People in Jail Deserve Effective Drug Treatment, not Forced Withdrawal

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By Amy Roe

Nearly 30 years ago, when he was 18 years old, Sy Eubanks had surgery for a knee injury he got while competing on his high school’s wrestling team. His doctor prescribed him opioid painkillers, the dangers of which are now widely known. All Sy knew was that he liked the feelings his prescription gave him, and he wanted more.

After graduation, Sy got a job as a logger. It was then he realized he couldn’t stop taking opioids. Whenever he did, he’d get so sick from withdrawal that he couldn’t work. To support his opioid addiction, Sy resorted to increasingly desperate measures: shoplifting, stealing, and pawning items to get money or drugs. By his mid-20s, Sy was using heroin, too.

Opioids reduce pain, produce euphoria, and are highly addictive. They include prescription painkillers and street drugs heroin and illicit fentanyl. People who are unable to stop using them may have Opioid Use Disorder (OUD), a chronic condition often accompanied by changes to brain chemistry.

Sy kept trying to overcome his OUD, which is a disability protected under the Americans with Disabilities Act (ADA). About 15 years ago, he went to a drug counseling center and received his first dose of methadone, one of three medications now used as part of MAT (Medication Assisted Treatment), a treatment of OUD. MAT limits the euphoric effects of opioids, relieves physiological cravings, and helps normalize body functions — all without the negative effects of having to obtain and use illicit opioids. It is widely regarded by the medical community as a very effective way to treat opioid use disorder and can be an effective way of reducing the risk of death from overdose.

With MAT, Sy has had success controlling his opioid use disorder. When he was booked into the Whatcom County Jail in September of 2017, Sy wanted to continue his treatment. But staff at the jail refused to let him — it only allows MAT to women who are pregnant.

Sy is a plaintiff in a lawsuit filed last week by the ACLU of Washington against Whatcom County. The class-action suit, Kortlever et al v. Whatcom County, could have national implications. It asserts the county’s policy of refusing to provide access to MAT to people with OUD in jail discriminates against them on the basis of their disability and exposes them to grave danger of relapsing and overdosing when they get out.

This is because the jail’s answer to OUD — withdrawal — does nothing to treat the underlying addiction and reduces one’s tolerance to opioids. There is a good chance that people who are forced into withdrawal in jail will start using again upon release, and now that their drug tolerance is lower, they’re more likely to take too much and die.

Utilizing the ADA to assert the right to medication for people with OUD is a novel approach and an essential one. America has long treated drug addiction as if it were a problem of morality rather than a public health concern. This has resulted in the favoring of abstinence-based programs, instead of more effective medical interventions.

Evidence that abstinence alone isn’t working can be found in every community in the country. In 2016, 42,249 people died of opioid overdose deaths in the United States. Washington lost 709 of these people. In 2016, at least 18 people died from heroin-related overdoses in Whatcom County, more than double the number of people killed by motor vehicle accidents. The fact that we possess a powerful tool to greatly reduce or even eliminate such deaths makes the willful refusal to use it all the more inhumane.

To someone with a life-threatening medical condition, treatment isn’t optional — it’s critical. MAT can be as life-saving to a person with OUD as insulin is to a person with diabetes. Withholding necessary medical treatment from one group of people — non-pregnant people with addictions — while giving the very same treatment to a different group of people — pregnant women — is discriminatory and dangerous.

It’s also shortsighted.

When people with OUD get the treatment they need, they are better able to take care of themselves and their families and to contribute to their communities. Whatcom County should be doing all it can to help people with opioid use disorder get access to MAT, instead of obstructing them.

Amy Roe is a Senior Writer with ACLU of Washington


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18 thoughts on “People in Jail Deserve Effective Drug Treatment, not Forced Withdrawal”

  1. Jim Hoch

    What a funny article. “the jail’s answer to OUD — withdrawal — does nothing to treat the underlying addiction and reduces one’s tolerance to opioids”

    As if giving methadone “treat the underlying addiction” and reducing “one’s tolerance to opioids” is a good thing by any standard . Methadone has been around since the 1960’s and is a terrible reality. Glad he had a chance to kick and hopefully he will stay clean.

  2. Don Shor

    Treating someone who is drug- or alcohol-dependent with the best current medical practices is just common sense, not to mention being ultimately cheaper for society in the long run. Not everyone who uses an opioid is dependent, just as not everyone who gets a DUI is alcohol-dependent. That’s why you need medical supervision. But overcoming the abstinence-only mentality is a big obstacle, even though it is about fifty years out of date with respect to the science of addiction.

