Synthetic Cannabinoids and the Lack of Substance Use Disorder Treatment in Carceral Settings

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By Aaron Steinberg, Ada Lin, Alice Bukhman, LaToya Whiteside, and Elizabeth Matos

The inability of prisons and jails to address the drivers of and treat substance use disorders, especially during the pandemic, is leading to underexplored health ramifications for prisoners, and particularly for prisoners who identify as Black, Indigenous, or other people of color (BIPOC), who already had comparatively poorer health outcomes.

This article focuses on one substance of growing popularity in carceral settings: synthetic cannabinoids (SC), which are frequently referred to as K2 or spice.

Over the past two decades, SC have emerged as a popular substance especially among communities who are heavily surveilled, such as people who are incarcerated or live in communities with over-policing.

Because they contain changing chemical combinations not detected on routine urine drug screens and are easily hidden, they are attractive to those seeking to evade detection by authorities, such as those experiencing homelessness and incarceration. Disciplinary report data from the Massachusetts Department of Correction (MA DOC) suggests that SC constitute most of the substances being used behind bars.

SC resemble marijuana in that they act on cannabinoid receptors, but the effects of these substances often are closer to those of amphetamines. While little is known about their long-term health effects, data from Europe suggests these are highly addictive substances. Qualitative studies in the U.K. reveal that SC are often used to “numb” people and to allow them to endure difficult living conditions, such as homelessness, while avoiding legal ramifications of illicit drug use.

There are limited treatment options for those dependent on SC. Unlike opiates and alcohol, SC have no widely accepted pharmacologic replacement. Many people use SC in lieu of marijuana. In the U.K., there are efforts to explore allowing access to marijuana to help curb use of other more dangerous substances. To date, there is no such effort in the U.S., where marijuana remains a schedule I controlled substance under federal designation. Even where there are established medications for substance use, these are of limited availability in Massachusetts prisons.

Instead, most treatment in prisons centers on a therapeutic community (TC) model, which focuses on personal responsibility and individual cognitive dysfunction as a driver for substance use. One recent study found that recently released BIPOC reported less engagement with this model, alluding to a need for more culturally appropriate therapeutic models. And this model seems particularly ill-suited to people for whom drug use is more of a reaction to structural forces, such as poverty and social isolation.

Indeed, isolation and boredom define much of the experience of people who are incarcerated. The carceral system subjects people to these forces both actively, as an intentional means of punishment and control (such as use of solitary or near solitary confinement), and passively, through lack of programming. Prior to the pandemic, BIPOC prisoners were less likely to have access to programming. A study by the National Institute of Justice indicates that their disproportionate placement in restrictive housing is a major contributor to this comparative lack of access to programming.

During the pandemic, programming was abruptly cut off throughout carceral settings, exacerbating what was already a great need for many of Prisoners’ Legal Services of Massachusetts’ clients, and particularly our clients of color. Compounding the isolation inherent to incarceration, restrictions on visitation during the pandemic and insufficient effort to make telecommunications financially accessible has made it more difficult for prisoners to communicate with friends, family, and support networks.

While there is a lack of access to data about the trend of drug use within Massachusetts prisons during the pandemic, it likely mirrored trends from the community at large, where use of a variety of illicit substances increased, likely as a result of increased levels of social isolation.

There are steps that could be taken to ameliorate the risk factors and lack of substance use disorder treatment in carceral settings. But, so far, authorities have been resistant to doing so. Their opposition to popular legislation like free phone calls for prisoners alludes to a greater concern for profit over wellbeing. Additionally, the lack of culturally specific treatment models for substance use is indicative of a larger lack of engagement with the impacts of systemic racism in the carceral system. Until there is a shift in focus to address the drivers of SUD and treatment for SC, particularly amongst BIPOC populations, this SC epidemic in prisons will proliferate unchecked. And like most issues in the carceral system, BIPOC prisoners will be disproportionately impacted.

Aaron Steinberg is Communications and Development Coordinator of Prisoners’ Legal Services of Massachusetts.

Ada Lin is Bart J. Gordon Legal Fellow and Staff Attorney of Prisoners’ Legal Services of Massachusetts.

Alice Bukhman is Director of Clinical Operations for Brigham and Women’s Faulkner Hospital’s Emergency Department and Health Care Advocate for Prisoners’ Legal Services of Massachusetts.

LaToya Whiteside is Senior Staff Attorney and Director of Prisoners’ Legal Services of Massachusetts Racial Equity in Corrections Initiative.

Elizabeth Matos is Executive Director of Prisoners’ Legal Services of Massachusetts.

Synthetic Cannabinoids and the Lack of Substance Use Disorder Treatment in Carceral Settings

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