Pew Charitable Trusts

After two decades of “tough on crime” policies, many states are taking a hard look at the way people are charged, how much time they serve, and what happens when they are released from prison.

While bills governing the use of body cameras and other police-related measures are likely to be considered this year, many states are looking at growing prison populations, obstacles to drug treatment, and high recidivism rates as reasons to re-evaluate their criminal justice systems.

The U.S. has the highest incarceration rate in the world, and many states are at a crossroads, weighing whether to build new prisons or change how they sentence people as well as how they guide them through parole and probation.

Several states, including Alaska, Maryland and Rhode Island, are considering sweeping criminal justice changes that would ease some of the punitive policies of the 1980s and ’90s, especially when it comes to drug offenders. In some places, lawmakers will consider recommendations made by criminal justice task forces, often with the guidance of outside groups such as the Council of State Governments (CSG) and The Pew Charitable Trusts (Pew also funds Stateline).

“If there’s a theme or common denominator, it is policymakers asking what the science says will work,” said Michael Thompson, director of the CSG’s Justice Center. “The question they’re asking is, ‘Can we get a better return on our investment?’”

Sentencing Reform

States that want to decrease the number of people going to prison often turn to reducing sentences, either by scrapping mandatory minimums or reclassifying some felonies as misdemeanors. They may also divert people into treatment for drug addiction or mental illness.

Nicole Porter with the Sentencing Project, which advocates for shorter sentences, said when states do reclassify crimes, it tends to be lower level felonies, such as drug possession and property crimes like theft under a certain dollar value.

Porter said some states may be inspired by what California voters did in 2014, approving Proposition 47, which reduced some felonies, such as nonviolent property theft and drug crimes, to misdemeanors.

Not only did the state decrease the number of people going into prison, but thousands of inmates were eligible to be released early under the new law. As of September, nearly 4,500 people were released under Prop. 47. And the state’s Department of Corrections estimates 3,300 fewer people will be incarcerated each year.

Holly Harris with U.S. Justice Action Network, a coalition of liberal and conservative groups pushing for criminal justice changes, said reducing felonies to misdemeanors could have a big impact on women. Though they are the fastest growing segment of prison population, many women are nonviolent offenders or are serving time for drug crimes that might be reclassified.

In Alaska, the state’s Criminal Justice Commission in December called for limiting prison beds to serious and violent offenders, reclassifying many of the lowest level misdemeanors as violations punishable by a fine, and shortening jail time for more serious misdemeanors to no more than 30 days. The panel also called for changing simple possession of heroin, methamphetamine and cocaine to a misdemeanor.

But states that are adjusting sentences aren’t just shortening them. Last year, Maine legislators reduced sentences for some drug possession crimes, but increased themfor cocaine and fentanyl powder, one of the opioids that have concerned state leaders as they battle heroin addiction.

“The dichotomy feels like legislators have a split personality,” said Alison Holcomb, director of the American Civil Liberties Union’s Campaign for Smart Justice, which lobbied against the increased sentences in Maine. Holcomb said while attitudes around some drugs have relaxed, some states that are trying to crack down on the abuse of opiates have imposed harsher sentences.

But reducing sentences could have unintended consequences. In Utah, state Rep. Eric Hutchings, a Republican, said the reclassification of some crimes as misdemeanors blocked some people from drug courts and treatment programs meant only for felons — something he said the state will fix this year.

Many states may also consider ending some mandatory minimum sentences, which have helped to swell prison populations in several states. Iowa Attorney General Tom Miller, a Democrat, said he wants the Legislature to eliminate mandatory minimums for less serious crimes, which under current law can land someone behind bars for decades.

Bills in several states, including Florida, Massachusetts and Virginia, would either scrap mandatory minimums or give judges more power to depart from them when issuing sentences. Last year, Maryland, North Dakota and Oklahoma gave judges more discretion to exempt some people from mandatory minimums, according to Alison Lawrence with the National Conference of State Legislatures.

Changes to Parole and Probation

States are also looking to get people who are already in the criminal justice system out faster and to help them transition back into society while on parole.

One option is “presumptive parole,” which means presuming that inmates are eligible for parole, rather than requiring them to convince the parole board they should be released, an approach Mississippi adopted in 2015. Michigan’s House is currently weighing the policy, something the state’s Department of Correctionsestimates will free up enough beds to save the state $82 million a year.

“It puts the burden on the state to show a compelling reason why you should not be released on parole,” Harris said.

States may also consider scaling back the amount of time prisoners must serve before they become eligible for parole. Mississippi used to require convicted felons to complete 85 percent of their sentence before they were eligible, but changed the law in 2014. Now nonviolent offenders must serve 25 percent of their time, while violent offenders must serve 50 percent, before they can be considered for parole.

Some states are trying to make their parole process more responsive to parolees’ behavior.

Several states, including Alabama and Utah, have adopted “swift, certain, fair” approaches, which aim to provide an immediate response to parolees’ behavior, whether it’s jail time after a failed drug test or a reduced parole term if someone has been following the rules and  making a lot of progress in post-prison life.

Hutchings said Utah legislators passed such a measure last year after examining the recidivism rates of parolees. One-third were back in prison because they had committed new crimes, but two-thirds were there for parole violations.

People need a quick, clear response when they do something wrong in order to change their behavior, Hutchings said, but the state was taking too long to get people in front of a judge when they violated parole — and they were often sent back to prison for too long.

“These are not people we’re afraid of. They’re just people who are not doing what they said they were going to do,” he said. “It’s kind of like the game Chutes and Ladders. You get your stuff together but then one slip-up and you’re back at the beginning. Even if you just get sent back to jail for 60 days, you don’t show up for work so you lose your job. You can’t make your car payments so it gets repo’ed. You go all the way back to zero.”

The state adapted one of its facilities to include a special section for parolees and probationers, giving them access to drug treatment, therapy, and their parole or probation officer. Officers can also order parolees and probationers to sleep at the center for a few nights, to make sure they stay out of trouble, or to be locked up for up to five days — or even longer with a judge’s approval.

Michigan state Sen. John Proos, a Republican, said he wants to expand his state’s “swift and certain” program, which now operates only in some counties. He’d also like the state to open it up to probationers.

But he also wants to understand why prison doesn’t better prepare inmates for parole. “Do we need more education? Do we need more resources?” he asked.

Several states already provide some resources, including substance abuse and mental health treatment, before people even go to prison.

Maryland’s working group on criminal justice reform found the state spends about $26 a day to incarcerate one person, versus $4.55 per person for probation and parole. To reduce the number of people entering prison, the group proposed starting a grant program to cover the county costs of specialty courts and re-entry programs.

Collateral Consequences

Some states are likely to consider ways to remove some of the barriers that make it difficult for people to make a life for themselves once they get out of prison.

