Addiction first took hold of Mark Christian’s life when he was a teenager who liked to surf the laid-back waves at Kalapaki Beach.
It started with marijuana and cocaine, then progressed to more dangerous substances. Drug use led to drug dealing.
Christian, now 66, said he felt powerless to break the cycle of methamphetamine and heroin abuse that for years yanked him from the streets of Lihue to the Kauai jail and back again.
Then last summer, to Christian’s own astonishment, he found a way out.
After a positive drug test landed him back in detention at Kauai Community Correctional Center in March, Christian said he was treated with anti-addiction medication for the first time in a half-century of drug abuse.
When he started taking a prescribed opioid in May to curb the cravings that fuel his drug use, Christian said he still planned to use heroin after he left jail. But when he was released from custody in July, he said he was stupefied by his own disinclination to drift back into the throes of addiction.
“I was more confident when I went on the streets when they let me out this time, so instead of starting (drugs) again I have this thing to just take the edge off,” said Christian, who takes two film strips a day that dissolve under the tongue.
The use of medication to help inmates recover from drug addiction while doing time in correctional facilities has a controversial history, primarily because some of the FDA-approved medications are opioids themselves, prompting concerns over the efficacy of swapping out one drug for another.
But the devastation resulting from the opioid epidemic has gradually bolstered support for these programs in prisons and jails across the country. Various national studies show that medication-assisted treatment is more successful than abstinence-based programs. And it helps reduce violent crime and recidivism rates.
Medications like buprenorphine, also known as Suboxone and Sublocade, also reduce the high risk of death from drug overdose for offenders released from incarceration, especially in the first few weeks after their release when they are much more sensitive to drugs following a period of forced abstinence.
In response, more than 30 states have enacted some form of medication-assisted treatment for inmates.
Hawaii joined those ranks in 2020 when Dr. Graham Chelius, a Kauai family medicine doctor, started volunteering to help staff at KCCC launch a new program to dispense medication-assisted treatment to inmates.
Chelius said he spearheaded the project because he was fed up with watching the criminal justice system derail his patients’ treatment, making them more vulnerable to overdose upon release from detention. Drug overdose deaths on the Garden Isle have more than quadrupled over 10 years from fewer than five in 2012 to 18 in 2021, contributing to an alarming rise in fatal drug use statewide, according to Hawaii Health Department data.
All told, 1,057 Kauai inmates have been screened for opioid addiction since January 2021 and 101 inmates have received medication to treat the disorder, according to the Hawaii Public Safety Department. Addicts take a dose that’s high enough to blunt the symptoms of withdrawal but too low to produce a feeling of euphoria.
The program at the Kauai jail has evolved from an unfunded pilot project to a growing statewide initiative funded through 2024 by the American Rescue Plan Act. The funds cover the cost of medication, lab tests and contracted services from the Hawaii Health and Harm Reduction Center, as well as a gradual transition from volunteer to paid contractor for Chelius.
Now the program is expanding beyond the smallest state-run jail on Kauai. Last year medication to treat opioid addiction started being dispensed to inmates at Oahu Community Correctional Center, Halawa Correctional Facility and Waiawa Correctional Facility, according to DPS spokeswoman Toni Schwartz.
“Things are slowly developing,” Chelius said. “We really haven’t maximized the potential of the program yet.”
All told, 88% of Hawaii jail and prison inmates show some need for substance abuse treatment, according to research by Dr. Timothy Wong, a research analyst at the Hawaii Interagency Council on Intermediate Sanctions. About 14% of inmates have substance abuse problems that qualify as severe.
There are kinks to be ironed out.
An inmate’s treatment can be derailed, for example, if a judge unexpectedly releases him or her from detention during a court hearing. So this month the Kauai jail will start issuing a card to inmates who’ve been prescribed medicine to treat opioid addiction so they can use it at participating pharmacies to obtain a new prescription if they’re released from custody without notice, according to Schwartz.
Another problem: Inmates at KCCC are frequently released from detention without one or more of the following: an ID, a cell phone, housing, transportation or an established primary care doctor to help them continue their opioid addiction treatment outside of jail. Without these basic resources, Chelius said newly released inmates can too easily slide back into drug use or other criminal behaviors.
