The U.S. and New Zealand are the only two countries that allow direct advertising on prescription drugs, according to University of Wisconsin-Madison School of Pharmacy professor Dr. David Kreling, a pharmaceutical policy and marketing expert.
In the U.S., the Food and Drug Administration approves marketing of prescription drugs through the Federal Food, Drug and Cosmetic Act. The act also prohibits using false or misleading information in advertisements.
The FDA requires advertisements to present the statement on a drug’s side effects in a “clear, conspicuous, and neutral manner.”
Most countries prohibit direct advertising of pharmaceuticals because some available drugs aren’t tested enough to guard against rare but potentially severe side effects.
While the U.S. has never had a federal law banning direct advertising of prescription drugs, companies did not publicize prescription information through direct advertisements until the 1980s. Previously only doctors and pharmacists received that information.
U.S. Sen. Ron Johnson, R-Wis., made the claim April 21.
This fact brief is responsive to conversations such as this one.
Sources
University of Wisconsin-Madison School of Pharmacy: David Kreling
A pharmacy manager retrieves a bottle of antibiotics. (Photo by Joe Raedle/Getty Images)
WASHINGTON — President Donald Trump signed an executive order Monday aimed at lowering drug prices by pressuring pharmaceutical companies to align their U.S. pricing models with those in similarly wealthy countries.
“We’ll slash the cost of prescription drugs and will bring fairness to America,” Trump said at a morning White House event. “We’re all gonna pay the same.”
The executive order, which the White House dubbed the “most-favored-nation” policy, gives pharmaceutical companies 30 days to negotiate lower drug prices with the government.
If no deal is reached in that time, Trump said a new rule will be set so that the United States will have a price model similar to the lower rates patients abroad pay. According to the executive order, Health and Human Services Secretary Robert F. Kennedy Jr. would be responsible for the rulemaking “to impose most-favored-nation pricing.”
“We are going to pay the lowest price there is in the world,” Trump said.
A White House official previewing the policy in a background call with reporters Monday said the president will direct the Department of Commerce to “take all appropriate action” on countries that “suppress drug pricing abroad.”
The Food and Drug Administration will also consider expanding imports of pharmaceutical drugs from nations beyond Canada, the White House official said.
Former President Joe Biden issued an executive order to direct the FDA to work with states to import prescription drugs from Canada.
The White House official said Kennedy “will set clear targets for price reductions across all markets in the United States.”
Kennedy appeared at the White House alongside the president Monday morning.
“The United States will no longer subsidize the health care of foreign countries, which is what we were doing,” Kennedy said. “If the Europeans raise their price of their drugs by just 20%, that is tens of trillions that can be spent on innovation and the health of all people all across the globe.”
Trump said Monday the drug pricing policy would be included in the “one, big, beautiful,” reconciliation bill that is the top priority of congressional Republicans. The measure is also expected to provide tax cuts and a significant funding increase to border security.
Staff on the House Energy and Commerce Committee told reporters twice during a background briefing around the same time that most favored nation prescription drug pricing would not be in that reconciliation package.
First term
The order is similar to an effort the president made in his first term, which was struck down in federal court.
The White House official said Monday’s order is an expansion of those first-term efforts, which tried to apply the pricing model for those with Medicare – the health insurance program for those who are 65 or older and certain people under 65 who have disabilities – to 50 drugs.
“The expectation should not be that we will just be pursuing that same rulemaking,” a White House official said. “We have moved on from that for broader action.”
The pharmaceutical industry has long opposed such a move and is already bracing for the president’s planned tariffs on prescription drugs.
More details on specific actions in Medicare will be announced later, according to a White House official.
“We will be taking action in the Medicare program if the pharmaceutical companies do not come to the table and lower their prices across markets,” the White House official said.
Effort unserious, leading Democrat says
U.S. Senate Finance Committee ranking member Ron Wyden, Democrat of Oregon, slammed Monday’s executive order.
“If Trump was serious about lowering drug prices, he would work with Congress to strengthen Medicare drug price negotiations, not just sign a piece of paper,” Wyden said.
The Inflation Reduction Act that Democrats passed along party lines in 2022 when they held unified control of Washington allowed for drug negotiating pricing that aims to lower drug costs for those with Medicare.
“Democrats took on Big Pharma and won by finally giving Medicare the power to negotiate lower drug prices on behalf of seniors and capping their out-of-pocket costs for expensive prescriptions,” Wyden said, referring to the law.