Each year, several states take up “ban the box” legislation, which blocks employers from asking on job applications whether someone has served time. The idea is that if employers have a chance to get to know applicants before finding out about a criminal past, they are more likely to give them a second chance.

While 19 states have some sort of ban the box policy, sometimes it only applies to the state or its contractors, but not private employers. Arkansas state Sen. Jeremy Hutchinson, a Republican and the chairman of the Senate Judiciary Committee, said he expects the state to consider such a policy this year, but he’s not sure how far he wants to go.

“There’s a lot of hesitancy, even on my part, to dictate to employers what should be on their job application, but the state can be a model,” he said.

States are also likely to consider laws that allow for the expungement or sealing of records, or certificates of rehabilitation, which allow a state to vouch for the good reputation of people who have been convicted of crimes and served their time.

This month, the Kentucky House voted to let people convicted of most Class D felonies — the lowest level of felony, punishable by one to five years in prison — erase their criminal records and get a second chance at jobs, housing and other opportunities sometimes denied felons.

Juvenile Justice

Some states are also reevaluating their juvenile justice systems and trying to open them to an older population, prompted in part by new brain science which suggests cognitive abilities are not fully formed until age 25.

In New York, after failing to change the state’s status as one of the few where 16- and 17-year-olds are automatically tried as adults, Democratic Gov. Andrew Cuomo issued an executive order in December requiring that young prisoners be housed separately from older inmates — an idea that has been talked about in other states as well.

Read original article
States at a Crossroads on Criminal Justice Reform

A week before 22-year-old Joe White was slated for release from the Barnstable County Correctional Facility, 26 law enforcement officials and social workers huddled around a table to discuss his prospects on the outside.

For substance abusers like White, they aren’t good.

In the first two weeks after a drug user is released from jail, the risk of a fatal overdose is much higher than at any other time in his addiction. After months or years in confinement, theoretically without access to illicit drugs, an addict’s tolerance for drugs is low but his craving to get high can be as strong as ever.

Most inmates start using drugs again immediately upon release. If they don’t die of an overdose, they often end up getting arrested again for drug-related crimes. Without help, very few are able to put their lives back together while battling obsessive drug cravings.

Barnstable, on Cape Cod about 70 miles from Boston, has broken that cycle with the help of a relatively new addiction medication, Vivitrol, which blocks the euphoric effects of opioids and reduces cravings. Such medications have been shown to be far more effective at helping people quit drugs than counseling and group therapy programs that do not include medication.

But even as the nation grapples with an epidemic of opioid overdoses, the use of medication to treat opioid addiction has faced stiff resistance: Only about a fifth of the people who would benefit from the medications are getting them.

The opposition is especially strong in prisons and jails. About two-thirds of the nation’s 2.3 million inmates are addicted to drugs or alcohol, compared to 9 percent of the general population, according to a study by the National Center on Addiction and Substance Abuse at Columbia University. Yet only 11 percent of addicted inmates receive any treatment.

White, whose story was relayed by Barnstable officials and who asked that his real name not be used, was a homeless substance abuser when he began a yearlong stint for stealing credit cards. He was set to receive a Vivitrol injection two days before he walked out — improving his chances of surviving long enough to get a second 30-day injection and some counseling.

Barnstable has been offering the medication to departing inmates for nearly four years. During that period, the recidivism rate among Vivitrol recipients has been 9 percent. That’s compared to a national re-arrest rate for drug offenders of 77 percent within five years of release, according to the Bureau of Justice Statistics. (Like many jails, Barnstable does not track its own recidivism rate.)

Beyond Barnstable

Since 2014, nine Massachusetts prisons and 10 jails have added Vivitrol to their drug treatment arsenals. About 50 state prisons in Colorado, Kentucky, Missouri, Pennsylvania, Tennessee, Utah and West Virginia now dispense the medication. And at least 30 jails in California, Illinois, Indiana, Kentucky, Maryland, Michigan, Missouri, New York, Ohio, Utah, Wisconsin and Wyoming also are offering it to departing inmates, according to the drug’s manufacturer, Alkermes.

The nation’s nearly 200,000 federal prisoners have not been offered any addiction medicines, though the Federal Bureau of Prisons is considering changing that policy this year.

Addiction experts argue medication-assisted drug treatment is not spreading fast enough in U.S. prisons and jails.

One of three medications approved for opioid treatment, Vivitrol is not a narcotic and therefore not a controlled substance. The other two medications, buprenorphine and methadone, are narcotics, which are anathema to most criminal justice systems.

The downside to Vivitrol is that patients must be off of all opioids for at least seven days before receiving an injection, a painful and sometimes costly proposition. Being behind bars obviates that problem, since most addicts do not have access to drugs while incarcerated.

Addiction specialist Dr. Kevin Fiscella said the failure to offer medication to more incarcerated addicts is “a missed opportunity” to treat inmates, many of whom are motivated to beat the disease that put them in prison, in a controlled environment. “There is no better place to intervene in an individual’s addiction than in corrections,” he said.

For one inmate at a Massachusetts prison, opting for Vivitrol was easy. In a video provided by corrections officials, he said he injured his shoulder playing lacrosse in high school and was prescribed Percocet, an opioid painkiller. He said he fell in love with the way it made him feel and quickly moved to heroin, a cheaper, more available alternative. Right after he graduated, he was arrested for breaking and entering and theft, and was sent to prison.

“I have friends that have sworn up and down about Vivitrol and how good it is and how it takes away the urge. They all have jobs now. They’ve been out of trouble forever. So when I got offered it, I said, ‘Don’t even finish the sentence, I’ll sign up right now,’ ” the inmate said.

Not a ‘Magic Cape’

Vivitrol is an injectable form of naltrexone, an oral medication that has been used to treat opioid addiction since 1984. It is similar to naloxone or Narcan, which reverse the effects of an opioid overdose.

Vivitrol and related medications, called antagonists, block the brain’s opioid receptors, making it nearly impossible to get high from opioids. Although scientists are not exactly sure how, antagonists reduce the addicted brain’s obsessive cravings for drugs.

Approved for opioid treatment by the U.S. Food and Drug Administration in 2010, Vivitrol was added to Barnstable’s longstanding re-entry drug treatment program in 2012.

Inmates who enter the program are told about the potential benefits of the medication and given the option of receiving their first injection a few days before being released.

“No matter how long they’ve been drug-free, inmates tell us they start actively dreaming about getting high in the last few weeks before they’re released,” Barnstable Sheriff James Cummings said.

Of the nearly 200 inmates who have chosen to receive the injection, about half have remained sober. Only one has died of an overdose.

“It’s not a magic cape,” said Andrew Klein, a corrections expert who is working with prisons and jails — including Barnstable — on medication-assisted treatment programs.

The biggest challenge, Klein said, is getting inmates to continue taking the medication once they leave the facility. “The physical symptoms of their addiction clear up pretty quickly and they feel like they’ve licked it, so they stop showing up for the monthly injections,” Klein said. “That’s when they tend to relapse.”

