By Cayla Mihalovich, CalMatters
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Los Angeles County jails pared back access to life-saving opioid addiction treatment this fall during one of the system’s deadliest years on record, according to records obtained by CalMatters and interviews with staff.
The policy change came one week after Attorney General Rob Bonta filed a lawsuit against the county over “inhumane” conditions across its jail system, citing a “shocking rate of deaths,” including overdoses.
In interviews with CalMatters, two Correctional Health Services physicians expressed alarm over the reductions, saying that even the slightest delay in treatment is “wildly dangerous” and can lead to more fatal overdoses.
“Patients are begging me for help,” said a physician who spoke with CalMatters on the condition of anonymity because of fear of professional retaliation. “I’m on edge, waiting to see if someone is going to die.”
The reduction in treatment also comes as the jails hold about 700 more people every day as a result of a tough-on-crime ballot measure voters approved last year. Proposition 36 increased sentences for certain drug and theft crimes, leading to a surge in jail populations and straining county resources, according to a Sept. 10 Correctional Health Services memo to the Board of Supervisors.
Los Angeles County allocates roughly $25 million annually for the treatment program. County supervisors this year gave the program an additional $8 million from opioid lawsuit settlements. That sum ultimately did not increase funding for treatment because the county shifted an equivalent amount of money to a different need, according to a statement from the Los Angeles County Department of Health Services.
“The overall (medication-assisted treatment) program funding remained the same” despite the extra money the department received, the statement reads.
In a Sept. 16 memo obtained by CalMatters, Chief Medical Officer Sean Henderson said Correctional Health Services “will be taking a pause on primary care in ordering buprenorphine.” The medication reduces cravings and prevents overdoses.
The new mandate restricts how quickly and broadly Correctional Health Services physicians can prescribe the medication. Priority will be given to people when they first enter the jail system — the largest in California — which houses roughly 13,000 people across nine main facilities. Everyone else who wants medication will be placed on a waitlist.
“It’s misleading because we just put people on this list and then they stay on the list,” said a physician.
That means that if someone does not accept treatment upon arrival, they won’t be able to access it during the remainder of their incarceration, even if they change their mind, said both physicians who spoke with CalMatters.
Legal experts and physicians say there could be a myriad of reasons why people deny treatment when they’re first arrested and incarcerated. For example, a person could be unfit to make medical decisions if they are in active withdrawal.
Waitlist grew for opioid treatment
Between 2,350 and 2,650 incarcerated people in Los Angeles County receive medication-assisted treatment on any given day, said the Los Angeles County Department of Health Services in an email to CalMatters.
As of Sept. 15 — just one day before the policy change went into effect — 363 people were on a waiting list for treatment, the department said.
But that number skyrocketed to 835 people as of Oct. 31. The total includes 471 newcomers who have never been on the program; the remainder are people who asked to re-enroll after dropping out. As of October, the average wait time is 25 days, the department said. The department declined to answer how long the person waiting the longest has been in line for treatment.
In a statement to CalMatters, the Los Angeles County Department of Health Services said the policy change was intended “to help maximize the reach of (its) treatment program within the jails by leveraging the existing medical staff in the (Inmate Reception Center) where patient traffic is constant.”
The department maintained that medication-assisted treatment is “still available for all inmates, including those who may have declined treatment when they first arrived.”
“Length of incarceration varies for each inmate, from just a handful of days for some and many months for others; whether an individual will access (medication-assisted treatment) during their incarceration is based on their personal choice, unique case and the length of time they will remain incarcerated,” wrote the department.
Melissa Camacho, a senior staff attorney at ACLU of Southern California, said the reduction in treatment is “mind boggling” in a year where there are record-breaking deaths.
“I’d like to know how many people who died from overdose deaths were on the waiting list,” she said. “Having a waitlist doesn’t matter if the waitlist is too long to get treatment.”
More money for L.A. jail health care
Medication-assisted treatment combines counseling with FDA-approved medications, including buprenorphine, methadone and naltrexone to treat certain substance use disorders. A 2021 report from the National Commission on Correctional Health Care found that drug and alcohol overdoses constitute the third leading cause of death in jails, following illness and suicide.
Los Angeles County was an early adopter of medication-assisted treatment in its jails. Since the program’s inception in 2021, roughly 25,000 incarcerated people have been treated with Suboxone, an oral form of buprenorphine administered daily by medical professionals. But reliance on Suboxone alone proved to be challenging because of staffing limitations, said the Los Angeles County Department of Health Services in an email to CalMatters.
That’s why, according to Correctional Health Services physicians, the current regimen only allows someone to access Suboxone for 30 days when they first arrive in custody. After that, they can receive a long-acting injectable form of buprenorphine that’s administered once a month.
Since July 2022, nearly 40,000 doses of injectable buprenorphine — which cost roughly $1,600 per shot — have been administered to incarcerated people, according to the Los Angeles County Department of Health Services.
In a Sept. 10 memo to the Board of Supervisors, Correctional Health Services’ Director Christina Ghaly said overdose deaths constitute at least 28% of deaths this year. That’s a steep increase since 2016, when they accounted for 9% of in-custody deaths.
“Of all the medical care that we offer in the jail, opioid use disorder treatment is by far and away the most life-saving measure we provide,” said a second physician who spoke with CalMatters on the condition of anonymity because of fear of professional retaliation. “It seems paramount to protect these services.”
‘It seems like it’s backtracking’
In a written statement, the Los Angeles County Chief Executive Office said the county increased funding for health care in jails by $33 million last year to $580 million. The office said the county has been making improvements to the jails that collectively expanded access to care.
“It is true that critical unmet needs remain, and the county is focused on working with (the county health department and jail health care) to meet their highest priority needs in an environment of extremely limited local funding and service reductions to public facing services across multiple departments,” the statement read.
The state’s lawsuit against the jail system claims Los Angeles County and Correctional Health Services failed “to address the unconscionable mass overdose incidents occurring inside (its) jails” and limited access to the medication-assisted treatment program.
According to the lawsuit, three dozen in-custody deaths — approximately one per week — had taken place in Los Angeles County jails this year by the time of the filing. At that rate, the lawsuit stated, this year will account for the highest number of in-custody deaths over the past 20 years.
“Although (medication-assisted treatment) is known to prevent opioid related overdose and deaths and reduce recidivism, (Correctional Health Services) has an exceedingly long waitlist and failed to offer continued maintenance of medication,” the attorney general’s office wrote in the complaint.
“Persons in custody who have overdosed report not having access to (medication-assisted treatment) or receiving their initial dose of the medication but then being placed on a waitlist for access to follow-up medication, with a delay possibly causing a relapse and avoidable withdrawal symptoms.”
Mark Benor worked as a Correctional Health Services physician from 2018 until 2023, as the department was ramping up its medication-assisted treatment program. During that time, he said he became known as “the Suboxone doctor” as he traveled all over the jails to interview people who wanted to participate in the program and submit orders for their treatment.
“They created something that is impressive in the biggest jail system in the world,” he said. “It seems like it’s backtracking.”
This story was updated to clarify how Los Angeles County used opioid lawsuit settlement money to fund addiction treatment in its jails.
Cayla Mihalovich is a California Local News fellow.
This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.