The death of convicted racketeering boss Michael J. Miske, Jr. of an apparent accidental overdose of fentanyl while in Honolulu’s Federal Detention Center came as a shock to many of those who had followed his high-profile criminal prosecution, six-month trial, and ultimate conviction on multiple counts.

In some ways, though, it should not have been a surprise, as fentanyl use and overdose deaths have soared exponentially in the past 10 years. Fentanyl and related synthetic opioids now accounts for most drug overdose deaths in the U.S, according to a factsheet published by the Drug Enforcement Administration.

Producing illicit fentanyl is not an exact science. Two milligrams of fentanyl can be lethal depending on a person’s body size, tolerance and past usage. DEA analysis has found counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet.

42% of pills tested for fentanyl contained at least 2 mg of fentanyl, considered a potentially lethal dose….

It is possible for someone to take a pill without knowing it contains fentanyl. It is also possible to take a pill knowing it contains fentanyl, but with no way of knowing if it contains a lethal dose.

“Fentanyl can be injected, snorted/sniffed, smoked, taken orally by pill or tablet, and spiked onto blotter paper,” according to the DEA. “Illicitly produced fentanyl is sold alone or in combination with heroin and other substances and has been identified in fake pills, mimicking pharmaceutical drugs such as oxycodone.”

Further, although federal prison facilities like Honolulu’s Federal Detention Center have enjoyed a reputation for housing inmates safely and securely, that reputation cloaks some long-standing administrative issues.

Inspector General study of federal inmate deaths

A report published by U.S. Department of Justice in February 2024 found there had been nearly 350 inmate deaths in federal prison facilities over an eight-year period between ending in 2021, half of them suicides and at least 70 the result of drug overdoses (“Evaluation of Issues Surrounding Inmate Deaths in Federal Bureau of Prisons Institutions,” DOJ Office of Inspector General, February 15, 2024).

The Inspector General studied 344 inmate deaths in facilities operated by the Federal Bureau of Prisons from FY 2014 through FY 2021. The deaths fell in four categories–suicide, homicide, accident, and those from “unknown factors.

The largest category was suicide, which accounted for 187 deaths, more than half of the total. Homicide was the second most frequent cause of death.

The report also found 70 inmates, or 20% of the total, had died of drug overdoses during the period. This number appears to include both suicides and accidental overdoses.

“Many of the deaths that occurred under accidental or otherwise unknown circumstances involved drug overdoses,” the report found.

The report found “long-standing operation challenges,” including the difficulties of screening for contraband, “further impair the BOP’s ability to reduce the risk of inmate deaths.”

The OIG has repeatedly identified long-standing operational challenges, including contraband interdiction, that negatively affect the BOP’s ability to operate its institutions safely and securely, some of which may increase the risk of inmate deaths. We found that, in nearly one-third of the inmate deaths in our scope, contraband drugs or weapons contributed, or appeared to contribute, to the death, including 70 inmates who died from drug overdoses. Other operational challenges include staffing shortages; an outdated security camera system; staff failure to follow BOP policies and procedures; and an ineffective, untimely staff disciplinary process. One or more of these challenges was a contributing factor in many of the inmate deaths in our scope, and these long-standing challenges continue to present a significant and critical threat to the BOP’s safe and humane management of inmates in its care and custody.

It also highlighted internal issues with responses to medical emergencies, including drug overdoses.

…[W]e found significant shortcomings in staff’s emergency responses to nearly half of the inmate deaths in our evaluation scope. These shortcomings include a lack of urgency in emergency response, failure to bring or use appropriate emergency equipment, unclear radio communications, and issues related to administration of naloxone. Ensuring that BOP staff are trained in the use of automated external defibrillators (AED) and cut-down tools and that all equipment is in working order and readily available at each institution would better prepare institution personnel to respond to high stress, potentially life-threatening inmate emergency situations. Similarly, enhanced staff training on using the radio to communicate clear, descriptive information during inmate medical emergencies; administering naloxone to an unresponsive inmate suspected of having experienced a drug overdose; and executing post-incident evidence recovery protocols would collectively help mitigate the risks that contribute to the deaths of inmates in federal custody.

Legislative efforts

Bills have been introduced in Congress over the past two years seeking to crack down on the problem of fentanyl and other illicit drugs entering federal prison facilities through inmate mail.

In 2023, a bipartisan group led by Rep. Rep. Don Bacon, (R, NE) introduced H.R. 5266. A Senate bill was introduced by a similar group led by Sen. Bob Casey (D, PA).

Both would “require the Director of the Bureau of Prisons to develop and implement a strategy to interdict fentanyl and other synthetic drugs in the mail at Federal correctional facilities.”

The House resolution, H.R. 5266 garnered 128 co-sponsors, but stalled after being referred to the House Judiciary Committee. The Senate bill also died in the lame duck session.

The House resolution included a section of “Findings” spelling out the concern that inmate mail is “a primary entry point for smuggling drugs into correctional facilities….”

SEC. 2. FINDINGS.

Congress finds the following:
(1) The Bureau of Prisons has 122 institutions located throughout the United States, employs nearly 38,000 employees, and is responsible for more than 150,000 Federal inmates.

(2) Inmate mail is a primary entry point for smuggling drugs into correctional facilities, with tainted mail incidents also on the rise.

(3) Elimination of dangerous contraband, including synthetic drugs, in mail is essential to protecting the health and safety of employees of the Bureau of Prisons and Federal inmates.

(4) Prisons in the United States are increasingly deadly facilities, with a 600 percent rise in drug overdoses in recent years.

(5) The introduction of synthetic drugs, particularly fentanyl and fentanyl analogues, into correctional facilities by mail threatens employees, inmates, and the security of correctional institutions, and the practice of deliberately lacing opioids to ensure targeted lethality represents a dramatic emerging concern.

(6) The foregoing factors add tremendous pressures and workload that further burden existing employees, commonly reassigning officers from other functions to assist in processing mail.

(7) Employees at correctional facilities at Federal, State, and local levels continue to request drug interdiction technologies to protect themselves and inmates.

(8) A congressionally authorized digital mail scanning pilot program at the Federal Correctional Institution, Beckley, West Virginia, and the United States Penitentiary, Canaan, Pennsylvania, from March 2020 through June 2021, demonstrated effective interdiction technology and practices aimed at eliminating dangerous contraband arriving through the mail and served as an effective deterrent to smuggling attempts.

(9) Apart from digital mail scanning, there is no widely deployed interdiction technology that has demonstrated a 100 percent efficacy to detecting fentanyl, and other synthetic drugs, arriving through the mail at Bureau of Prisons facilities.

(10) Removing mail processing from Federal prisons and relieving Bureau of Prisons employees from mail sorting duties will result in an extensive budgetary relief to the Bureau and decrease the staffing shortages facing prisons.