Experts agree that medications should be combined with behavioral counseling.

But the precise amount and type of counseling hasn’t been established. “At the very least, they need to be reminded to keep taking the medicine,” said Klein, a consultant withAdvocates for Human Potential, which specializes in behavioral health.

Although Vivitrol’s efficacy at dampening drug cravings has been shown, the drug is relatively new and no definitive study has proven its long-term effectiveness at preventing relapse.

Dosing and Counseling

At Barnstable, only 34 of the inmates who took Vivitrol completed an intensive six-month rehabilitation program before release. Despite agreement on the effectiveness of combining counseling and other types of therapy with the medicine, Barnstable does not require it.

“We’re seeing Vivitrol as a lifesaving medication,” said Jessica Burgess, the jail’s health services director. “We’re not going to deny it to anyone.”

Inmates interested in receiving it are given a physical exam. They also receive a short-acting oral form of the drug to check for potentially severe adverse reactions such as gastrointestinal disorders or dizziness. Inmates are also warned that once they are released, the long-acting medication will prevent them from getting high on opioids or alcohol.

On average, participants in the Barnstable program received five shots, including the injection they received before being released. Some stopped taking the injections after two or three months and relapsed. But according to Cummings, the sheriff, most were eager to get back on the medication.

Most ex-prisoners can’t afford to continue on the medication — which costs $1,000 per injection — without insurance coverage of some kind. In Massachusetts, prisons and jails enroll departing inmates in the state’s Medicaid program, which covers the cost.

Word of Mouth

Nearly half of the inmates in Barnstable’s 588-bed facility are addicted to opioids when they arrive. But in the nearly four years Vivitrol has been offered, fewer than 200 have opted to take it.

Their reasons for declining it vary. Most are in denial that they have an addiction. Many are unwilling to give up drugs and alcohol. Some don’t want to make the monthlong commitment that comes with receiving the injection.

But officials here say resistance is starting to diminish.

“The number of requests we’re receiving from inmates asking for Vivitrol has been steadily increasing since the start of the program,” Burgess said. “We attribute this to word of mouth and increased awareness.”

In the first year of the program, 37 inmates received the shot, followed by 51 the second year and 53 the third year. Since May 2015, 50 have signed up.

People outside of corrections who seek treatment for opioid and heroin addiction also have reservations about Vivitrol. Abstaining from opioids for seven days can be painful and dangerous. If patients relapse, they are at high risk for an overdose.

At Gosnold, a treatment center in nearby Falmouth, CEO Raymond Tamasi said the most common objection is fear of using drugs while on the medication and overdosing. That’s despite clear evidence that people who try to abstain from drugs without the help of medications are far more likely to die from an overdose, he said.

“Advances are coming in pharmacology,” Tamasi said. “Someday soon I expect we’ll view Vivitrol like the early days of penicillin.”

Read original story – Published January 13, 2016
Helping Drug-Addicted Inmates Break the Cycle

Dr. Marvin Seppala wrote a book on conquering drug addiction with counseling and group therapy.

The spiritual, abstinence-based strategy pioneered by Alcoholics Anonymous helped him overcome his own alcohol and cocaine addiction when he was 19. As medical director of Minnesota’s fabled Hazelden clinic, he watched it work for patients.

He believed in it — and then he changed his mind.

In 2007, Seppala began working at Beyond Addictions, a now defunct treatment center in Beaverton, Oregon. Instead of relying solely on counseling, the center gave its patients a relatively new medication, buprenorphine, to relieve their drug cravings.

Back in Minnesota, his patients had been bailing out of treatment to use illicit drugs again. In Oregon his patients on buprenorphine weren’t relapsing or overdosing — they reported feeling “normal” again.

Nearly a decade later, doctors and brain researchers agree that medications such as buprenorphine, methadone and naltrexone are the most effective anti-addiction weapons available. Nevertheless, more than two-thirds of U.S. clinics and treatment centers still do not offer the medicines. Many refuse to admit people who are taking them.

The result is that hundreds, perhaps thousands, of Americans are dying unnecessarily, victims of an epidemic that killed more than 28,000 people in 2014 — more than homicides and almost as many as auto accidents.

The research is unassailable: Staying in recovery and avoiding relapse for at least a year is more than twice as likely with medications as without them. Medications also lower the risk of a fatal overdose.

Addicts who quit drugs under an abstinence-based program are at a high risk of fatally overdosing if they relapse. Within days, the abstinent body’s tolerance for opioids plummets and even a small dose of the drugs can shut down the lungs.

And yet as the country’s opioid epidemic worsens — every day, more than 70 Americans die from overdoses, and the numbers are climbing — only about a fifth of the people who would benefit from the medications are getting them, according to a new study by the Johns Hopkins Bloomberg School of Public Health.

“When we discovered medications that worked for AIDS, deaths immediately plummeted. It became a chronic disease instead of a terminal disease,” said Dr. Andrew Kolodny, chief medical officer of the Phoenix House treatment centers, based in New York.

“This epidemic could be the same,” he said. “We have medications for addiction now. But unfortunately, we’re not making them available enough.”

People who could benefit from the medications are not getting them for numerous reasons. Among them:

• Too few health care professionals have specialized training in addiction medicine. Although some primary care doctors have stepped in to fill the void, most are unwilling to treat patients with addictions and say they are often recalcitrant and disturbing to others in their waiting rooms.
• Insurance coverage is limited. Few private insurers and state Medicaid programs cover all of the medications approved by the Food and Drug Administration. When they do, they typically limit the dosage or how long patients can take the medication or require them to first try group therapy, which is cheaper.
• Many leaders of traditional drug treatment centers, such as national detox chains and residential rehab programs, are recovering addicts who conquered their own addictions without medication. They reject the notion that an addict can truly recover from a drug problem by becoming dependent on a different drug.
• Greater use of medication could cut into the centers’ revenue, by reducing the number of people who opt for expensive residential stays. And smaller clinics that might want to add medication services would have to hire a physician to do so, which many of them could not afford.

Dr. Kelly Clark, an addiction specialist in Kentucky and president-elect of the American Society of Addiction Medicine, said some of the resistance is cultural, rooted in a widespread belief “that drug addiction is a moral failing, and that people should just get over it.”

“There is no other disease where approved medications are not provided to everyone who needs them,” Clark said. “We used to consider people with mental illness inferior, even possessed. Scientific advances have combatted stigma around a wide variety of brain diseases, but not addiction.”

Hazelden was one of the many treatment centers that resisted the use of medication — until Seppala returned from his stint in Oregon in 2009 and began pushing the board to shift course. Hazelden started offering the medications shortly thereafter.

“It’s hard to argue when you have patients dying of overdoses,” Seppala said. “We said this is truly a crisis, we can’t just base our service on philosophy, we have to look at the data and base our treatment on the best way to save lives.”

