‘We just don’t want them to die': As drug deaths double, inmates get overdose training (2024)

A few times a month, a team of health care workers stands in front of inmates at the New Orleans jail, quizzing them about the signs of overdose.

On a recent afternoon, 24-year-old Dontrace Young nodded as the group talked about the shallow, slow breathing that precedes a drug death. Two of his cousins died from opioid use in their early 20s. He ticks off the drug users in his life: his mother, grandmother, uncles, aunts.

“It’s been my whole life,” said Young, who was born in the 7th Ward and grew up on the West Bank. “I’ve been around it. There hasn’t been a moment when I wasn’t.”

When the training ended, the inmates left knowing how to use Narcan, an overdose reversal nasal spray that blocks the effects of opioids in the brain. But Young also left a phone number. When he’s out, he’ll get a call from the Formerly Incarcerated Transitions Clinic. He needs help with his mental health.

“I never tried to kill myself directly,” said Young, who was facing a charge of aggravated 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 the information about overdoses could save a life once the inmates reenter society. But she also hopes the session, conducted with community health workers who have been incarcerated themselves, will be a gateway to a better life for a community that has seen drug deaths more than double in the last four years. Overdose training is the first step.

“While people are figuring 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.

Skyrocketing overdoses

Taking lethal amounts of drugs is increasingly the most pressing health issue for people leaving incarceration. The risk of overdose is 129 times higher when someone comes out of jail, according to a 2007 New England Journal of Medicine study.

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

More and more, bystanders are involved in overdose reversals with Narcan.

From 2019 to 2023, bystander Narcan use increased nearly 1,000%, from just 22 to 253, according to the New Orleans Health Department. The bulk of Narcan, also known as naloxone, is administered by EMS.

Health workers with the FIT Clinic have presented to about 175 people detained at the Orleans Justice Center, and another 170 correctional officers, who are often on detail in places like the French Quarter where overdoses are more concentrated, said Niyogi.

Overdose rates rise for inmates right after release because tolerance drops in jail, said Dr. Kasha Bornstein, who addressed a group of inmates in the common area of a two-story block of cells.

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 ten years before becoming a doctor. “It's all fentanyl.”

Bornstain told inmates about finding people who fatally overdosed, often in the library or a McDonald’s bathroom, and the stigma that leads people to use drugs alone.

At the start of the presentation, about 12 inmates were listening. By the end, the number grew to 18. Thirty minutes into the presentation, an inmate interrupts.

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

Gaining trust

On another day at the jail, in a room containing a large easel with grammar tips and a portable baptizing tub on the floor, Niyogi pointed to a poster on the wall with the FIT Clinic’s number.

“It's going to connect to Mr. Haki or Ms. Danielle, and they’ll talk with you and figure out what you need,” said Niyogi.

Haki Sekou and Danielle Metz are the 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 difficulties of reentry.

The clinic provides primary care, as well as coordination and referrals for diseases that might have worsened in jail, such as HIV, hepatitis and lung and heart disease. But it also acts as a bridge for people who are deeply distrustful after experiencing unpredictable health care in the jail system.

"They think doctors are going to use them as a guinea pig," said Sekou. "That's one of the words they use commonly."

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

One middle-aged patient desperately needed heart surgery upon release, but his own mother couldn't convince him to stay in the hospital. He told Sekou he was planning to overdose and die on his own terms instead.

Because they had done time at Angola together, Sekou was able to convince him to get the surgery, explaining that doctors wanted to see him healthy.

Lately, he's hearing the same thing over and over from people who are struggling with mental health issues but can't verbalize it.

"They just say, 'I need some help,' said Sekou. "They really can't tell you what they want."

'I need help'

As Niyogi unboxed the Narcan, an inmate recalled when he woke up after an overdose. He's still struggling with a constant urge to use.

"It ain't like it can stop or be shut down," he said. "I need help."

Jails are uniquely positioned to start patients on treatment for substance use disorder. Prescription drugs likemethadone and buprenorphine, or Suboxone, have been shown to quiet the brain's cravings for opioids and lower the risk of overdose by 50%.

Drug use has also spilled over within 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. One drug death at the jail last year was an inmate who had been hospitalized twice before for an overdose.

Substance use disorder is much higher in jails than the general population. Some estimates peg it at around 60%, said Dr. Benjamin Springgate, an addiction medicine specialist the FIT Clinic often recommends.

“There is a nexus of people right there," said Springgate. "There’s more than 1,000 people there every night, a large proportion of whom use.”

A new health provider, Wexford Health Services, took over at the jail in June. Medication-assisted therapy is written into the contract. Wexford, a medical contractor for more than 100 jails and prisons across the country, has been sued for failing to provide substance use disorder treatment to inmates.

Currently, the jail is treating 51 inmates with a buprenorphine-based medication. Another 100 detained persons are awaiting treatment, which a jail spokesperson said was due to a cut in funding for the program.

"We are working with the OPSO on plans to obtain staff and funding to expand this program during the course of our partnership," read a statement from Wexford sent through an OPSO spokesperson.

At the end of the presentation, Niyogi asked if anyone wanted more information on medication-assisted treatment for opioid use disorder when they get out.

Seven of ten raised their hands.