Oregon bill would provide prisoners substance use and mental health treatment

Many of those who serve time in a state prison are in need of treatment for mental health or substance use disorder. That treatment is largely unavailable but a bill in the Oregon Legislature aims to change that. Oregon Rep. Maxine Dexter, D- Portland, says the lack of treatment means that adults in custody are losing their constitutional right to health care while incarcerated. They also are not getting what they need to be successful in the community when released, as approximately 90% ultimately are. We talk with The Lund Report’s managing editor Emily Green about what the bill would do and why supporters say it’s so desperately needed.

The following transcript was created by a computer and edited by a volunteer:

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Many people who serve time in Oregon prisons need treatment for mental illness or substance use disorder, but that treatment can be very hard to get. A bill in the Oregon legislature right now aims to change that. Emily Green wrote about the bill recently for the Lund Report and joins us now to talk about it. Emily, welcome back.

Emily Green: Thanks for having me.

Miller: Can you give us a sense for the numbers? How does the availability of treatment for substance use disorder and mental illness compare to the need?

Green: When people enter Oregon’s prison system, they are screened for their health needs. And from that data we know that about two thirds of Oregon State prisoners have a substance use disorder that they need treatment for. In today’s prison population that equates to about 8,000 prisoners who could benefit from some sort of addiction treatment. But among Oregon’s twelve state prisons, only four of them have any kind of intensive structured treatment program for addiction. And the programs that do exist are small. At Oregon State Correctional Institution outside of Salem for example, there are more than 800 prisoners, but the program there only takes 24 at a time. And the demand is great. The prison’s behavioral health administrator told me that prisoners are “banging down the door” to get into some of these programs.

Mental health is a little more developed, but there are still gaps. From the screening, we know 62% of prisoners would benefit from some level of mental health care, but the department says only 42% of those in need of services are getting them. So again, we have the vast majority of prisoners who need the services going without.

Miller: So what does it take for someone to get these limited services?

Green: Well, for addiction treatment as it is now, a prisoner must be approaching their release date to qualify for any kind of program. So if they’re serving a life sentence or they have a long sentence ahead of them, they’re completely ineligible. I had a prisoner who works as a alcohol counselor with one of those programs, his name is Ga Lo Vann, and he told me that getting into his program is like getting a winning lottery ticket.

Miller: You mentioned the release date there as one of the ways you can be bumped up in priority. The vast majority of people who are not getting this treatment are going to be released back into society at some point sooner or later. Is there a proven connection between a lack of treatment and recidivism?

Green: Yeah, there have been multiple studies over the years of different in-prison drug treatment programs that show participants of those programs, in some cases significantly, are less likely to reoffend the non-participants. And there appears to be a cost savings associated with that. One cost estimate in Washington State showed in-prison drug treatment saves taxpayers and crime victims about $10 for every dollar spent. But in Oregon, where we’re spending more than $50,000 a year to house each prisoner, we have 80% of those who need addiction treatment being released without ever getting it.

Miller: Did voter-passed Measure 110, which decriminalized illegal drugs in this state, provide more treatment options for people in prisons or jails?

Green: While it provided some funding for reentry programs after people are released, it did not include programs for the corrections department. But there is actually legislation pending right now that is aimed at changing that, among other things. So the department could apply for some of that grant funding in the future.

Miller: It may seem that even without treatment, prison is a place where people have no choice but to get clean cold turkey because of a lack of access to illegal drugs. But you note that that’s not the case. Can you give us a sense for the level of drug access in Oregon prisons?

Green: Yeah, I think that’s a common misconception, but drugs are very frequently smuggled into prisons, and Devarshi Bajpai, the prison’s behavioral health director, told me that it’s actually a significant problem in Oregon’s system. One prisoner told me that drugs are so plentiful in the Willamette Valley prisons that even when visitations were halted during the pandemic, there were still a lot of drugs making it in, and this is backed up with the overdose data that we’re seeing. There were four non-fatal overdoses last year, two from heroin and two from fentanyl, and there appear to have been a couple of fatal overdoses this year as well, suspected to be fentanyl, though the medical examiner is still evaluating those cases so that hasn’t been confirmed yet.

The reality is that even prisoners serving life sentences could benefit from treatment because drugs are still available.

Miller: So all this is the background for this House Bill 2890 that Portland Democrat Maxine Dexter has introduced. What would it do?