Robert F. Kennedy Jr., the secretary of Health and Human Services, testifies during his Senate Finance Committee confirmation hearing at the Dirksen Senate Office Building on Jan. 29, 2025, in Washington, D.C. (Photo by Win McNamee/Getty Images)
WASHINGTON — Less than half of Americans have confidence in federal public health agencies’ ability to regulate prescriptions, approve vaccines and respond to outbreaks, according to a poll released Tuesday by the nonpartisan health research organization KFF.
The survey shows that just 46% of the people questioned have at least some confidence in federal agencies ensuring the safety and effectiveness of prescription drugs.
Even fewer, 45%, have confidence in the safety and effectiveness of vaccines and only 42% said they have confidence federal health agencies to respond to infectious disease outbreaks, like bird flu and measles.
An especially low percentage of those polled, 32%, had either some confidence or a lot of confidence in federal health agencies acting independently without interference from outside interests.
“There are remarkably low levels of trust in the nation’s scientific agencies, shaped by partisan perspectives, and that presents a real danger for the country if and when another pandemic hits,” KFF President and CEO Drew Altman wrote in a statement accompanying the poll.
Confidence in agencies sags or rises by party affiliation
The percentage of people overall who hold confidence in the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to provide reliable information about vaccines has dropped since a similar survey in September 2023, though party affiliation shows differing trends.
Democrats with a fair amount or great deal of trust in the FDA’s vaccine information has decreased from 86% to 67%, while trust among Republicans has increased from 42% to 52%.
When combined with independents, overall trust in the FDA’s information about vaccines has decreased, from 61% to 57%.
Confidence in the CDC providing reliable information about vaccines has also shifted based on party affiliation.
During the Biden administration, 88% of Democrats had a fair amount or great deal of trust in the CDC, though that has since dropped to 70%. Republicans have started to come back around to the CDC’s vaccine information, with their level of trust increasing from 40% to 51%.
Altogether, trust in CDC has dropped from 63% to 59%, according to the survey.
“The overall level of trust in each case is similar to where it stood in September 2023, though the poll reveals significant partisan shifts as the second Trump administration and Health and Human Services Secretary Robert F. Kennedy Jr. have started to change vaccine policies and messaging,” the poll states.
Local sources trusted
Health care providers and local public health departments are overwhelmingly looked to as trusted sources for reliable information on vaccines, according to the survey.
Eighty-two percent of respondents said they either have a great deal or a fair amount of trust in doctors and health care providers to give them reliable information about vaccines.
Eighty-one percent said they trust their child’s pediatrician, 66% responded they have confidence in their local public health department, 59% believe in the CDC, 57% trust the FDA and 51% have confidence in pharmaceutical companies to provide factual information about vaccines.
Those polled held less trust in politicians, with 41% believing Kennedy’s comments about vaccines and 37% trusting President Donald Trump “to provide reliable information about vaccines,” according to the poll.
A majority of those surveyed, however, are somewhat or very confident in the safety of several vaccines, including 83% for measles, mumps and rubella, or the MMR vaccine; 82% for pneumonia; 79% for shingles; 74% for the flu; and 56% for COVID-19.
The poll included 1,380 U.S. adults contacted online or via telephone from April 8-15, for a margin of error of plus or minus 3 percentage points.
A Wisconsin couple is suing Walgreens and a pharmacy benefits management company, alleging that their son died because he couldn’t afford a sudden $500 spike in his asthma medication.
Shanon and William Schmidtknecht of Poynette filed their lawsuit in federal court in Milwaukee on Jan. 21, a year to the day that their son Cole died at age 22.
According to the lawsuit, Cole Schmidtknecht suffered from asthma all his life. He managed it with daily inhaler doses of the medication Advair Diskus and its generic equivalents.
He stopped at a Walgreens pharmacy in Appleton on Jan. 10, 2024, to refill his prescription and was told the cost had jumped from $66 to $539 out-of-pocket. Unable to afford the new cost, he left the pharmacy without the medication. He tried to manage his condition with his rescue inhaler but suffered a fatal asthma attack days later, according to the lawsuit.
The Schmidtknechts allege that pharmacy benefits management company OptumRX violated Wisconsin law by raising the cost of the medication without a valid medical reason and failing to provide 30 days’ advance notice of drug price increases.