Freedom from Drugs

Opponents say addiction medications such as buprenorphine reduce drug cravings, but they don’t attack the underlying psychological problems that often go with addiction. Nor do they address shame, guilt and self-loathing — as counseling does.

Dr. Robert Mooney’s belief in abstinence has never wavered. As medical director at Vista Taos, a treatment center in New Mexico, he refers his patients elsewhere if they want to take medication. “What we do here is abstinence-based, because there are some people that nothing else will work on,” he said.

Mooney, a psychiatrist and board-certified addiction specialist, beat his own addiction to alcohol and cocaine with an abstinence-based approach, and he grew up in an abstinence-based treatment business. His parents, Dr. John and Dot Mooney, a surgeon and a nurse, overcame their own drug and alcohol addictions through abstinence and opened a treatment center, in Statesboro, Georgia, in 1971, to help others tread the same path.

“I tell patients, ‘We’re going to take you off all medications and give your brain a chance to land, and it’s going to be a long road.’ You need to prepare people for that.”

Mooney said he isn’t interested in arguing with those who believe in addiction medications, because in his view there has not been adequate research on the long-term effectiveness of either approach. “But let’s at least hang on to an abstinence-based philosophy, because we absolutely need it as part of the solution,” he said.

Seppala’s 2001 book, Clinician’s Guide to the Twelve Step Principles, embraces the approach first laid out in 1935 by Alcoholics Anonymous, “a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem.”

He still says addicts who want abstinence-based treatment should get it. But, he said, medication should be offered. Like other addiction doctors, Seppala stresses that medication should be combined with counseling and group therapy whenever possible. Given the horrific toll of the drug epidemic, “We ought to put everyone on some sort of medication and give them all the psychosocial counseling we can,” he said.

The scope of the epidemic is staggering. Since 2008, more than 115,000 Americans have died from overdoses of prescription opioid painkillers and nearly 39,000 have died from heroin overdoses — reaching an overall death rate of 9 per 100,000 in 2014. That’s six times the drug overdose death rate of the 1970s, according to data from the U.S. Centers for Disease Control and Prevention.

New data from the CDC indicate the death toll from this epidemic has not yet peaked. Prescription opioid overdose deaths rose 16 percent from 2013 to 2014, to nearly 19,000. Heroin overdose deaths rose 28 percent and deaths from relatively new illicit opioids, such as fentanyl and tramadol, spiked 79 percent.

According to the U.S. Department of Health and Human Services (HHS), nationwide medication-assisted treatment capacity has increased somewhat in the past decade, but not enough to keep pace with the worsening opioid epidemic.

Many of the nation’s hardest-hit areas are rural and suburban. Rates of addiction are much higher in those areas and the shortage of providers is even worse.

“There are entire communities that are devastated by this epidemic,” Clark said. “If you have an opioid addiction, the odds are good that many, many in your world have the same disease. I’ve treated adolescents and their parents and grandparents.”

Nationwide, nearly 22 million people have some kind of substance use disorder, but only one in 10 goes to a treatment center, according to the most recent survey by the U.S. Substance Abuse and Mental Health Services Administration. In contrast, the treatment rate is as high as 80 percent for other chronic diseases such as diabetes, asthma, heart disease and high blood pressure.

Difficult Terrain

Addiction to opioids, including heroin and prescription pain pills, is difficult to treat. Not everyone recovers. Among those who do, most relapse at least once before entering a period of sustained recovery. For the millions of opioid addicts who are uninsured, homeless or recently incarcerated, getting on medication — and staying on — is a struggle.

But the affluent and the well-educated are also victims of this new epidemic. Their search for effective treatment can be frustrating and dangerous, their relapses frequent.

Kevin Flattery seemed to be in an ideal position to beat his addiction to OxyContin, a widely abused opioid painkiller.

After graduating from the University of Virginia, in 2010, Flattery moved to Hollywood to pursue his passion for filmmaking. Opioid painkillers were cheap and easy to acquire on the street there. Kevin tried them and liked them, in part because they relieved some of the stress he was experiencing as he pursued his high-pressure career.

Two years later, he realized he had an addiction that was taking over his life. Kevin decided to move back to his parents’ home in Mount Vernon, Virginia, an upper-middle-class suburb of Washington, D.C., to find help.

He had family support, financial means and no shortage of local treatment providers. But he got conflicting signals from the counselors he saw.

He checked himself into Inova Fairfax Hospital for detox, and the experts there suggested he start taking buprenorphine, one of the FDA-approved drugs.

The medication worked well for Kevin — at first. But he veered off course a couple of times, stopping the daily medication and buying OxyContin to get high. Each time, he got himself back on buprenorphine within a few days.

Experts say that’s a typical path for people who take such medicines. It often takes several tries before they stabilize and enter a period of sustained recovery.

But after a few months, Kevin wasn’t sure he wanted to stay on the medication for the long term. He attended local 12-step programs where he was criticized for taking it.

Kevin’s father, Don Flattery, said his son was confronted with judgment and pressure about it. “He was made to feel that he was not in recovery, not serious about his sobriety, and substituting one addiction for another — all utterly false but damaging to him nonetheless.”

Conflicted about how to proceed, Kevin stopped taking buprenorphine. Ten days later, he relapsed and suffered a fatal overdose, at age 26.

Three Medications

Buprenorphine and methadone are regulated as controlled substances by the U.S. Drug Enforcement Administration (DEA). Like the opioid painkillers that cause the addictions they are meant to relieve, both are commonly sold on the street.

But their euphoric properties are limited, making them poor options for getting high. The illicit use of methadone can cause a fatal overdose, particularly when combined with other drugs. But buprenorphine is relatively safe, even when used illicitly.

Methadone can cost less than $5 per day; buprenorphine costs about $10 per day. Although medical research has yet to establish standard lengths of time for using either, many have maintained recovery for decades on methadone. Buprenorphine has been used successfully for years by some, and only months by others.

A 2000 federal law requires doctors to seek a special waiver from the DEA to prescribe buprenorphine and limits their number of patients to 30 in the first year and to 100 in subsequent years. HHS may loosen the patient limit this year.

Methadone can only be dispensed by about 1,400 licensed clinics nationwide, both stand-alone and in prisons or hospitals. Most of them are in major cities, meaning the medication is unavailable to most in rural areas. Patients must show up every day to receive their dose under the supervision of a licensed professional.

Vivitrol, an injectable form of naltrexone, is not a narcotic and therefore not regulated. Instead of fulfilling the addicted brain’s perceived need for opioids, it blocks the effect of the drugs and thereby reduces cravings.

Any doctor can prescribe and administer Vivitrol. But it has a major drawback: To avoid severe and dangerous withdrawal symptoms, patients must completely detox from all opioids for at least seven days before receiving the first shot. For many, that means residential treatment, which can be costly. The drug itself is also expensive, at $1,000 per month.

