By JC Grant
Compstat is CDCR’s official packaging of statistical data. Month to month numbers including everything from how many hours were worked by sergeants, how many open slots in an inmate GED class, how many staff misconducts for this or that, how many of almost any computational data entered in their Sex Offender Management System (SOMS), and other databases CDCR uses is compiled into one. Almost all illegal activity reported within CDCR can be found here. You can see how many cell phones were found at this or that prison for this date or that. The total amount of methamphetamine recovered in a certain month. The total amount of heroin, codeine, marijuana, barbiturates, morphine—even “Spice” (synthetic cannabis) rules violations can be found. Everything, but Suboxone data. Turns out, CDCR will keep track of inmates who misuse barbiturates, and those amounts. But they will not house specific data on the misuse and illicit trade/confiscation of Suboxone, even though such misuse and black-market sales have been known (and perceived a problem by most corrections officers) for three years. When I spoke to a sergeant about my findings (or lack thereof) he said, “They don’t want the numbers to reflect the misuse [of Suboxone]. It’s now the number one drug inmates get caught with.”
CDCR’s “Impacts of the Integrated Substance Use Disorder Treatment Program” report states that the cost of the MAT/ISUDT program was 160 million dollars a year (in its first phase). CDCR cites the National Institute on Drug Abuse (NIDA), which claims that “every dollar invested in SUD treatment yields a return on investment (ROI) of between $4 and $7 in criminal justice costs, and when accounting for avoided health care costs, SUD treatment can yield an ROI of 12 to 1.” It seems that CDCR has placed a big bet on its MAT/ISUDT program and expects to get a big return. Which makes sense. Why allow for any flaws to be noted until tangible returns are enumerated. I wanted to get clearer insight on whether these expected returns were based on fiscal numbers of the experience of individuals, and by an odd set of circumstances I would get my chance to get a view from the top. Perhaps it was my constant probing and submitting interview request forms to various medical departments regarding the MAT program. Whatever it was, I found myself scheduled for a mysterious appointment. An appointment that turned out to be with the doctor who was just a couple of rungs down the ladder of the Correctional Health Care Services MAT program. Somehow, I had been afforded an interview for an opportunity to be prescribed Suboxone. I didn’t care for Suboxone (I like clarity; after all, how could I be productive, research and write otherwise?), what I cared for was what he had to say.
I met with Dr Bzoskie on June 2nd 2022 via video. Dr B is old school. He has been working for CDCR since the nineties. We were both a little perplexed as to why I was there. I told him it might be because I was looking for interviews and information. Right away I asked him if he thought the program worked (seeing as he was the main prescriber of Suboxone for CDCR). “With people we diagnose as having a disease, the process seems to work really well… It’s the system that doesn’t work well, and the people who aren’t honest [those who get on the drug for reselling purposes or just to get high]… It has to do with individuals, for people who get on the program who aren’t addicts, might become addicts. The thing about Suboxone is that it’s about harm reduction. One aspect of this is that it is at least legal, and they [inmates/public] don’t get in trouble for using it.” I followed up by asking Dr B to give me a specific example of why he sees the program as a success and he sees it also as a failure, since he seems to have mixed feelings about it.
“So, we treat addiction as a disease model, and we have medical evidence for this. Then we brought in people in the past who don’t understand prison to treat addiction in prison. Maybe the way we should go about treating addiction in prison is with the mentality of prison. And if this program has the potential to change things, that’s huge!” What I took from that was that people in prison will use drugs as they will, and if you forced them to participate in intensive programming while giving them a narcotic handout that would prevent overdoses and reduce cravings then you won, and part of that involves allowing the Suboxone to get into the hands of those who don’t have it prescribed. Even if you don’t always succeed, the harm reduction succeeds overall. A prison approach to treating addiction. He continued, “But one of the things is that the problems we have are many and we don’t have the resources. The average person on Suboxone treatment sees a doctor six times a year. What happens if you multiply that number to all the people on the program? How many hours of seeing a doctor is that? And how many doctors do we have? And what does that mean for the average inmate? Less time they get seen. It’s like the fruit at the top doesn’t know what the roots are doing. What we need to do is treat these people to a community standard. These doctors take a ten-hour course and then they are fit to prescribe? We need more than that.” Dr Bzoskie, by the way, is an addiction specialist.
When my meeting finished with Dr B, a meeting that oddly ended with him asking me if I wanted to be prescribed Suboxone (and I said, “No, thank you”), I felt a little different about the whole Suboxone MAT/ISUDT approach. Even though I was left with an odd whiff of the old OxyContin sales pitch. Online, the Correctional Health Care Services dashboard can be found, which shows how many people have been provided with MAT (over 14,000 at time of writing), CBI (Cognitive Behavioral Intervention) and so on, but it doesn’t tell you how many people have failed or have been caught misusing the substance. You can’t pitch the failure rate of a product you are fully invested in and trying to sell. A product that, once the CDCR started offering it, caused, according to the New York Stock Exchange, the product’s manufacturer’s stock to gradually increase to $340 a share at the time of writing. As one inmate said to me, “They have taken away the power from illegal orgaizations.”
The person who said this, the Chairman for the Inmates Advisory Council, added that “Suboxone is a substance that creates mass control, instead of mass incarceration.” Following his comment, another inmate stated, “Funny, we can’t get dental implants when we have teeth that prevent us from getting sales jobs or forming relationships when we get out, but we can get free drugs and leave with them too.”
As this writing has shown, the views vary greatly from person to person. Each one has their own take and their own experience. I came to writing this piece thinking the Suboxone program was a waste of tax payer dollars and only enabled those wanting to use. Now I am not so sure. The truth is, it does save lives. The truth is, it does put a dent in criminality. The truth is, that with rigorous ISUDT classes there is the potential for people to be “rehabilitated” as the head of the ISUDT program (at this prison) CCIII Davis told me, “Suboxone helps people in our program, by them not sitting and thinking about wanting to use while they are in our groups.” And as we know, you can’t learn and pay attention if your mind is elsewhere. The truth is also that people misuse it. But isn’t that the truth about any tool? Where CDCR goes from here remains to be seen.
JC Grant is incarcerated in California