The Kensington community is still reeling after the deaths of Amanda Cahill and Joey Gabor, who both died in custody shortly after being arrested during the area’s controversial narcotics sweeps at the end of 2024. While we don’t know the details behind these deaths, they are alarming and depict the vulnerability of those incarcerated with substance use disorder. We as physicians working to curtail the opioid epidemic must advocate for increased access to care in prisons for some of our most vulnerable patients to see further preventable tragedy.
On September 4, a 31-year-old mother of two was arrested during a sweep in Kensington conducted by the Philadelphia police. She was taken to the Philadelphia Industrial Correctional Center and died during the early hours of September 7. While the cause of death remains unknown, she is among more than 20 individuals who have died while in custody in the Philadelphia prison system according to the Inquirer. On December 12, yet another tragedy occurred as Joey Gabor, a 41-year-old resident of Fishtown, was arrested in Kensington on December 11 and later found unresponsive on December 12 and was subsequently pronounced dead. Drug paraphernalia was reportedly found around his body, raising continuous concern for the issue of understaffing and oversight within the jail and prison system.
The criminalization of addiction has been a long-standing problem across the United States with dire consequences for individuals impacted. In 2020, a class action lawsuit was filed against the Philadelphia Department of Prisons and the city alleging inhumane conditions. After a settlement agreement in 2022, the city of Philadelphia was ordered to pay $25 million after being found in contempt of that agreement. The state of Philadelphia prisons has been thoroughly documented by the Pennsylvania Prison Society, an organization whose mission is dedicated to reporting on prison conditions. As recently as August 2024, their report detailed inadequate meal portions, insufficient time out of cells, and physical plant issues including excessive heat and leaky pipes. Another notable finding was a reported wait time of more than one week for requested medical care. Concerns surrounding short-staffing and dangerous conditions persist despite years of efforts to inspire change and the most recent deaths continue to highlight the need for drastic improvements.
It is ethically dubious to criminalize behavior that results from disease and the recent events in Philadelphia highlight the significant repercussions of arresting people for using illicit substances without a system for prompt and effective medical care. Punitive measures are not effective for treating substance use disorder and can cause significant morbidity and mortality during initial intake and release. Data from 2009 indicated that half of people in prison had an undiagnosed and untreated use disorder. After release from prison, a person has a significantly increased risk of drug overdose, with research suggesting ten times more risk than the general population. We know the dangers of criminalizing substance use. Yet, we still do not have a system in place to safely treat people arrested for illegal substance possession secondary to a substance use disorder or an alternative to incarceration.
“Deliberate indifference to the serious medical needs of prisoners” was deemed constitutionally prohibited in a 1976 Supreme Court case. Still, outside of these ambiguous terms, there are no universal standards or regulations for health care in U.S. prisons or jails. Organizations like the National Commission on Correctional Health Care set standards of care and offer accreditation, but federal, private, and state prisons and jails are subject to varying federal, state, and county guidelines. People with substance use disorders are even worse off due to the undertreatment of their disease while in prison.
Ultimately, we do not know all the specifics of what happened to Amanda Cahill and Joey Gabor. Still, their deaths shine a light on the need for increased access to medical care in prisons for our most vulnerable patients suffering in this epidemic. Having access to addiction-medicine-trained physicians who can assist with withdrawal and initiating medications for opioid use disorder (MOUD) while incarcerated can be one step forward.
The physicians and medical students at Doctors for America continue to advocate for patients with substance use disorder and call on our lawmakers to do the same.
Kendall Major, Tommy Gautier, Alyssa Lambrecht, and Elle Saine are members of the Doctors for America Substance Use Disorder Subcommittee.