Research on Vivitrol’s long-term effectiveness is still to come, but its use is spreading, particularly in jails and prisons. Patients are also increasingly opting for Vivitrol because the shots are effective for 30 days, tempering the temptation of stopping daily doses to get high.

Addiction doctors agree that all three medications should be available to patients, because one may be more effective than another, depending in part on the person’s age, length of time as an addict, home and work environment and underlying mental health issues. The American Medical Association, the American Academy of Addiction Psychiatry and the American Society of Addiction Medicine unequivocally support their use.

Patients should have a say in the kind of medication they want to receive, said Dr. David Gastfriend, scientific adviser to the Treatment Research Institute, in Philadelphia, which analyzes the effectiveness of addiction treatments. “They’ve heard about certain drugs from their friends or they’ve had past experiences and they often have ideas about what they want,” he said. “Treatment works much better with patient buy-in.”

Gastfriend and other addiction experts emphasize that medication should be accompanied by at least some counseling or group therapy. How long patients must stay on the medications remains unknown.

A Turning Point?

For advocates of medication-based treatment, recent policy changes are cause for optimism. The Affordable Care Act allows states to expand health insurance coverage to low-income adults and, for the first time, makes Medicaid and private insurance coverage of substance abuse treatment mandatory.

In the past, Medicaid only covered low-income pregnant women, children and disabled adults. Any drug or alcohol coverage was limited to those three populations. A severe drug or alcohol addiction, while debilitating and life-crushing, did not qualify on its own as a disability.

Under the ACA, 30 states plus D.C. have opted to expand Medicaid to low-income, able-bodied adults, giving millions of poor Americans coverage for addiction treatment. The health law also requires all state Medicaid programs and all insurance companies to cover the gamut of recommended treatments for addiction.

In addition, the federal Mental Health Parity and Addiction Equity Act, although not enforced everywhere, requires insurers to pay for proven addiction treatments at the same dollar level as medical and surgical treatment for purely physical diseases such as cancer.

“There has never been a better time to confront the addiction problem we have in this country,” said Michael Botticelli, director of the U.S. Office of National Drug Control Policy.

“We know so much more about addiction from years of scientific research. We know that substance use disorders are diseases of the brain, that they can be chronic and relapsing,” Botticelli said. “But we also know that like other diseases, they can be prevented, treated and people can recover.”

Read original article – Published January 11, 2016
In Drug Epidemic, Resistance to Medication Costs Lives

Dr. Kelly Eagen witnesses the ravages of drug abuse every day. As a primary care physician at a public health clinic here in the Tenderloin, she sees many of the city’s most vulnerable residents.

Most are homeless. Many suffer from mental illness or are substance abusers. For those addicted to opioid painkillers or heroin, buprenorphine is a lifesaver, Eagen said. By eliminating physical withdrawal symptoms and obsessive drug cravings, it allows her patients to pull their lives together and learn how to live without drugs.

Clinical studies show that U.S. Food and Drug Administration-approved opioid addiction medicines like buprenorphine offer a far greater chance of recovery than treatments that don’t involve medication, including 12-step programs and residential stays.

But as the country’s opioid epidemic kills more and more Americans, some of the hardest-hit communities across the country don’t have enough doctors who are able — or willing — to supply those medications to the growing number of addicts who need them.

More than 900,000 U.S. physicians can write prescriptions for painkillers such as OxyContin, Percocet and Vicodin. But because of a federal law, fewer than 32,000 doctors are authorized to prescribe buprenorphine to people who become addicted to those and other opioids. Most doctors with a license to prescribe buprenorphine seldom — if ever — use it.

Buprenorphine is the primary addiction treatment tool for Eagen and the seven other staff physicians at the Tom Waddell Urban Health Clinic.

Getting patients started on the medication can be time-consuming. When they’re too busy with other patients, they rely on a small medical team at a county-funded center in the nearby Mission District to screen patients and, if the medication is appropriate for them, determine the correct dose.

At this central “induction center” on Howard Street, a half-time doctor, two nurse practitioners, a behavioral health counselor and two administrators have been providing screening and initial care for low-income opioid and heroin addicts since 2003.

Eagen said working with the Howard Street team makes her life easier. “When the patient is handed back to me, I know that the person is not at risk for imminent relapse. They’re the easiest patients I have.”

Unrealized Potential

With its long history of providing drug treatment and free health care to uninsured residents, San Francisco is particularly well-equipped to battle the opioid and heroin epidemic. But even here, federal prescribing restrictions and lack of information keeps many doctors from entering the fray.

When the National Institute on Drug Abuse funded the research that led to buprenorphine’s development more than a decade ago, it hoped that office-based prescribing of buprenorphine, which comes in a soft tablet and dissolvable film, would mean greater access to addiction medication nationwide.

It hasn’t happened. Most doctors claim they don’t have the training or the time to treat high-maintenance opioid addicts in their busy practices, despite urgent calls from federal and state officials. “I really think doctors are scared of prescribing it,” Eagen said. “They worry they’re going to make people sick when they start taking it.”

But an increasing number of physicians are starting to push for greater use of buprenorphine.

“We doctors are the ones who caused this epidemic by overprescribing pain medications. We need to get more involved in fixing it,” said Kelly Pfeifer, a physician with the California HealthCare Foundation, which advocates for greater availability of addiction treatment and prevention.

Nationwide, about 21.5 million people 12 and older, or 8 percent, had some kind of substance use disorder in the past year, according to a national survey by the U.S. Substance Abuse and Mental Health Services Administration. Of those, almost one in 10 were hooked on painkillers — 1.9 million — and more than half a million were hooked on heroin. And those numbers are rising. Among the low-income adult population served by Medicaid under the Affordable Care Act, the rate is much higher: An estimated 13 percent of newly eligible Medicaid enrollees suffer from addiction.

In California, which was among the first states to expand Medicaid, as many as 370,000, of the 2.9 million people newly eligible for Medicaid, may be in need of treatment.

Under a first-of-its-kind agreement with the federal government, California’s county-run Medicaid programs are slated to begin covering a full set of addiction treatment options recommended by the American Society of Addiction Medicine, including opioid addiction medications. San Francisco County and the rest of the Bay Area will be the first to roll out the new drug treatment benefits later this year.

Federal Rules

Three medications have been approved to treat opioid and heroin addiction. Methadone, a long-acting opioid that fulfills the addicted brain’s perceived need for heroin, was approved for treatment in 1964 and is dispensed at highly regulated clinics scattered around the country, mostly in urban areas.

Patients must visit the clinics daily to swallow a liquid dose of methadone under supervision of a certified health professional. For many, that means traveling substantial distances early in the morning before work. Some patients can qualify for take-home doses for use on weekends.

