smaller jail in each of four boroughs. For its documented violence and inhumane treatment, Rikers Island is infamous. 

But by treating opioid use disorder with medication, Rikers Island is notable for offering what many call an effective and humane way to meet people who stand at the familiar crossroads of substance abuse and the criminal justice system. It’s clear to advocates that in this regard, Rikers should serve as a model for other facilities. 

“We just need to ensure there’s an unbroken continuum of care for people,” said King with the Drug Policy Alliance in New York. “And of course we have to change society’s outlook.” 

Trish Herring, whose son detoxed in solitary confinement in Dutchess County Jail, agrees that the collective attitude toward opioid use disorder needs to change in order to eliminate the stigma surrounding it. 

“It is a health crisis. Look what we did for AIDS,” she said. 

During his last stint in jail before his death, Matthew Herring so clearly wanted health care in the form of medication that he sneaked in Suboxone as contraband. 

His mother views the months of that bid as a missed opportunity for medical treatment. Dutchess County Jail and Altona Correctional Facility offered him nothing but detox. After Matthew left prison in 2017, she said, he met a fate whose commonness is well-documented.

“People that are untreated that are released are relapsing and dying,” she said. “He’s one of those statistics, 72 days after he was released.”

For those seeking methadone or buprenorphine while being held in the overwhelming majority of New York state jails and prisons, treatment will have to wait.

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