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overdosed and died. He’s had several nearmissesovertheyearshimself,over- dosing but somehow surviving. He de- cided he didn’t want to tempt fate any more. In Search Of A ‘Normal Life’ Overdoses are common among recently released inmates because while inside, inmates with opioid use disorder either go through withdrawal or take smug- gled drugs—usually Suboxone, a pre- scription opioid substitute. As a result, when inmates are released, Jones says, “your tolerance is so low, you can’t take asmuch,butyoumaythinkyoucan.You get out, and bam, next thing you know you’redead.Me,Iusedtodoagram.But getting out of prison, there’s no way I can do half of that.” A2018studyinthe AmericanJournalof PublicHealth backshimup.1 Itexamined North Carolina death reports and found thatintheperiod2000–15,1,329former inmates died of opioid overdoses. The most dangerous time was in the first two weeks after release, when former inmates were forty times more likely thanmembersofthegeneralpopulation tosufferafataloverdose;overthecourse of a year, they were eleven times more likely to do so. Green was unfazed when Jones blew him off. He’s a patient man who knows what it’s like to come out of prison and struggle to find housing, health care, and employment. As Green often tells his clients,“I served eleven years, eight months,six days,andsixhours”instate prison for an armed robbery. It was his first and only conviction, for a crime he committed at the age of twenty-one. He makes no excuses for his actions then. He grew up in a middle-class fami- ly with two working parents, but he was drawn to trouble early.“I was always playing on the edge,”he says. He fell in with a group of people “I shouldn’t have beendealingwith,”hesays,“andIchose to be a criminal.”After he was convicted in 2003 and found himself in prison, he resolved to transform himself. “I made up my mind that if I lived through this experience, I would never jeopardizemylife,myfreedom,myfam- ily again,”he says.“And I also made a vow to help anybody I can [avoid] mak- ing these same mistakes.” InprisonGreenavoidedconflictswith other inmates, partly because he’s big and powerfully built—“a man of size,” as he puts it, whom nobody wanted to mess with—and he read voraciously. When he checked his library card seven years into his term, he found he’dread over a thousand books. When he finally got out, Green moved back into his old room in his father’s house,andthreemonthslaterhelanded a job as a parking lot attendant. He earned two promotions there before learning last year that the FIT Program was hiring a community health worker toworkwithnewlyreleasedinmates.He jumped at the opportunity and had just the right background and skills. Today his prison experience is an as- set that gives him street cred, empathy, and instant entrée with his clients. It’s also a prerequisite for his job.“This is like the only profession where being a criminal is a plus,”he says.“But you have to be a reformed criminal, of course.” When Jones was ready, he met with Green and, a few days later, with Evan Ashkin, a professor of family medicine at the University of North Carolina (UNC) at Chapel Hill who serves as the primary care doctor for FIT patients in Orange County. Ashkin founded the FIT Program and works as its statewide medical director. He is certified by the Drug Enforcement Administration to prescribe Suboxone and began doing so for Jones, as he does for seven other FIT patients. Jones says that his daily dose of Sub- oxone “keeps me from withdrawal and makesmeabletoliveanormallife.”The drug, which combines buprenorphine and naloxone, occupies the brain’s opi- oid receptors, keeping users from get- ting high from other opiates.“If I go out right now and get some heroin or a pain pill, it’s not going to affect me,”Jones says. He knows this to be true because he’s tried, and “it didn’t do nothing. A big waste of money.” Tackling Systemic Barriers For Ashkin, starting the FIT Program grew out of a sense of social commit- ment that was nurtured by his residency at the University of California San Fran- cisco (UCSF) in the 1990s, during the height of the AIDS epidemic. He moved to North Carolina in 1998 and ran a sec- tion of the family residency program at UNC Chapel Hill that worked to provide care to the underserved. “I started to understand that if they had a history of incarceration, that led tofurtherbarriersandreally,reallypoor access to health care services,”Ashkin says. Because North Carolina didn’t ex- pandMedicaid,whenpeoplewereincar- cerated,“it was the first time they had aconstitutionalrighttohealthcare.And they were getting diagnosed with high blood pressure, diabetes, and chronic kidney disease.” When they get out, most recently re- leased inmates have other priorities than health care, like getting housing and reporting to their probation offi- cers. Since health care isn’t high on the list, and they can’t afford it anyway, many simply don’t get care—even when they have serious health, mental health, or substance use problems. Even clinics that aim to serve low-income people of- tenrequirecopaymentsof$20or$25for clinical visits and $4 to $10 for medica- tions, Ashkin says. The lack of coordination shocked Ashkin, who laughs at his own naïveté. Getting help:Justin Jones (right) has been addicted to opioids and has shuttled in and out of prison at least fifteen times. Now, with the help of community health worker Tommy Green and the Formerly Incarcerated Transition Program, he’s getting medication that keeps him off heroin and protects him from a fatal overdose, like the ones that have killed ten of his friends this year. Photograph by Rob Waters October 2019 38:10 Health Affairs 1617