Naltrexone, a daily pill approved in 1984 for heroin addiction, can also be prescribed by a doctor. But until 2010, when naltrexone was introduced in injectable form, as Vivitrol, it was considered much less effective than either methadone or buprenorphine at keeping people in recovery from heroin addiction.

Buprenorphine, approved in 2002, is prescribed by doctors in an office setting, making it much more convenient than methadone. Patients simply pick up a monthly supply of the medication and take it on their own. Like methadone, it is a long-acting opioid that relieves drug cravings and physical withdrawal symptoms with fewer of the side effects of other opioids.

In anticipation of buprenorphine’s approval, a 2000 federal law required doctors to seek a special license from the U.S. Drug Enforcement Administration to prescribe it. The federal law requires eight hours of training and limits the number of patients per doctor to 30 in the first year and 100 in subsequent years. That limit was established to prevent “pill mills,” in which doctors prescribe the medication for a fee without ensuring that patients are actually using the pills to stay in recovery from a drug addiction.

Although the vast majority of doctors with a buprenorphine license see only a few patients, the federal limit prevents some doctors in high-demand communities and urban neighborhoods from providing care to everyone in need.

In response to the worsening heroin and opioid epidemic, the U.S. Department of Health and Human Services is considering an increase in the patient limit for prescribing buprenorphine. Advocates for greater availability of addiction medicines argue HHS should go further, eliminating the cap altogether and allowing nurse practicioners and physician assistants to prescribe the medication.

But the federal government argues that without adequate record keeping and physician oversight, too many patients could end up selling the medication on the street.

Although buprenorphine does not produce the euphoric effects of heroin, many drug users purchase it to tide themselves over until they can score the real thing. Doctors who advocate for greater use of buprenorphine argue that the threat of diversion is minor compared to the lifesaving potential of the drug.

‘Summer of Love’

Buprenorphine doesn’t just save lives by fighting addiction, advocates say. It also connects drug addicts to mainstream medical care and can help improve their health, which drug users typically neglect.

Dr. David Smith, a San Francisco physician credited with starting the first free health clinic in the country, in 1967, argues that in the long run, patients are better off in the care of physicians than addiction treatment providers, such as counselors and therapists, without medical training.

“We’re finding that when people with addictions start going to a primary care doctor, their physical health starts to improve, too. They start getting regular treatment for diabetes, infections and heart disease, for example,” Smith said. “They tend to stay in treatment longer and their outcomes tend to be much better.”

Smith, who runs a private addiction practice here, treated young middle-class kids who flocked to the Haight-Ashbury neighborhood during the “Summer of Love,” in 1967, to experiment with drugs. Many were dying of overdoses and nearly all of them were neglecting their health, he said.

“I came to a realization back then that health care was a right, not a privilege, and I’ve never changed my thinking,” Smith said. Hundreds of other doctors came to the same realization in the 1980s, when the city became ground zero in the AIDS epidemic.

Then in the 1990s, heroin returned and doctors realized that intravenous drug users were getting HIV. “People were dying all over the city,” said Dr. Judith Martin, medical director for substance abuse services at the San Francisco Department of Public Health.

Many of San Francisco’s doctors began embracing methadone, the only addiction medication back then, Martin said. Addicts who showed up at clinics to get their daily cup of methadone weren’t dying of overdoses and they weren’t contracting AIDS. As a result, Martin said, the department’s doctors are believers in addiction medicines and they’re committed to fighting the disease.

As soon as buprenorphine was approved, the department asked all of its doctors to apply for federal permission to prescribe it, and nearly all did. They were eager to help. But the prospect of fitting droves of drug-addicted new patients into their busy practices worried them.

So in 2003 the department and San Francisco General Hospital teamed up to make it easier for doctors to work with patients fighting addiction. At a cost of about $1 million per year in general tax revenue, more than 1,300 addicts have passed through the Howard Street doors and on to the care of doctors elsewhere in the city.

Once the clinic transfers patients to a primary care provider, they are removed from the rolls, allowing Howard Street’s lone doctor to keep initiating people on buprenorphine without exceeding her 100-patient limit.

San Francisco has seven methadone clinics, more than most cities its size. It also has two mobile clinics that travel to underserved neighborhoods and the jail. Three primary care sites and two pharmacies are also licensed to distribute methadone.

Getting Started

On a rainy Monday morning earlier this month, four of the eight patients in Howard Street’s Spartan waiting area sat uncomfortably on metal chairs looking like they had the flu. They were the ones scheduled to receive their first dose of buprenorphine. A handful of other patients looked much happier. They were the ones who had gotten through the rough part.

For patients who decide to quit opioids or heroin and get on buprenorphine, the first step is to stop using drugs for at least 12 hours or until they start having at least moderate withdrawal symptoms — chills, fever, body aches, watery eyes and restlessness.

That’s what they’re told when they walk in to the center on the ground floor not far from the city’s financial district, in the same building as the Department of Public Health’s mental health and residential substance abuse branch. From the Tenderloin, it’s a short walk downhill.

Patients come on their own to sign up or get referred here by a primary care doctor, a county jail or a hospital. Many want to try buprenorphine but don’t know what to expect. Some are on their second or third try at sobriety.

The first visit takes at least two hours, sometimes more, and patients are almost always filled with anxiety, said Jadine Cehand, the nurse practitioner on duty. Many are ambivalent about their decision to quit, she said. Nearly all patients are fearful of what lies ahead. “We keep telling them that they’re doing the right thing,” she said.

After the first day, patients take a dose or two of the medication home with them and come back every morning for the rest of the week to report their symptoms and get another dose. Check-ins can be less frequent the week after, depending on how they respond to the medication. “It’s amazing to see how quickly they improve,” Cehand said. “By the end of the week they come in with their hair washed and a smile on their faces.”

Read original article – January 15, 2016
Few Doctors Are Willing, Able to Prescribe Powerful Anti-Addiction Drugs

When Milwaukee resident Linda Hopgood found out last summer she was about to lose her food stamp benefits, she immediately started looking for work. But she said she quickly became discouraged by employers telling her she did not have the skills they were looking for.

The 48-year-old former nursing aide has been out of work for four years. She lives in her son’s house and spends her days watching her daughter’s three children. Without the $187 in food stamps she had received each month for the last seven years, she’s now walking to church every day for free meals.

Hopgood lost her benefits when Wisconsin reinstated work requirements for food stamps. With 22 new states reinstating the requirements as of Jan. 1, another 500,000 or more people could find themselves in her situation by spring.

The reinstated requirements are only for able-bodied adults between the ages of 18 and 49 who have no young children living with them. If they do not work 80 hours per month, or take part in 80 hours of a qualified job-training or educational program, they can only receive food stamp benefits for three months out of every three years.

The federal government suspended the work requirements on those food stamp recipients nationwide in 2009, when jobs disappeared and unemployment rates shot up during the Great Recession. Over time, as their economies have improved, states have had to reinstate the work requirements.