    1. Tia Will

      Jim

      What you are missing is the concept of harm reduction which is in many cases the medical best practice. You correctly write that those on methadone are dependent. But they are dependent on a substance that will not kill them, and will decrease their desire for and dependency on more hazardous substances. The recidivism rate for those who are forced off their opioid of choice is very high. The recidivism rate for those who have been successfully treated with methadone is very low if they are allowed to continue treatment.

       

  3. Craig Ross

    Jim: The first question you have to ask, what is best medical practice?  The complaint in this article is that the jail isn’t using that.  Are you?

    1. Jim Hoch

      “what is best medical practice” is clearly the wrong question as the “best practice” may not be “medical”. 

      Have you ever been to a methadone clinic?

        1. Jim Hoch

          Howard: “Methadone has been around since the 1960’s and is a terrible reality. Glad he had a chance to kick and hopefully he will stay clean.”

          That is my statement and I’m sticking to it.

      1. Tia Will

        Jim

        I have never been in a methadone clinic, but I have had many patients who have been on methadone successfully. What is your experience that has made you feel so negatively about methadone.

        1. Jim Hoch

          Hi Tia,

          I have physically been to at least six methadone clinics. Most (3-4) were run by a company called Western Pacific though one was run by  the Suicide Prevention Center, one was run by the Chinese Government in the PRC, and the others I forget.

          The Chinese one was run completely from a harm-reduction HIV containment perspective with recovery from addiction a tertiary objective.  Admission to the methadone program required a police referral. After the Jing Cha 警察 was tired of throwing you in work camps and the like they would give up. If you were HIV+ and therefore not a potential organ donor they would take you to the methadone clinic. I had lunch once with the program director who said he had treated 2,000 drug addicts with psychotherapy and not one had stayed clean. The Chinese government does not like the self directed aspect of 12 step programs so they were trying to create some kind of hybrid model.

          In the California methadone is a for profit enterprise whose goal is to keep people on methadone for the rest of their lives. The goal of the “counselors” was to increase everybody dose to the max (80mg at the time) in order to keep them from leaving the clinic. Since their bodies had saturated mu receptors methadonians  were heavy drinkers and takers of other drugs. It was unspeakably depressing and the closest to classical zombies (slow zombies not the controversial fast ones) I have ever seen.

           

        2. Howard P

          See, Jim?

          Much better to make statements, like you did with your 6:03 post…

          Thank you for the information… very compelling… reminds me of other sources, other conditions, where the goal is to make folk compliant, never mind addressing the underlying causes… or, the cost to the “individual” from the ‘treatment’…

  4. WesC

    For some very good insight on addiction I highly recommend you read  The Biology of Desire, Why Addiction is not a Disease by Marc Lewis, PhD.  Lewis is a neuroscientist and professor of developmental psychology at Radboud University in the Netherlands who also taught at the University of Toronto for more than 20yrs.  Lewis also happens to have been an drug addict himself during his early years.

  5. Tia Will

    WesC

    I have not read Marc Lewis book and so can not speak to his work. However, I would make one cautionary point. It is not unusual for those who suffer from any condition, be it addiction, depression, migraines, to misperceive their experience as what is the norm. I will provide an example.

    In this article, the point is made that opioids result in euphoria. But not universally. I am an outlier. Taking opioids is a dysphoric experience for me. Dysphoric to the point that after several surgeries including Cesarean, and during the passage of a kidney stone, I opted for pain management with Motrin alone. This is highly unusual, but not unheard of. I mention it to stress that while this author may not consider, given the totality of his experiences, addiction to be a “disease”, there are many who would argue against his hypothesis. Whether or not one chooses to frame addiction in this particular way is not really the most pertinent point. The point from both the individual and societal view would include how best to prevent the cravings that trigger continued use and the criminality that many resort to in order to support their addiction.

  6. John Hobbs

    People in jail deserve appropriate medical care be it for addiction or cancer, but the CDC has an abysmal track record of not treating inmates with serious illnesses, instead giving them palliatives and letting them die.

    1. WesC

      A little bit of history and CDCR healthcare…

      The 1970s brought about changes that started the get tough on crime movement (war on drugs, 3 strikes your out, etc) measures that increased the prison population. From 1982 to 2000, California’s prison population increased 500%. To accommodate this population growth, the state of California built 23 new prisons at a cost of $280 million to $350 million apiece.  

      Many of these prison were built and staffed with little to no thought for medical/mental health care.  For example Pelican Bay Prison held several thousand inmates, but had a medical/mental health staff dept. that consisted almost exclusively of  Medical Technical Assistants (combination prison guard and LVN).