Pharmacy benefits managers act as intermediaries between health insurance companies, prescription drug companies and pharmacies. Optum Rx services prescription claims for more than 66 million people across the United States, according to the lawsuit.
The lawsuit alleges that the Walgreens pharmacy staffers failed to offer Cole any workarounds to obtain his usual medication. They told him there were no cheaper alternatives or generic medications available, they didn’t contact OptumRx to request an exception on Cole’s behalf, and they didn’t ask Cole’s doctor to request an exception for him, his parents contend.
The lawsuit seeks unspecified damages.
“The conduct of both OptumRx and Walgreens was deplorable,” one of the family’s attorneys, Michael Trunk, said in a statement. “The evidence in this case will show that both OptumRx and Walgreens put profits first, and are directly responsible for Cole’s death.”
OptumRx spokespeople didn’t immediately reply to Wednesday messages seeking comment. In a statement last April extending sympathy to the family, the company said that a review of Cole’s claims showed that on the day he visited the pharmacy, he did buy a different asthma medication, generic Albuterol, for a $5 co-pay on Jan. 10 — a medication that it says he also obtained in October 2023. His case was handled “consistent with industry practice and the patient’s insurance plan design,” the company said.
Trunk, though, said Wednesday that the $5 generic prescription Cole filled was for his rescue inhaler, not the Advair Diskus inhaler that he took daily. He said Cole was not able to fill his Advair Diskus prescription because it had suddenly become too expensive.
Walgreens officials didn’t immediately respond to a Wednesday email seeking comment on the lawsuit.
Wisconsin Watch is a nonprofit and nonpartisan newsroom. Subscribe to our newsletter to get our investigative stories and Friday news roundup.This story is published in partnership with The Associated Press.
Young Black men in cities across America died of drug overdoses at high rates in the 1980s and 1990s. During the recent fentanyl crisis, older Black men in many cities have been dying at unusually high rates.
They’re all from the same generation.
An investigation of millions of death records — in a partnership between The New York Times, The Baltimore Banner, Big Local News and nine other newsrooms across the country — reveals the extent to which drug overdose deaths have affected one group of Black men in dozens of cities across America at nearly every stage of their adult lives.
In recent years, the opioid epidemic has brought dangerous drugs to every corner of the country, and overdoses have risen among younger, whiter and more rural populations.
That huge tide now appears to be ebbing — but not for this group of Black men. In the 10 cities examined in this partnership, including Baltimore, Chicago, San Francisco, Newark, Washington, Milwaukee and Philadelphia, Black men ages 54 to 73 have been dying from overdoses at more than four times the rate of men of other races.
“They were resilient enough to live through a bunch of other epidemics — HIV, crack, COVID, multi-drug-resistant tuberculosis — only to be killed by fentanyl,” said Tracie M. Gardner, the executive director of the National Black Harm Reduction Network and a former New York state health official.
In all, the analysis identified dozens of cities, mostly in the Northeast and Midwest, where a generation of Black men were at higher risk of overdose deaths throughout their lives. In many of those places, cities have done little to distribute resources to this population.
The details vary from city to city.
In Chicago, there is no focused effort in nearly $1.3 billion of state opioid settlement money to help older Black men, despite a heavy death toll for this group, The Chicago Sun-Times found.
In Pittsburgh, Black men in jail with opioid use disorders have been less likely to receive medications to combat their addictions than white men, a PublicSource investigation has found, though local officials are working to close the gap.
In San Francisco, many of the men vulnerable to overdoses use both opioids and cocaine, a combination that may make treating their addictions more complex, according to an analysis of mortality data by The San Francisco Standard.
In Newark, NJ.com/The Star-Ledger also found that overdose victims were using both opioids and cocaine.
InPhiladelphia, older Black men were actually less likely to die than their white peers — until recently. By 2018, their death rate had shot up, according to a Philadelphia Inquirer analysis.
InWashington, local regulations and insurers have prevented doctors from giving longtime opioid users effective doses of drugs meant to curb their cravings, reporters for The 51st found.
In Indianapolis, Black men said they were reluctant to use public health solutions like syringe exchanges or fentanyl test strips because of a fear of harassment by police, Mirror Indy found.
In Milwaukee, around half of older Black men lost to drugs spent time in state prison. Wisconsin is trying to increase access to a Department of Corrections treatment program, which has a waitlist of 11,700, Milwaukee Neighborhood News Service and Wisconsin Watch found.
