Executive Summary

"I've been in 14 months straight, and just got another 20 months for possession... It's really taking a toll on me. . . . I need some kind of therapy because the cell is closing in on me. I feel paranoid, I can't sleep. I feel like people are against me. I'm restless, I'm talking to myself."

- Nathan T, 32, prisoner at the Upstate Correctional Facility in Malone, New York [1].

When Human Rights Watch met with Nathan in July 2008, his hands and feet were shackled with heavy chains. He had been in disciplinary confinement ("the box")-punishment reserved for serious prison offenses-for 14 months. When Nathan entered prison in 2000, he was identified as in need of substance abuse treatment and placed on a waiting list. Because he relapsed into drug use in violation of prison rules, he lost his place on the waiting list, and was sent to the box.  Nathan is addicted to opiates and other drugs, and continues to relapse, as is common for people with drug addiction. There is no treatment in the box. Indeed, Nathan has never received any treatment in prison.  He now faces another 20 month sentence in the box for using drugs, without access to treatment.

New York State prison officials have identified three out of four prisoners as in need of substance abuse treatment. With the number of prisoners living with HIV and hepatitis C among the highest in the nation, New York State prisons have an obligation under international, US and state law to protect prisoners' right to health. Under these standards, prisons must provide drug dependence treatment and harm reduction programs equivalent to those available in the community. International and national standards for prison health care reflect the fundamental principle that "good prison health is good community health," as 26,000 people rejoin New York communities from prison each year. This Human Rights Watch report documents New York's failure to ensure access to substance abuse treatment while pursuing a program of harsh punishment for drug use that bars prisoners from treatment as part of the disciplinary sanction.

Drug dependence is a chronic, relapsing disease. Drug users, both in and out of prison, have a right to access health care that should include drug dependence treatment and harm reduction measures to reduce health risks such as transmission of HIV and hepatitis B and C. Prison treatment programs should be available, accessible, appropriate and of good quality.  But in the New York State prisons, drug treatment programs are filled to capacity. Prisoners face long waiting lists for substance abuse treatment.  Despite overwhelming evidence that Medication-Assisted Therapy is the most effective treatment for opioid dependence, the majority of New York State prisoners dependent on heroin or other opioids have no access to methadone or buprenorphine. Between 1996 and 2005, twenty-seven prisoners died of overdose of illegal drugs in New York State prisons.

At the same time, punishment for drug use in the New York State prisons is severe and out of proportion to the seriousness of the offense. Thousands of New York State prisoners, many of them struggling with addiction, are sentenced to "the box"- a disciplinary sanction that removes them from the general population, restricts many activities of daily life, and where they have no access to drug dependence treatment. In New York State prisons, drug users are locked in "the box" for months, even years, barred from treatment. New York's severe punishment of drug use in prison, while delaying or denying access to treatment and harm reduction services, violates prisoners' right to health and the right to be free from cruel and inhuman treatment under international law.

Human Rights Watch's investigation of New York State's treatment of drug users in prison included interviews with more than 50 current and recently released prisoners at 8 correctional facilities, including the "supermax" facilities where prisoners are held in disciplinary segregation. The investigation also included visits to prison drug treatment facilities, review of documents obtained from Freedom of Information Law requests, and meetings with drug and alcohol treatment officials, judges, legislators, advocates and other experts on New York State substance abuse, criminal justice and prison health law and policy.

Human Rights Watch found that the New York State Department of Correctional Services (DOCS) failed in the following ways to provide adequate health services for prisoners who use drugs:

• Drug dependence treatment is frequently delayed and, for prisoners in disciplinary confinement, denied altogether. Long waiting lists result in treatment delays of months, sometimes years, for many prisoners.

·DOCS fails to provide Medication-Assisted Therapy to the majority of opioid-dependent prisoners. Despite having identified thousands of prisoners as opioid users in need of treatment, New York State continues to ignore well-established evidence that methadone and buprenorphine are the most effective treatment for opioid dependence and increasing evidence of its successful implementation in prison settings.

·DOCS fails to provide translation services to ensure that drug dependence treatment programs are accessible to non English-speaking prisoners. DOCS further fails to make accommodations in these programs for prisoners with low literacy skills.

·New York State fails to make essential harm reduction services available in prison. New York's failure ignores well-established evidence that condom distribution, sterile syringes, bleach, tattoo education, and Medication-Assisted Therapy and overdose prevention programs for opioid dependence reduce prisoners' exposure to HIV and hepatitis, sexually transmitted diseases, and death from overdose. 

New York State's forms of punishment for prisoners who use drugs constitute cruel, inhuman and degrading treatment in violation of international human rights law in several ways:

The penalties provided for and imposed for punishment of drug use and possession are grossly disproportionate to the severity of the offense. Internal guidelines for sanctions are often exceeded, resulting in months, even years, of isolation and confinement. Disciplinary sanctions for drug use also result in the loss of good time accrued toward early release, imposition of special diets, restricted recreation, visits, packages, showers and telephone calls, and denial of access to educational and other rehabilitative programming. Extended isolation and harsh conditions of confinement violate international standards for the humane treatment of prisoners.

New York State prisons pursue a mandatory urine testing program that carries harsh penalties upon detection of drug use. This program removes many prisoners from treatment and results in disciplinary charges for what may be the symptom of a chronic, relapsing disease.  Further, this program may endanger prisoners' health by moving them toward use of injection drugs that are less easily detected by urinalysis, increasing their risk of contracting HIV and hepatitis C through shared needles.

 In addition to raising serious human rights concerns, punitive approaches to drug use that remove patients from treatment, encourage use of more dangerous drugs and continue to punish prisoners whose behavior may indicate severe addiction are counterproductive from a policy perspective. New York prisons spend millions of dollars annually on an array of alcohol and drug treatment programs. These programs are less effective, and demand for drugs in prison is increased, when treatment for drug dependent prisoners is denied or delayed.  Support offered to prisoners at re-entry, a substantial investment on the part of  New York State, will be undermined if adequate drug treatment is not available during incarceration.  Without treatment both during and after time in prison, a drug dependent person is likely to return to the criminal justice system.

In recent years, many correctional systems in the United States and throughout the world have responded to high rates of HIV and hepatitis in prisons by implementing harm reduction measures that focus on preventing and reducing the harmful consequences of drug use through a range of targeted interventions. Medication-Assisted Therapy for prisoners addicted to opiates and condom distribution programs to reduce transmission of HIV and other sexually transmitted diseases are operating successfully in US jails and prisons without compromising security.  Based on a pragmatic and therapeutic response to drug use in prison, these measures are endorsed by US and international experts on drug use and correctional health, including the National Institute on Drug Abuse, the National Commission on Correctional Health Care,  and the United Nations Office on Drugs and Crime.

 Without delay, New York State prisons must increase access to drug dependence programs and implement evidence-based harm reduction programs, including Medication-Assisted Therapy and overdose prevention for prisoners dependent on heroin and other opioids. Disciplinary procedures for drug use must be proportional to the offense and disciplinary sanctions should never prevent prisoners from accessing necessary drug treatment and harm reduction services.