Now, all but seven states — California, Illinois, Louisiana, Michigan, Nevada, Rhode Island and South Carolina — and the District of Columbia have work requirements for able-bodied adults without dependents in at least part of the state. For work requirements to be waived, unemployment must be higher than 10 percent, or states must prove a lack of jobs.

Some governors have not sought permission to forgo the requirements, despite high unemployment rates. For instance, this year, Mississippi (6.6 percent), New Mexico (6.2 percent) and West Virginia (7 percent) could have applied but didn’t, said Ed Bolen, senior policy analyst at the left-leaning Center on Budget and Policy Priorities (CBPP).

And South Carolina (6.7 percent) only sought permission to forgo the requirements until March.

States also can seek federal permission to waive the requirements only in areas that continue to lack jobs. But many of them haven’t.

Wisconsin, for instance, could have sought to forgo work requirements in Milwaukee, where jobs are harder to come by. But Republican Gov. Scott Walker chose not to, saying that the requirements would boost the workforce.

“We aren’t making it harder to get benefits — we are making it easier to get a job,” said Laurel Patrick, Walker’s press secretary.

Others, however, say reinstating the requirements makes life harder for people like Hopgood who already face barriers to employment. And, they say, few states have taken the time or money to set up programs that would help people find jobs or get trained.

“If the state doesn’t provide any of these [programs], you’re out of luck,” Bolen said. “And that model doesn’t lead people to get jobs — it makes them desperate.”

Poor and Uneducated

About one in 10 food stamp recipients, or about 4.7 million, fall into the category of being able to work and having no dependent children, according to new data from the U.S. Department of Agriculture, which oversees the Supplemental Nutrition Assistance Program, or SNAP, better known as food stamps. On average, their households receive about $191 a month in food stamp benefits.

They are poor, with an average household income of about $3,768 a year. And they are uneducated — one in four didn’t graduate high school, and two in four only earned a high school diploma, according to a January report by the CBPP.

The federal government offers more than $90 million a year for employment and training programs, and requires states to offer them to this population.

But the programs can be as basic or comprehensive as the state wants — from offering advice on resumes and job searching, to providing individualized case management that matches a person with a relevant job skills training program. USDA strongly encourages states to move toward the latter.

If any state offers a model for providing education and job skills to this population, it may be Washington.

The state’s program started small in 2005, in one community center serving just its immediate area, and now serves the entire state in all community colleges and 29 community-based organizations, said David Kaz, director of policy and communications at the nonprofit Seattle Jobs Initiative.

With work requirements back in place in Seattle and surrounding areas starting this month, Kaz said the programs — which include job search instruction, job training, GED prep, English language classes, vocational education and job retention services — should have the capacity to serve anyone who needs it.

Washington is one of a few states that make use of federal matching funds available for establishing programs in community colleges or in contracting with nonprofits to provide job skills and training.

One nonprofit, FareStart, offers a 16-week, hands-on culinary and life skills training program that prepares students to work in the food services industry. The program has more than doubled with the state funding, now serving about 300 people each year, according to Molly Hancock, vice president of programs.

Of the people who enroll, 55 percent graduate, and of those who graduate, 93 percent find jobs within three months, Hancock said.

State data show that, overall, about 70 percent of people who use the state’s programs become employed, Kaz said.

Washington is also one of 10 states that received grants from the federal government in 2014 to test different kinds of employment and training strategies, which could serve as models in the future. The others were California, Delaware, Georgia, Illinois, Kansas, Kentucky, Mississippi, Vermont and Virginia.

Measuring success

While there is evidence in Washington that education and training programs help people rejoin the workforce, there is little data or research that has shown that cutting food stamps motivates people to work.

When the CBPP, for example, looked at food stamp data in 2013, it concluded that receiving food stamps does not create disincentives to work. Yet when looking at public benefits offered during the recession, including additional food stamp benefits, Casey Mulligan, a professor of economics at the University of Chicago, came to the opposite conclusion.

New data available from Kansas, which restored work requirements in 2013, show that work requirements do get people working, said Jonathan Ingram, vice president of research at the conservative Foundation for Government Accountability. The state tracked employment and earnings of adults subject to the requirement, and the foundation is planning on releasing a report with details this winter.

The data show that of the 25,913 who faced the work requirement, 12,807 left the program, Ingram said. Of those, about half found employment within three months. Among those who continued to be enrolled in food stamps, the work participation rate rose from 13 to 35 percent and average income more than doubled, from $1,867 to $4,346 annually.

“That’s the whole point of the work requirement is you want to get these able-bodied adults working,” he said. “What they really need is a good-paying job, not more welfare.”

Differing views

After Walker reinstated the work requirement in Wisconsin, in April, about 15,000 adults like Hopgood lost their benefits between July and September when they didn’t meet the requirements. In that same period, about 3,200 people who were enrolled in the state’s employment and training program found new employment.

Some look at those numbers and see success, while others see failure. Milwaukee Hunger Task Force Director Sherrie Tussler said she doesn’t think the state is providing adequate support.

With all the need in the community, Tussler said she fears her organization — which is also the area’s food bank — will run out of food.

But Patrick, Walker’s press secretary, said the state is committed to helping people re-enter the workforce, and has spent $50 million on comprehensive employment and training programs.

The state is one of five this year, along with Colorado, Delaware, South Dakota and Texas, that have pledged to provide employment and training programs to anyone who wants them.

Republican state Rep. Mark Born, chairman of Wisconsin’s Public Benefit Reform Committee, said the number of people who found work is impressive. And, he said, the fact that thousands chose not to participate in the state’s program was their own decision.

“If you are an able-bodied adult and you choose not do anything to help yourself, you shouldn’t expect the state government or federal government to provide benefits for you,” he said.

Yet sometimes, states have trouble simply finding people to let them know their benefits are expiring.

Hopgood, in Milwaukee, said it took the state two months to track her down, as she is technically considered homeless. That means she had 30 days to meet the requirement.

“I would think that before they just give you a three-month notice about your life they could explain everything,” she said. “And give people a chance to see if they could find work, or not.”

Read original article – January 19, 2016
New Work Requirements Put Food Stamps at Risk

Johnny Waller Jr.’s 1998 felony drug conviction has haunted him since the day he left a Nebraska prison in 2001.

Waller, now 38, applied for 175 jobs without getting one. He had trouble getting a federal loan for college because of his drug conviction, so he started his own janitorial business, in Kansas City, Missouri. And when his toddler son, Jordyn, was diagnosed with stomach cancer and needed full-time care, Waller’s record disqualified him from receiving food stamps.

“I really needed assistance there,” Waller said of the time in 2007 he had to give up his job to care for Jordyn. But he couldn’t get it, he said, because of a conviction “when I was 18 years old that didn’t have anything to do with my son.”