In Boston, where this generational disparity is a more recent phenomenon, older Black men feel less welcome in treatment programs, the Boston Globe found.
‘Dying for decades’
Black men of this generation, born from 1951 to 1970, came of age at a time of wide economic disparities between Black and white people in their cities. Some of them served in Vietnam, where they were first exposed to heroin. In cities where heroin was available, others started using the drug closer to home in the 1970s and ’80s, and became addicted.
Many have continued to use drugs on and off for decades. Though some managed their addictions safely, the risk of overdose was always there.
Mark Robinson, 66, grew up in Washington and now runs a syringe exchange program in the city. He estimates he knows 50 people who have died over the years from overdoses, including one of his best friends.
“Black men didn’t just start dying,” he said. “We’ve been dying for decades as a direct result of opioid use disorder.”
The cities with this pattern of drug deaths tend to be places with large Black populations, intense residential segregation and heroin markets that were active in the 1970s, when the oldest of these men were young and first became exposed to illicit drugs, according to Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco.
“Heroin has become an endemic problem,” he said. “It never went away.”
In addition to the risk of overdose, men of this generation lived through convulsions in public health and criminal justice. In the 1980s, some became exposed to HIV through drug injections. In the 1990s, more aggressive sentences for drug crimes meant many of them spent time in jails or prisons.
Several public health researchers said widespread incarceration may have reduced these men’s chances of staying clean. “You’re basically disarming them from having a good life,” said Ricky Bluthenthal, a professor of public health at the University of Southern California, who has studied injection drug users for decades. “They lose girlfriends, they lose houses, they lose connections to their children.”
They have lived through the social upheavals of COVID, a period of isolation that coincided with an increase in the overdose rate for nearly all groups.
They also stand to benefit from the recent embrace of more medical approaches to drug addiction. Drugs that can reverse an overdose are widely distributed in many cities now. And more doctors are willing to prescribe medications that can curb drug cravings for people who want to quit.
But in many of the cities where older Black men are dying at high rates, those innovations may not be reaching this group.
Decades of drug use, criminal risk and stigma have made some reluctant to discuss their addictions. The Philadelphia council member Kendra Brooks said she recently learned about nine overdoses among older Black residents in her neighborhood. The overdoses had happened quietly, in private homes.
“In this generation, you don’t get high in public,” Brooks said. “It’s something very private and personal. Amongst folks that I know, it’s like a secret disease.”
Older Black drug users have been less likely than white ones to receive prescription medicines that are now the gold standard for addiction treatment.
Medicare, the public program that insures older Americans, tends to cover fewer addiction services than insurance for younger people.
And, more generally, many outreach programs are aimed at younger populations.
“If you go to a harm reduction program, it’s not typically set up with older folks in mind,” said Brendan Saloner, a professor of health policy at Johns Hopkins in Baltimore, who studies access to health care among people who use drugs. “They’re not in any way unwelcome, but they’re not generally the target.”
In Chicago, Fanya Burford-Berry, who directs the West Side Heroin and Opioid Task Force, pleaded with state officials to devote more resources to the city’s older Black drug users at a recent meeting.
“It seems like there’s a blind spot when it comes to prioritizing Black men, older Black men and drug usage,” she said.
‘Not any real heroin’
This generation’s experience also highlights how much more dangerous the drug supply has become. Despite better treatment and more resources to combat addiction, the overdose death rate among older Black men in these cities has risen in recent years, as heroin has been replaced by the more potent fentanyl.
“There is not any real heroin being sold in the streets, period,” said Joe Henery, 77. Henery, who lives in Washington, used heroin for 30 years before getting clean. He said his friends who are still alive were “fortunate enough to survive the epidemics of all sorts,” but he worries about the risk of overdose for those who are still using. What was once heroin in Washington is now almost all either replaced by or mixed with fentanyl.
Fentanyl is easier for cartels to manufacture in labs and smuggle into the country. But the high doesn’t last as long as heroin’s, which often means drug users take more doses a day to avoid withdrawal symptoms. And its variable strength makes it more likely for even experienced users to take a fatal dose accidentally.
Nora Volkow, the director of the National Institute on Drug Abuse at the National Institutes of Health, said the pattern of deaths in Baltimore reported by The Times and The Banner has caused her to seek new research on why these men are dying and how to prevent it.
Volkow acknowledged that their drug addiction has long placed them at risk, but she said that fentanyl has greatly intensified that risk.
