America's addiction problem is in its prisons; they're getting hotter in a warming world, and are disproportionately rural

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Addictions to opioids or methamphetamine often form a web of crises, and incarceration can be one of them. While it's hard to directly tie drug addictions in rural areas like Appalachia to incarceration in one of the region's prisons, the correlation bears review, as do the conditions in U.S. prisons.

For rural populations, imprisonment rates have increased beyond those of cities. "You're more likely to go to jail if you live in a rural community," reports Debby Warren for Nonprofit Quarterly. "For decades, your odds of getting locked in jail in cities greatly exceeded your odds of getting jailed in rural areas. . . . Today, people in rural counties are more than twice as likely to go to jail as people in urban areas. And the gap continues to grow. Jail populations have dropped 18 percent in urban areas since 2013 but have climbed 27 percent in rural areas."

With those rates in mind, the National Institute on Drug Abuse reports, "The substantial prison population in the United States is strongly connected to drug-related offenses. While the exact rates of inmates with substance use disorders are difficult to measure, some research shows that an estimated 65% percent of the United States prison population has an active substance-use disorder. Another 20% percent did not meet the official criteria for an SUD but were under the influence of drugs or alcohol at the time of their crime."

If many rural people with SUDs are in prison, what are those prisons like? They are hot. They are also more black than white. "Temperatures within America's prison walls are often unbearable. . . . 38.5% of incarcerated people are Black, even though we only make up 13.6% of the population," reports Maya Richard-Craven of Word in Black. David Dosa, an associate professor of medicine at Brown University, "has studied heat in prisons for the past three years and is the co-author of a 2022 study about extreme heat in Texas prisons. Only 30% of living units in Texas prisons have air conditioning. . . . The problem is particularly acute in the South. As the Prison Policy Initiative reported in 2019, 'Although 95% of households in the South use air conditioning, including 90% of households that make below $20,000 per year, states around the South have refused to install air conditioning in their prisons, creating unbearable and dangerous conditions for incarcerated people.'. . . It's not just an issue of being hot and uncomfortable. Dosa and his fellow researchers found more people are dying in prisons without air conditioning compared to those with air conditioning."

While extreme heat in prisons is not new, it has been reported since the 1940's, climate change has exacerbated the problem that has not been addressed in some of the hottest states. Richard-Craven writes, "According to the Prison Policy Initiative’s 2019 report, at least 13 states — Alabama, Arizona, Florida, Georgia, Kansas, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, South Carolina, Texas, and Virginia — do not have universal air conditioning in their carceral facilities. . . . Emery Nelson, a public affairs specialist for the Federal Bureau of Prisons, said that the bureau takes the impact of heat on incarcerated individuals seriously — people are 'treated on a case-by-case basis.'. . . Nelson wrote that 'Heat stroke is treated as a medical emergency and appropriate care is rendered to the inmate patients. There are nursing and paramedic protocols to treat heat-related illness, to include instructions for vital sign monitoring, interventions such as IV fluids and body cooling, as well as indications of when to transfer to a higher level of care.'"

"That raises the question — what was happening in December 2020 when Tommy Lee Rutledge, a 44-year-old Black man, died in an Alabama prison mental health ward from extreme heat? His body temperature reached 109 degrees, and a federal lawsuit brought after his death noted that 'he was literally baked to death in his cell,' Richard-Craven adds. Julie Skarha, an environmental epidemiologist at Brown University, told Aryn Baker of Time magazine: "At this point, the state [of Texaas] has probably spent more money fighting these AC bills than it would actually cost to install AC in these facilities. In the context of climate change, AC is not a luxury. It’s a human right.” Baker reports, "But as temperatures keep rising, the costs of medical care for heat-stressed prisoners, wrongful death lawsuits and staffing for ever-hotter prisons will too. . . . Part of the problem is that legislators still see air conditioning as a luxury, says Skarha. No one disputes the need for TV in prison, which is arguably less important for human health than air-conditioning."