Behind prison walls in Ohio, inmates regularly are abusing an opioid normally used to wean people off of drugs.
Inmates, many of whom were sent to prison on drug charges in the first place, are sneaking in suboxone, which is legally prescribed to treat people recovering from heroin addiction. The drug is vying to become the most common contraband drug in state prisons -- neck and neck with marijuana.
Prison officials say a strip of suboxone the size of a postage stamp, which melts on the tongue, goes for about $100 or more in a lucrative prison black market. They are similar to small mouthwash strips, but these contain a slow-acting opioid.
"Suboxone is a wonderful thing in its proper usage, controlled and monitored," said Ed Voorhies, the Ohio Department of Rehabilitation and Correction prison operations director. "But it can be abused and perverted."
"Suboxone strips are most prevalent in prison because they are so small and easy to conceal," Voorhies said. "It's been particularly difficult for us."
The strips are easy to hide behind a postage stamp, in the spine of a book, slipped into a greeting card, or liquefied and placed on paper so it looks like a smudge but retains its drug properties. The inmate then eats the paper.
In response to a Dispatch records request, prison officials provided drug test records for three years. Prisons randomly test 5 percent of inmates for illegal drugs each month, and a smaller number "for cause," cases in which prison workers suspect an inmate is high on drugs.
Random drug tests performed on 5 percent of inmates last December showed about one in 20 inmates tested positive for drugs, including 59 for suboxone and 68 for marijuana. Testing done "for cause" in December produced much higher results, with 39.3 percent testing positive for drugs, including 128 for suboxone and 135 for marijuana.
The annual average of positive drug tests has been creeping up for years: 3.6 percent in 2014, 3.9 percent in 2015 and 4 percent last year. Year-end random testing showed 5.9 percent of inmates were using illegal drugs in November and 5.5 percent in December.
Prison officials first began testing for suboxone, also known as buprenorphine, in 2014. Since random drug testing began in the early 1990s, results ranged from a high of 6.9 percent in 1990 to a low of 0.8 percent in 2006.
Results vary month to month and by institution. At the Belmont Correctional Institution in St. Clairsville, 82 inmates were tested "for cause" this past November and 40 had illegal drugs in their system, including 25 on suboxone. At the Richland Correctional Institution in Mansfield, random tests on 296 inmates showed 1 in 5 were on illegal drugs.
Some drugs come in through the mail to prisoners or from visitors, or are brought in by corrections officers or outside contractors. Quite often, drugs are simply thrown over prison perimeter fences and recovered by inmates.
Voorhies said every piece of mail, tens of thousands of items each year, is now being inspected using a black light to detect drugs adhering to paper or cardboard. He said each prison will also soon be outfitted with ion scanners which "sniff" for trace drug residue on objects and people.
"We spend a great deal of time, effort and money to intercept and figure out the newest way inmates are getting drugs," Voorhies said, "but just like the people on the street, people who do that can get really creative to convey their illegal drug trade. As long as there's that much money involved, they will find a way.'"
Prison officials have taken a number of counter-measures in recent years -- installing more lights, cameras and motion detectors on fences; increasing perimeter patrols; clearing out nearby trees so would-be smugglers can't hide; and using drug-sniffing dogs.
Doug Mosier, a 29-year corrections officer at the Mansfield Correctional Institution and an Ohio Civil Services Employees Association union steward, said the flourishing drug trade in prisons in dangerous for inmates, staff members and the public.
"It creates a challenge for us," Mosier said. "It causes thievery and the inmates become increasingly more violent." A drug incident also distracts officers from hundreds of other inmates they supervise, he said.
It's not just drugs flowing into the black market pipeline. A pound of tobacco that costs $15 on the outside sells for $1,800 inside prison, where tobacco, while not illegal, is against prison rules.
A 2016 report by the Correctional Institution Inspection Committee, a prison watchdog agency, found overall contraband seizures jumped nearly 64 percent between 2013 and 2015. From 2010 to 2015, there were 11,255 seizures of drugs and alcohol, 6,982 of weapons, 2,637 of cell phones and 2,590 of tobacco, the report said.