“If you were, in the past, using heroin, your chances of dying were much, much lower than your chances of dying now,” she said. “The key element now is the dangerousness of the drugs.”
Reporting was contributed by Cheryl Phillips, Eric Sagara, Sarah Cohen and Justin Mayo of Big Local News; Frank Main, Elvia Malagón and Erica Thompson of The Chicago Sun-Times; Aubrey Whelan and Joe Yerardi of The Philadelphia Inquirer; Venuri Siriwardane and Jamie Wiggan of PublicSource; Abigail Higgins and Colleen Grablick of The 51st; Ryan Little of The Baltimore Banner; David Sjostedt, Noah Baustin and George Kelly of The San Francisco Standard; Steve Strunsky and Riley Yates of NJ.com/TheStar-Ledger; Darian Benson and Mary Claire Molloy of Mirror Indy; Edgar Mendez and Devin Blake of Milwaukee Neighborhood News Service and Wisconsin Watch; and Chris Serres and Yoohyun Jung of the Boston Globe.
About this project
The data and methodology behind this project can be downloaded from the Stanford Digital Repository. This article was published in partnership with The Baltimore Banner, Stanford’s Big Local News and other local news outlets: The Chicago Sun-Times; The Philadelphia Inquirer; PublicSource; The 51st; The San Francisco Standard; NJ.com/The Star-Ledger; Mirror Indy; Milwaukee Neighborhood News Service and Wisconsin Watch; and the Boston Globe.
Reading Time: 8minutesClick here to read highlights from the story
Milwaukee County is among dozens of U.S. counties where drugs are disproportionately killing Black men born between 1951 and 1970.
Black men of the generation accounted for 12.5% of all drug deaths between 2018 and 2022. That’s despite making up just 2.3% of the total population. The trend has only accelerated in more recent years.
Most of the men who died used cocaine that was cut with stronger fentanyl — the faster-acting drug has fueled the national opioid epidemic. Most had a history of incarceration.
Limited options and lingering stigma prevent a generation of Black men from accessing drug treatment.
In many ways, Hamid Abd-Al-Jabbar’s life story involved redemption. A victim of abuse who was exposed to alcohol and drugs while growing up on Milwaukee’s North Side, he made dangerous choices as a teenager. By age 19, he landed in prison after shooting and killing a man during a 1988 drug house robbery.
But he worked on himself while incarcerated, his wife Desilynn Smith recalled. After he walked out of prison for good, he found a calling as a peace activist. He became a violence interrupter for Milwaukee’s 414 Life program, aiming to prevent gun violence through de-escalation and intervention.
Abd-Al-Jabbar may have looked healed on the outside, but he never moved past the trauma that shaped much of his life, Smith said. He wouldn’t ask for help.
That’s why Smith still grieves. Her husband died in February 2021 after ingesting a drug mixture that included fentanyl and cocaine. He was 51.
Smith now wears his fingerprint on a charm bracelet as a physical reminder of the man she knew and loved for most of her life.
“He never learned how to cope with things in a healthy way,” said Smith, executive director of Uniting Garden Homes, Inc., an organization that provides mental health and substance use services on Milwaukee’s North Side. “In our communities addiction is frowned upon, so people don’t get the help they need.”
Desilynn Smith is still grieving the loss of her husband Hamid Abd-Al-Jabbar, who died in 2021 after ingesting a mixture of cocaine and fentanyl. She is shown Jan. 23, 2025, in her office at Uniting Garden Homes, Inc., in Milwaukee. (Joe Timmerman / Wisconsin Watch)
Abd-Al-Jabbar is part of a generation of Milwaukee’s older Black men who are disproportionately dying from drug poisonings and overdoses, even as the opioid epidemic slows for others.
Times and Banner reporters initially identified the pattern in Baltimore. They later found the same effect in dozens of counties nationwide.
In Milwaukee, Black men of the generation accounted for 12.5% of all drug deaths between 2018 and 2022. That’s despite making up just 2.3% of the total population.
The county’s older Black men were lost to drugs at rates 14.2 times higher than all people nationally and 5.5 times higher than all other Milwaukee County residents.
Six other Wisconsin counties — Brown, Dane, Kenosha, Racine, Rock and Waukesha — ranked among the top 408 nationally in drug deaths during the years analyzed. But Milwaukee was the only one in Wisconsin where this generation of Black men died at such staggering rates.
