By Alison Knopf
As authorities start recognizing the need to treat opioid-dependent detainees in jails and prisons, rather than let them detox cold turkey, the importance of opioid treatment programs (OTPs) to corrections is growing.
Last fall, a federal court granted a preliminary injunction giving methadone treatment to an incarcerated patient.
This was the first federal court—it was in Massachusetts—to find that denying medication can violate both the Americans with Disabilities Act and the prohibition against cruel and unusual punishment of the U.S. Constitution. The American Civil Liberties Union (ACLU) of Massachusetts, along with the law firm Goodwin Procter, brought the case on behalf of Geoffrey Pesce, a methadone patient. In March, another Massachusetts patient sued the federal Bureau of Prisons, demanding that she be able to stay on methadone when she begins serving her sentence.
States are continuing to consider legislation to require jails and prisons to offer methadone to detainees, based on successful work done in Rhode Island and Connecticut.
In fact, it looks as if corrections—which has in the past been interested in Vivitrol—is going to be a growth area for OTPs.
“The overwhelming majority of jails and prisons in this country fail to provide any of the three life-saving medications to treat opioid use disorder,” said Sally Friedman, vice president of legal advocacy at the Legal Action Center, referring to the Massachusetts decision. “This decision makes it clear that these practices are not only harmful, but illegal. Jails and prisons need to offer all three FDA-approved medications to treat opioid use disorder.”
Voices From New York
Indeed, New York State is considering such a move. “With up to 25 percent of the country’s incarcerated population suffering from opioid use disorder, it is time for jails and prisons to provide life-saving medication,” said Paul Samuels, president and director of the Legal Action Center. “We urge New York lawmakers to act quickly to ensure that the Department of Corrections is offering all three FDA-approved medications to incarcerated individuals with OUD across the state,” added Samuels. Legislation proposing that all three medications (methadone, buprenorphine, and naltrexone) be available in all lockups in the state has been offered in New York.
But it costs money, and it’s a battle. The state is not putting up enough money, meaning that counties—already strapped in many cases—would need to pay for methadone treatment for jail and prison detainees. That could be a heavy lift.
At a meeting in February, which was in part a protest against the budget and in part a rally for medication-assisted treatment (MAT) in jails and prisons, legislators and others spoke loudly.
“Throughout New York State, we have a critical opportunity to help fight the opioid epidemic, by establishing comprehensive addiction-treatment programs within correctional facilities; programs that include all three FDA-approved medications to treat opioid use disorder,” said Allegra Schorr, President of the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State (COMPA).
“What’s more,” she added, “we need to provide connections to effective services, and treatment upon reentry into the community. Rhode Island and Connecticut have demonstrated the effectiveness of these life-saving programs. New Yorkers deserve a similar chance.”
OTPs and others have called on the state to urgently pass and fully fund A833/S2161–the bill to establish MAT in all New York State jails and prisons. At a press conference after Gov. Andrew Cuomo released his budget, speakers criticized the allocation of only $3.75 million to finance 50 county MAT programs in county jails across the state, forcing the counties themselves to bear much of the cost.
“More than 75 percent of incarcerated individuals in New York State have a diagnosed substance use disorder, yet just a few state prisons offer a comprehensive medication-assisted treatment program,” said Assembly member and bill Sponsor Linda B. Rosenthal. “Our state prisons and local jails provide medication to individuals with other medical disorders. To ignore the needs of those with substance use disorders, especially at a time when overdose rates are skyrocketing, is simply inhumane. My legislation would right this wrong and require all state prisons and local jails to make all FDA-approved forms of MAT available to those who need them.”
“Every person deserves to be treated in a humane manner, whether they are incarcerated or not,” said Senator and bill Sponsor Jamaal Bailey. “New Yorkers who are incarcerated should have access to adequate medical treatment—especially when we are suffering through an opioid crisis. It is unfortunate that instead of rehabilitating those who suffer from drug abuse, in New York’s prisons, individuals have been allowed to suffer on their own, often leading to their death. This is why I am proud to support the Medication Assisted Treatment bill, and hope to see it come to fruition.”