Two-thirds of a cohort of 30 inmates who answered a verbal intake survey administered by nurses at the Kauai jail between Nov. 23 and Dec. 14 did not have an ID on hand, according to data provided by Chelius, who noted that not every inmate is surveyed.
More than three-quarters of those surveyed said they would not have a mode of transportation upon their release from detention, according to the data. About half said they did not have housing.
“I’ve seen inmates shopping for groceries after they just got released and everyone’s staring at them because they’re in those orange or white paper jumpsuits,” said Michael Miranda, a former probation officer who is the coordinator of Life’s Choices Kauai, a county-run drug prevention program. “A lot of them are released with absolutely no support — no ID, which would make it impossible or difficult to enroll in medical insurance; no money, no way get around except for hitchhiking or on foot.”
The Kauai jail is located on a rural highway with steady high-speed traffic, narrow shoulders and no sidewalks. Kauai County Council member Felicia Cowden, who chairs the Public Safety and Human Services Committee, said that on about a dozen occasions she has picked up a newly released inmate wearing a nearly transparent paper jumpsuit along that highway, or outside the courthouse, and taken them shopping for clothes or a warm meal.
“They’re usually completely embarrassed when I walk up to them with this offer and they always say ‘yes,’” she said. “I want to get rid of those transparent paper suits so that they don’t release people practically naked like that. They should be able to walk away (from jail) with a certain amount of dignity.”
The Hawaii State Rural Health Association, which is assisting DPS with additional funding for medication for inmates with opioid use disorder, is piloting a project at the Kauai jail to supply inmates leaving detention with re-entry packs containing a bus pass, a taxi voucher, a cell phone, a Longs Drugs gift card, instructions on how to obtain a state ID, a list of job resources and helplines for mental health crises and other emergencies and the lifesaving opioid overdose antidote naloxone, commonly known by the brand name Narcan. The program expects to start distributing the packs later this month.
KCCC is the focus of the initiative because there are fewer resources available for its newly released inmates than those exiting detention facilities on other islands, according to Madison Smith, an undergraduate social work student at the University of Hawaii Manoa who’s working with HSRHA to help launch the program.
All inmates departing the Kauai jail will be eligible for the packs, but the program will focus on supplying them to opioid addicts to help them adhere to their treatment.
The project is supported by donations, funding from HSRHA and a $5,000 grant from Life’s Choices Kauai. If successful, it will be rolled out at the Maui jail next and, eventually, detention facilities statewide.
After he left detention in July, Christian said he walked from the Kauai jail to a bus stop, although he had no money for a ride.
He loitered there awhile, eventually walking roughly four miles to Lihue, the island’s social services hub where he submits to regular drug tests and meets with a probation officer.
Although he lost driving privileges years ago, Christian said that upon release from jail he would typically find a way to procure a car, using it for both transportation and shelter. Last year this scenario ended badly, he said, when police found illicit drugs in his car, impounded the vehicle and sent him back to jail.
Now that he’s “thinking straight,” Christian said he wants to pay off his motor vehicle fines and earn his license back. He gets around Lihue on a bicycle now. And he sleeps in the homes of friends or his sister, an option he said became newly available to him in sobriety.
Christian receives a monthly check of $941 from social security, something he said he didn’t have the wherewithal to access until he got clean. He’s trying to land a housekeeping job. And he’s working on an application for an apartment rental in a county-run senior housing facility.
But the medicine that’s helped him kick his heroin habit so far is not a miracle antidote to addiction. Staying clean also takes willpower.
“Today I thought about using,” he said on a recent Friday afternoon, smoking a cigarette on a picnic bench in Kalena Park.
Christian, who wears a barbell and eight gold hoops in his ears, was with a couple of addict friends who were going through withdrawal. He felt badly for them. And he had money in his pocket. Why not use it to buy drugs for them all?
Then he thought better. Instead of drugs, he bought his friends lunch. While they ate under the shade of a park canopy, Christian said he basked in the sun.
“You can be tired of being sick and tired,” Christian said. “The future? There was no future for me. At least now I’m living.”
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