      The 8th amendment prohibits the state from inflicting cruel and unusual punishment and the Supreme court has ruled that to be deliberately indifferent to the healthcare needs of inmates is a violation of the 8th amendment.  Class action litigation against CDCR for abysmal healthcare was initiated and CDCR eventually came up with a plan to remedy this.

      The reality is that to hire RNs, MDs Psychologists, Pharmacists, etc takes money.  To build clinic space where exams can take place takes money.  To send inmates out to community hospitals for cancer care, surgery, specialty consultations, etc takes money. Prescription medications are very expensive

      The politics were that our elected officials apparently did not want to be on record as voting for hundreds of millions of extra dollars for inmate healthcare, while at the same time voting to reduce or inadequately fund schools, roads, and other public services, so they refused to allocate funding necessary to implement the proposed improvements.  After several years of continued frustration at seeing legislative refusal to fund improvements and a snails pace of change a federal judge ordered  the entire inmate medical care program to be put under a federal court receiver who would only be answerable to the federal court judge,  who in turn if necessary could order the state treasury to release funds necessary to implement improvement in the medical care program, and hold the Governor in contempt of court if he refused to authorize release of funds.  This is the in a nutshell history of the long road from a bottom tier 3rd world healthcare delivery system to what we have today.  The same scenario was repeated for mental health care.

      Between 1990 and 2016, the share of prisoners 50 or older grew from 4% to 23%. During the same time period, the proportion of prisoners younger than 25 fell from 20% to 11%, leaving the average age of all prisoners at 39.4 years.  Older people have more health problems and are much more expensive to take care of.  In 2016, nearly 38,000 prisoners—roughly 30% of the prison population—were designated as needing mental health services, up from 15% in 2001.  Criminalization of mental health and using the prison system to deliver mental health care is much more expensive than to do it in the community.

      If you are a supporter of tough on crime and ok with a serial petty shoplifter, drug addict, schizophrenic, etc  getting  a very long prison sentence as a solution to the problem, then you will also have to accept that the state will be responsible for the increasing costs of administering medical/mental health care in a prison setting.

    2. WesC

      A little bit of history and CDCR healthcare…
      The 1970s brought about changes that started the get tough on crime movement (war on drugs, 3 strikes your out, etc) measures that increased the prison population. From 1982 to 2000, California’s prison  population increased 500%. To accommodate this population growth, the state of California built 23 new prisons at a cost of $280 million to $350 million apiece.
      Many of these prison were built and staffed with little to no thought for medical/mental health care.  For example Pelican Bay Prison held several thousand inmates, but had a medical/mental health staff dept. that consisted almost exclusively of  Medical Technical Assistants (combination prison guard and LVN).
      The 8th amendment prohibits the state from inflicting cruel and unusual punishment and the Supreme court has ruled that to be deliberately indifferent to the healthcare needs of inmates is a violation of the 8th amendment.  Class action litigation against CDCR for abysmal healthcare was initiated and CDCR eventually came up with a plan to remedy this.
      The reality is that to hire RNs, MDs Psychologists, Pharmacists, etc takes money.  To build clinic space where exams can take place takes money. To send inmates out to community hospitals for cancer care, surgery, specialty consultations, etc takes money. Prescription medications are very expensive
      The politics were that our elected officials apparently did not want to be on record as voting for hundreds of millions of extra dollars for inmate healthcare, while at the same time voting to reduce or inadequately fund schools, roads, and other public services, so they refused to allocate funding necessary to implement the proposed improvements.  After several years of continued frustration at seeing legislative refusal to fund improvements and a snail’s pace of change a federal judge ordered the entire inmate medical care program to be put under a federal court receiver who would only be answerable to the federal court judge, and who in turn if necessary could order the state treasury to release funds necessary to implement improvement in the medical care program, and hold the Governor in contempt of court if he refused to authorize release of funds.  This is the in a nutshell history of the long road from a bottom tier 3rd world healthcare delivery system to what we have today. The same scenario was repeated for mental health care.
      Between 1990 and 2016, the share of prisoners 50 or older grew from 4% to 23%. During the same time period, the proportion of prisoners younger than 25 fell from 20% to 11%, leaving the average age of all prisoners at 39.4 years.  Older people have more health problems and are much more expensive to take care of. In 2016, nearly 38,000 prisoners—roughly 30% of the prison population—were designated as needing mental health services, up from 15% in 2001. Criminalization of mental health and using the prison system to deliver mental health care is much more expensive than to do it in the community.
       
      If you are a supporter of tough on crime and ok with a serial petty shoplifter, drug addict, schizophrenic, etc  getting a very long prison sentence as a solution to the problem, then you will also have to accept that the state will be responsible for the increasing costs of administering medical/mental health care in a prison setting.

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