Hamid Abd-Al-Jabbar, right, helps distribute masks in Milwaukee during the pandemic-impacted April 2020 elections. After spending years in prison, Abd-Al-Jabbar found a calling as a peace activist. (Courtesy of City of Milwaukee Office of Violence Prevention)
Milwaukee trend accelerates
The trend in Milwaukee County has only accelerated since 2022, the last year of the Times and Banner analysis, even as the county’s total drug deaths decline, Milwaukee NNS and Wisconsin Watch found.
Drugs killed 74 of the county’s older Black men in 2024. The group made up 17.3% of all drug deaths — up from 16.2% in 2023 and 14.1% the previous year, medical examiner data shows.
Abd-Al-Jabbar’s story shares similarities with many of those men. Most used cocaine that was cut with stronger fentanyl — the faster-acting drug has fueled the national opioid epidemic. Most had a history of incarceration.
Boxes of Narcan are stored in the Uniting Garden Homes, Inc., office, Jan. 23, 2025, in Milwaukee. (Joe Timmerman / Wisconsin Watch)
Marc Levine, a University of Wisconsin-Milwaukee researcher, concluded in 2020 that “Black Milwaukee is generally worse off today than it was 40 or 50 years ago” when considering dozens of quality of life indicators.
Meanwhile, limited options and lingering stigma prevent a generation of Black men from accessing drug treatment, local experts told Milwaukee NNS and Wisconsin Watch.
“Black men experience higher rates of community violence, are often untreated for mental health issues and experience greater levels of systemic racism than other groups,” said Lia Knox, a Milwaukee mental wellness consultant. “These all elevate their risk of incarceration, addiction and also death.”
A network of organizations providing comprehensive treatment offers hope, but these resources fall far short of meeting community needs.
A silent struggle
Smith and Abd-Al-Jabbar first started dating at 14, and they had a child together at 16. But as their relationship blossomed, Smith said, Abd-Al-Jabbar silently struggled with what she suspects was an undiagnosed mental health illness linked to childhood trauma.
“A lot of the bad behaviors he had were learned behaviors,” Smith said.
Desilynn Smith, executive director of Uniting Garden Homes, Inc., wears a bracelet bearing the fingerprint of her late husband Hamid Abd-Al-Jabbar at Uniting Garden Homes, Inc., in Milwaukee. “I keep that with me at all times,” Smith says. (Joe Timmerman / Wisconsin Watch)
Abd-Al-Jabbar became suicidal as a teen and began robbing drug dealers.
When he entered prison, Abd-Al-Jabbar read and wrote at a fifth grade level and coped like a 10-year-old, Smith said. By age 21, she said, he’d already spent two years in solitary confinement. But he had the resolve to change. He began to read voraciously and converted to Islam.
He was released from prison after 11 years, but returned multiple times before leaving for good in 2018. Smith and Abd-Al-Jabbar married, and he started earning praise for preventing bloodshed as a violence interrupter.
Still, he struggled under the pressures of his new calling. The work added weight to the trauma he carried into and out of prison. His mental health only worsened, Smith said, and he turned back to drugs as a coping mechanism.
“The main thing he learned in prison was how to survive,” she said.
Most men lost were formerly incarcerated
At least half of Milwaukee’s older Black men lost to drugs in 2024 served time in state prison, Milwaukee NNS and Wisconsin Watch found by cross-referencing Department of Corrections and medical examiner records. More than a dozen other men on that list interacted with the criminal justice system in some way. Some served time in jail. For others, full records weren’t available.
Most of the men left prison decades or years before they died. But three died within about a year of their release. A 55-year-old North Side man died just 22 days after release.
In Wisconsin, DOC officials and prisoners say drugs are routinely entering prisons, putting prisoners and staff at risk and increasing challenges for people facing addiction.
Thousands wait for treatment in prison
The DOC as of last December enrolled 815 people in substance abuse treatment programs, but its waitlist for such services was far higher: more than 11,700.
“You don’t really get the treatment you need in prison,” said Randy Mack, a 66-year-old Black man who served time in Wisconsin’s Columbia, Fox Lake, Green Bay and Kettle Moraine correctional institutions.