“Prison and jail inmates are at high risk for illnesses related to poverty, addiction, or mental illness, and we have a constitutional obligation to provide health care to people in our custody,” said Assembly Health Committee Chair Richard N. Gottfried. “Medication-assisted treatment is the professional standard of care on the outside and should be equally accessible within prisons and jails. We should also expand the very successful 2009 law giving the Health Department oversight of HIV/AIDS and Hepatitis C services in prisons and jails to include substance use disorder.”
Program “Addresses the Cycle of Arrest and Incarceration”
“At the Albany County jail we’ve implemented this program because we know it will reduce the rates of overdose among people recently released, improve people’s ability to stay in treatment and live the lives they want, and will address the cycle of arrest and incarceration that many people with opioid use disorder face,” said Albany County Sheriff Craig Apple. “It took me a while to get on board with this, but we’re already seeing early success with our program. I wholeheartedly support the expansion of these efforts and dedication of resources being asked of our state leaders. I also encourage my fellow law enforcement leaders to get behind this.”
“Politicians have long ignored overdose deaths in black communities like mine. Despite the rhetoric of a kinder, gentler drug war as the overdose crisis spreads into white, rural and suburban communities, these same politicians still have not enacted basic, life-saving interventions. I have met many of these white families, and they feel just as stigmatized, ignored, and angry, as my community,” said Will Robertson, Leader at VOCAL-NY. “If the blue wave that hit New York State does not take action to end our state’s overdose crisis, it will mean nothing to any of these families, white, black or Latino.”
“I am a person that was arrested for just having a possession of a needle and it wasn’t even on me it was in a car however I was sent to the county jail while I was 8 months pregnant and ended up having a premature birth with my daughter because I was detoxing and didn’t have methadone,” said Stephanie, a member of the Katal Center for Health, Equity and Justice. “I didn’t have access to the methadone from the program that I was attending for a year! As a result of this my daughter was in the NICU for two weeks which was very terrifying and traumatic. If I was able to have this treatment while I was incarcerated at the county jail things may have been different. This may not help me today but I’m sure that it would help many people that are and will be in the same situation that I have been through and I hope that they don’t have to suffer the same traumatic and terrifying situation.”
“At Friends of Recovery-New York (FOR-NY), we hear time and time again stories of people in the NYS Justice System who did not receive medication-assisted treatment (MAT), which is evidence-based,” said Interim Executive Director, Allison Weingarten, adding, “This lack of treatment and connection to treatment or recovery support services leaving a correctional facility tragically often leads to overdose and death. MAT is shown to reduce cravings for opioids and is a proven pathway to addiction recovery, which is why FOR-NY strongly supports this legislation making MAT available in all jails and prisons throughout New York State.”
NYASAP: “Ensure a Smooth Transition When They Return Home”
“A comprehensive range of patient-centered prevention, treatment, recovery, and harm reduction services should be made available to all residents of New York’s prisons and jails who suffer from the disease of addiction,” said John Coppola, Executive Director of New York Association of Alcoholism and Substance Abuse Providers (NYASAP). “While providing all available treatment options to people in prison—we also need to ensure a smooth transition when they return home which includes making sure they maintain easy access to the medications they are taking.”
“The criminalization of substance use has pushed people in need of care into jails and prisons that are not equipped to provide effective medical care. Lack of sustained state resources, medical bias, and misinformation surrounding medication-assisted treatment, have created a massive treatment gap in New York’s jails and prisons,” said Dionna King of the Drug Policy Alliance. “The funding allocated through the 2019-20 budget will not adequately address the significant treatment need in resource-strained counties struggling to provide care to people who cycle in and out of jail. New York state leaders must move beyond rhetoric, ending the overdose crisis requires a commitment to providing care to everyone.”