Hundreds of thousands of Americans are serving time for drug offenses — nearly a half-million according to the latest numbers available, from 2013. For many like Waller, leaving prison with a felony conviction on their record adds to the hurdles they face re-entering society. A 1996 federal law blocks felons with drug convictions from receiving welfare or food stamps unless states choose to waive the restrictions.

The bans, which don’t apply to convictions for any other crimes, were put in place as part of a sweeping reform of the nation’s welfare system, and at the height of the war on drugs. Now many states are rethinking how to help felons become productive citizens and reduce the likelihood they will return to prison.

Since 1996, 20 states have lifted restrictions on food stamps, known as the Supplemental Nutrition Assistance Program, and 24 allow people with certain types of drug felonies to get those benefits — leaving six states where a felony drug record disqualifies a person from receiving them.

States have been more restrictive when it comes to extending welfare benefits through Temporary Assistance to Needy Families: 14 have lifted the restriction, 24 have some restrictions and 12 have full restrictions barring felons with a drug conviction from receiving cash assistance.

Marc Mauer, director of The Sentencing Project, which advocates reforming the laws, said banning people from getting food stamps runs contrary to policies designed to ease inmates’ re-entry to society and to curb recidivism.

“This increases the odds they will commit new crimes by virtue of the fact that you’re creating a significant financial obstacle,” Mauer said.

State Assistance

This year, Utah, Texas and Alabama became the latest states to lift blanket bans on receiving food stamps.

“If we want people to stay out of trouble we’ve got to give them a hand up, not a foot down,” said state Rep. Senfronia Thompson, a Democrat who pushed for the repeal in Texas. She said providing help is much less expensive for the state than paying for repeated incarcerations.

While Texas’ food stamp program is now open to anyone convicted of using or selling drugs, those who violate their probation or parole are ineligible for benefits for two years. If they are convicted of another felony, drug-related or otherwise, they are barred for life.

Alabama scrapped its ban on food stamps and cash assistance.

Carol Gundlach, a policy analyst for Alabama Arise, which lobbied in favor of the change, said it is especially important for formerly incarcerated mothers, who often struggle to feed their families when they return home.

But even as many states have scaled back their bans, others have considered re-establishing them.

A Pennsylvania bill would deny welfare benefits to anyone who served more than 10 years for a drug offense. State Rep. Mike Regan, the Republican sponsor of the bill, said it would target major drug dealers and save finite state resources for those who are more deserving of help. Regan, a retired U.S. Marshal, said that during his time in law enforcement he saw many dealers who were receiving food stamps. He sees his measure as a deterrent and a way to curb abuse of the system.

Education and Housing

While states can make changes to welfare and food stamp policy, it’s up to the federal government to remove the stumbling blocks that released drug felons face in receiving education and housing assistance.

In 2006, the federal government opened college grants and loans to those convicted of a drug felony, reversing a 1998 policy. However, those convicted of a drug crime while receiving aid will lose it until they complete treatment or prove sobriety.

All current inmates also are ineligible for federal Pell Grants (which are for lower-income people and do not have to be repaid) to help pay for college courses while they are in prison. However, U.S. Education Secretary Arne Duncan said this week that the Obama administration wants to change that, and will propose a pilot program that would allow prisoners to access nearly $6,000 a year.

The U.S. Department of Housing and Urban Development places a lifetime public housing ban on those who have been convicted of making methamphetamine in subsidized housing. It also imposes a three-year ban from public housing on those evicted from public housing for drug-related activity.

The department has encouraged local housing authorities to consider how long it has been since the conviction and whether applicants have gone through drug treatment programs when weighing public housing applications from felons. But local housing authorities have wide discretion in whether to accept someone with a record, particularly when there has been a pattern of drug use.

Felons also face discrimination in seeking housing on the open market, though some states are moving to ease that, too.

In Texas, for instance, the Legislature this year passed a law that gives landlords liability protection from negligence suits for renting to known convicts who then commit crimes in their apartments.

Texas Rep. Thompson said the law gives landlords peace of mind while helping ease discrimination on anyone who has returned from prison, whether they were recently released or they are looking for housing years later.

‘Too Late’ for Jordyn

Waller has experienced all of these roadblocks at one time or another since leaving prison. And changes in the laws often came too late to help him.

Initially unable to finance school or get a job, Waller moved in with his mother in Kansas City, though his presence was tough on her financially. She asked him to apply for food stamps to help out, but the food stamp office told Waller he’d be denied.

Waller said the restrictions put him on the brink of a breakdown, and he considered whether he might be better off returning to prison, which was a world that made sense to him. Then he had Jordyn, and he decided he was done with crime and prison.

“I’d been a gang member, I’d been shot in the head, and I’d gone to prison. There wasn’t anything else out of that lifestyle to get,” he said.

So over the next few years, he started his own janitorial service and eventually hired seven people. He made good money, drove a nice car and felt like he had gotten his life together.

But in 2007, he learned Jordyn, then two-and-a-half, had stomach cancer, which required multiple rounds of chemotherapy and then round-the-clock care. Jordyn was initially treated in Kansas City, but Waller thought Jordyn’s chances would be better at St. Jude’s Children’s Research Hospital in Memphis, Tennessee.

So the single father closed his business, packed his car and headed to Memphis. But with no income, Waller soon ran through his savings. His bills piled up and his car was repossessed. He needed help with food, as doctors required him to make fresh food for Jordyn every meal to avoid bacteria. But his past kept him ineligible for food stamps both in Tennessee and Missouri, where Waller and his son eventually returned.

Missouri changed its law last year to allow people like Waller to qualify for food stamps as long as they complete a treatment program or prove their sobriety with a urine test, which they have to pay for.

Missouri’s change of heart didn’t come soon enough for Jordyn, however. He died in 2008 while waiting for a bone marrow transplant, just days before his fourth birthday.

Since burying his son, Waller has continued to raise his other two children — daughter Alexandria, 8, and son Kendall, 7 — on his own. It hasn’t been easy, but he’s slowly made progress.

After returning to Kansas City from Memphis, he moved in with his mother because his criminal record kept him from renting an apartment, though he tried several times. After Waller had lived six years with his mother, her building’s landlord gave Waller a trial run, giving him a short lease on another unit. This year, he was finally able to sign a yearlong lease.

Once federal education finance laws changed, Waller enrolled at Rockhurst University in Kansas City and earned a bachelor’s degree in business management. In 2011 he was pardoned for his drug crime by former Republican Gov. Dave Heineman of Nebraska, which helped him get a job with a medical equipment company that doesn’t review pardoned crimes as part of its background check.

But Waller said he’s gotten used to watching others go through life without the same barriers, and he has learned to accept there are some things he’ll never be able to do.

“I want to change apartments to a nicer place in a better school district,” he said. “I live on the fringe of just being able to live a normal life. I’m right up against the glass.”

Read Original Article – December 29, 2015
States Rethink Restrictions on Food Stamps, Welfare for Drug Felons