Green: House Bill 2890 would require that the Oregon Department of Corrections make mental health and substance use disorder treatment available to all prisoners throughout their incarceration. This is a big lift from where the system is now. The bill’s sponsor hopes that in the immediate future, the bill would ensure access to medication assisted treatment for all prisoners, and that’s the use of medications like Suboxone to treat opioid cravings and withdrawal.

Miller: Maxine Dexter, the bill’s sponsor, the Portland Democrat, has said this is actually a constitutional issue. What’s her argument?

Green: The Eighth Amendment of the US Constitution prohibits cruel and unusual punishment, and this has successfully applied or been applied to a denial of medical care. So the argument here is that behavioral health care is medical care, so to deny it is unconstitutional. And Representative Dexter told me that she’s made other lawmakers aware of the constitutional implications of her bill, and that passing it is one of her top three priorities.

Miller: How much would this cost?

Green: The legislative fiscal office hasn’t put a price tag on it yet, other than to say it may be a significant cost. But for the provision of the bill that would get every prisoner who wants treatment the treatment that they need, the corrections department estimates it will cost about 23.4 million every two years. Now, keep in mind this is a department that already costs taxpayers about $1 billion a year, so that’s not a huge bump, relatively speaking.

Miller: It’s striking that one of the sponsors of this bill is Salem Republican Kevin Mannix, a tough on crime Republican who wrote Oregon’s mandatory minimum sentencing law Measure 11. What does that tell you?

Green: Well, Dave, I think it tells us that the pendulum which swung toward punishment and away from rehabilitation in the 90s is starting to swing back. We’ve seen behavioral health care access become an increasingly bipartisan issue. We’re also seeing bipartisan support for other bills aimed at addressing the opioid crisis this session, including Representative Dexter’s opioid harm reduction package, which expands access to opioid overdose reversing drugs upon passage. It already passed the House with broad bipartisan support. In fact, Dexter told me she’s concerned that the Senate Republican walkout is risking lives because it’s inadvertently stalling the passage of that package.

Miller: Is there organized pushback to this bill?

Green: Not that I’m aware of. It passed unanimously out of committee, and all the testimony was either neutral or in support of it that was brought before lawmakers.

Miller: Maxine Dexter’s bill is not only focused on behavioral health care, it would also fund and strengthen the Department of Corrections’ independent ombudsman office. What exactly would that mean?

Green: The ombudsman office is a place where prisoners can lodge complaints, and it has the authority to investigate those complaints on their behalf. This has actually been an office that’s been around since the seventies, but funding over the years has been really inconsistent. In fact, it’s been frequently unfunded and vacant. It was reinstated last year, so this bill would strengthen that office so that it has the resources it needs to function on an ongoing basis.

Miller: What other legislative efforts with respect to corrections are being considered right now?

Green: There are a couple of bills that are aimed at expanding educational programs, and there’s a bill that relates to treatment that has actually already been signed into law this session, that’s Senate Bill 529, which loosens some of the requirements around a specific early release program that involves intensive treatment. The idea of that bill is it will make the program available to more prisoners with these changes, although only 18% of the prison population is eligible for that particular early release program.

But Dave, I think the takeaway here is that we have more than 2,000 prisoners who needed drug treatment and never got it that were released back into the community just last year. And meanwhile, taxpayers are spending billions of dollars on corrections. So the question is, what do they want out of that money?

Miller: Going back to House Bill 2890, how does it compare to what other states or the federal correctional system are doing right now, specifically with respect to people in prison who have substance use disorder?

Green: There are many county jails, including in Oregon, that broadly offer medications to prisoners to help quell opioid withdrawal and cravings. And federally, President Biden has said that by this summer, all of the country’s federal prisons will offer medication assisted treatment. So this really brings Oregon in line with that. And there are other states as well that offer medication assisted treatment in their prisons. In Maine, for example, prisons have seen a decrease in fights and suicide attempts, as well as incidents of self harm and overdoses go down, since expanding medication assisted treatment about four years ago.

Miller: Emily, thanks so much for joining us.

Green: Thanks, Dave.

Miller: Emily Green is the managing editor of The Lund Report. She joined us to talk about House Bill 2890, introduced by Democrat Maxine Dexter which would provide more behavioral health support in terms of mental health care and substance use disorder treatment for people incarcerated in Oregon’s prisons.

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