Randy Mack, a resident of Serenity Inns, talks with Ken Ginlack, executive director, in the facility’s library on Dec. 19, 2024. Expanding on its original outpatient treatment center on Milwaukee’s North Side, Serenity Inns also runs a residential treatment facility and a transitional living program and opened a drop-in clinic in January. (Andy Manis for Wisconsin Watch)
Leaving prison can be a particularly vulnerable time for relapse, Mack said. Some men manage to stop using drugs while incarcerated. They think they are safe, only to struggle when they leave.
“You get back out on the streets and you see the same people and fall into the same traps,” Mack said.
Knox, the wellness consultant, agrees. After being disconnected from their communities, many men, especially older ones, leave prison feeling isolated and unable to ask for help. They turn to drugs.
“Now with the opioids, they’re overdosing and dying more often,” she said.
Access to the program is uneven across the state. Corrections officials have sought to expand it using settlement money from national opioids litigation. In its latest two-year budget request the department set a goal for hiring more vendors to administer the program.
Democratic Gov. Tony Evers plans to release his full budget proposal next month. His past proposals have sought millions of dollars for treatment and other rehabilitation programs. The Republican-controlled Legislature has rejected or reduced funding in most cases.
Mack said he received some help while in prison, but it wasn’t intense enough to make a breakthrough. Now he’s getting more holistic treatment from Serenity Inns, a North Side recovery program for men.
Executive Director Kenneth Ginlack said the organization helps men through up to 20 hours of mental health and substance use treatment each week.
What’s key, Ginlack said, is that most of his staff, including himself, are in recovery.
“We understand them not just from a recovery standpoint, but we were able to go back to our own experiences and talk to them about that,” he said. “That’s how we build trust in the community.”
Fentanyl catches cocaine users unaware
Many of the older men dying were longtime users of stimulants, like crack cocaine, Ginlack said, adding they had “no idea that the stimulants are cut with fentanyl.”
They don’t feel the need to use test strips to check for fentanyl or carry Narcan to reverse the effects of opioid poisoning, he said.
A group discussion is shown at Serenity Inns in Milwaukee on Dec. 19, 2024. (Andy Manis for Wisconsin Watch)
Last year, 84% of older Black men killed by drugs had cocaine in their system, and 61% had fentanyl, Milwaukee NNS and Wisconsin Watch found. More than half ingested both drugs.
Months after relapsing, Alfred Carter, 61, decided he was ready to kick his cocaine habit.
When he showed up to a Milwaukee detox center in October, he was shocked to learn he had fentanyl in his system.
“What made it so bad is that I hear all the stories about people putting fentanyl in cocaine, but I said not my people,” Carter said. “It puts a healthy fear in my life, because at any time I can overdose — not even knowing that I’m taking it.”
Awareness is slowly increasing, Ginlack said, as more men in his program share stories about losing loved ones.
Milwaukee’s need outpaces resources
Expanding on its original outpatient treatment center on West Brown Street, Serenity Inns now also runs a residential treatment facility and a transitional living program and opened a drop-in clinic in January.
Still, those don’t come close to meeting demands for its services.
“We’re the only treatment center in Milwaukee County that takes people without insurance, so a lot of other centers send people our way,” said Ginlack, who said the county typically runs about 200 beds short of meeting demand.
“My biggest fear is someone calls for that bed and the next day they have a fatal overdose because one wasn’t available.”
‘I don’t want to lose hope’
Carter and Mack each intend to complete their programs soon. It’s Mack’s fourth time in treatment and his second stint at Serenity Inns. This time, he expects to succeed. He wants to move into Serenity Inns’ apartment building — continuing his recovery and working toward becoming a drug counselor.
“My thinking pattern has changed,” Mack said. “I’m going to use the tools we learned in treatment and avoid high-risk situations.”
Butterfly stickers adorn the windows of Desilynn Smith’s office at Milwaukee’s Uniting Garden Homes, Inc., on Jan. 23, 2025. They remind her of her late mother. (Joe Timmerman / Wisconsin Watch)
Carter wants to restore his life to what it was before. He spent years as a carpenter before his life unraveled and he ended up in prison. He knows he can’t take that life back if he returns to drugs.
“I have to be able to say no and not get high. It doesn’t do me any good, and it could kill me,” he said. “I have to associate myself with being clean. I don’t want to lose hope.”
As Smith reflects on her partner’s life and death, she recognizes his journey taught her plenty, too. “I was hit hard with the reality that I was too embarrassed to ask for help for my husband and best friend,” she said. “I shouldn’t have had that fear.”
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