People are getting more creative about smuggling drugs into jails and prisons.

What might appear to be a normal letter to an inmate could be saturated with liquid K2, a synthetic marijuana. An average-looking greeting card may be concealing drugs between its layers. In August, Pennsylvania state prisons went on a nearly two-week lockdown after the Department of Corrections claimed about 60 staffers were sickened by synthetic cannabinoids. That same month, nearly 30 employees at an Ohio state facility reportedly received treatment for fentanyl exposure, which some say can yield negative effects if accidentally touched or inhaled.

Citing similar safety concerns, state and local corrections facilities around the country are restricting prisoners' interaction with the outside world.

In 2015, New Hampshire banned drawings, greeting cards and colored paper. The state also limited prisoners' hugs with visitors to three seconds. Some jails have gone further, replacing in-person visits with video calls. Last year, Maryland prison officials unsuccessfully tried to limit inmates’ book access to just two vendors. Florida announced plans to cut down on contraband by housing prisoners outside their home counties.

After Pennsylvania's lockdown, the state implemented a rare policy of sending prison mail to a Florida-based company where it is scanned and stored on a database for 45 days. A digital copy of the mail is forwarded to Pennsylvania's state prisons for inmates to view. Legal mail from lawyers and courts now undergoes a separate but similarly stricter process.

Policies like these have been met with pushback from inmates, their families and legal advocates, who say this increased isolation violates inmates' rights, strains their relationships and harms their mental health.

In New Hampshire, for instance, the ACLU challenged the state, leading to a settlement permitting prisoners to receive some handmade drawings. The ACLU has also sued the Pennsylvania Department of Corrections (DOC) over the legal mail policy, arguing that it violates inmates' First Amendment rights.

Some lawyers have stopped sending mail to their clients due to the new policy because "it is insufficiently confidential," reports the Philadelphia Inquirer.

Lorraine Haw, a Philadelphia resident whose only child is serving life without parole in a state facility about a four-hour drive from her home, has similar concerns. She regularly sent her son cards and letters for 25 years until the state lockdown in August. Now, Haw says she and her son don't feel comfortable having personal information stored, so her letters have stopped coming.

"We've cried about it, but we've come to the same conclusion that we're not going to give in and do things their way," says Haw. "My son turned 43 on January 9, and this is the first year I didn't send him a birthday card."

Layne Mullett, a volunteer with the advocacy group Decarcerate PA, says the new policy also had a "chilling effect" on the mail she sends to imprisoned friends. It takes much longer for the mail to arrive, Mullett says, and "receiving a poor quality photocopy is no substitute."

Pennsylvania Secretary of Corrections John Wetzel says his department is working to fix the problems with image quality, but he believes the policy is necessary to ensure the safety of staff and inmates.

"Having drugs come in and having our staff exposed and inmates overdose is unacceptable. We'll do whatever means necessary to stop that," he says. “We identified every way that drugs were coming into facilities. We came up with an individual solution for each [avenue], even ones that aren’t used a lot in Pennsylvania but are used in other places."

The new mail policy is part of the department's $10 million security effort to stop drug flow. The state also installed drone detectors and established a separate center for inspecting book deliveries.

In addition to staff getting sick, the Pennsylvania DOC says a rise in positive inmate drug tests contributed to the new security measures. According to department data, the percent of random drug tests with positive results rose from 0.7 for most of 2018 to 1 in August. That number dropped after the state implemented its new mail policy in September but increased again to 0.7 percent in November and 0.9 percent in December. The new policy does, however, appear to be limiting contraband. The number of "drug finds" has fallen from 5.9 finds per 1,000 inmates in August to 3.4 in December.

California’s Humboldt County Correctional Facility has also beefed up security after a rise in drug smuggling. It purchased a scanner in 2016 to detect hidden drugs among incoming mail, and last year, it banned greeting cards and letters on colored paper or cardstock. Since then, the jail has “almost eliminated” contraband coming in, says Humboldt County Correctional Captain Duane Christian.

Letters are the primary means of communication for 92 percent of prisoners in contact with their family, according to a survey by the nonprofit think tank Vera Institute of Justice. The cost of receiving calls from inmates is unaffordable for many families, and because inmates are often incarcerated in different states or counties from their loved ones, visiting in-person is difficult.

An increasing number of jails and prisons are offering the chance to connect with inmates through video, email and instant messaging -- in many cases, eliminating in-person visits in exchange. That costs money too. Rates vary between the states and services but range from a few dollars for a 20-minute video call to $13 in others using the company Securus Technologies. One popular company, Global Tel Link, services about 2,300 correctional facilities around the U.S.

While corrections officials have praised such options, they have drawn critiques from prison reform advocates. The majority of jails with video visitation (74 percent) have also eliminated in-person visits, according to a 2015 study by the Prison Policy Initiative. These restrictions, coupled with the rise of a for-profit video visitation industry, are troubling, says Wanda Bertram, a communications strategist for Prison Policy Initiative.

“Our stance is not so much that video is evil, but jails should resist the urge to get rid of in-person visits," says Bertram. "There is a lot of pressure [on officials] to cut prison costs, and there are companies out there that see an opportunity here."

Research shows that visitation helps to reduce the risk of recidivism and facilitate better mental health. Prisoners with regular contact from loved ones and a strong support system are more likely to have success upon release, says Johanna Folk, a postdoctoral fellow in psychiatry who studies how community connectedness affects inmates. Studies are less clear on whether the medium of communication -- in-person versus video -- has a significant effect, she says. Still, access to video calls can provide more flexibility for inmates when families cannot travel to see them.

In a political world with increasing bipartisan support for prison reform, restricting prisoners' communication is not an easy sell to lawmakers.

Bristol County, Mass., announced plans in 2017 to end all in-person jail visitations in favor of video calls. Those efforts, however, were blocked last April after Republican Gov. Charlie Baker signed a criminal justice package that, among other reforms, prohibited eliminating in-person visits. Around the same time, however, the Massachusetts Department of Corrections restricted the number of visitors an inmate can have at one time.