People in Jail Deserve Effective Drug Treatment Not Forced Withdrawal

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. 

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Dr. Timothy Leary

"the dangers of which are now widely known": Not true, they were widely known in the past. There have been junkies around for a long time.

Jess Tilley

There have been DRUG USERS around for a long time. Stigmatizing language kills.

Anonymous

Thanks for this great article Amy. It is well time more people treated OAD people with respect, and see them as people instead of using demeaning word like "Junkies, addicts), etc in a derivative way. The MAT program helps street heroin addict live a stable life, keep jobs and avoid breaking the law to get to the drug that need. If a person is arrested MAT can go to nail or prison with that person, just like a mentally ill inmate would get there prescribed medication medication meds. This propaganda is fueled by the pharmaceutical companies to distract attention from these companies who push legal opiates in unethical and dangerous ways. Thanks Amy.

Anonymous

I agree with most of your posting, but you are ignorant and bandwagon jumping to suggest inmates are not receiving treatment, because Pharmaceutical Companies who promote opioids. Do you even realize there is a Pharma company which successfully negotiated with prisons and jail systems to have a treatment option available? (It’s still far from where it needs to be, but it’s a step in the right direction). Also, understand, much of the bureaucracy surrounding prisons and jails are there because many Americans see inmates as disposable, and therefore don’t wish to have their tax dollars spent on providing better care, which is ignorant, being that most are released back into the community.

Anonymous

Thank you Amy. I agree. To the comment on your post, yes Alkhermes and their vivitrol has been promoted and lobbied to law enforcement and prosecutors...all for money. Vivitrol has unproven effectiveness. Big Pharma wants the over $1,000 per month so yes, they are lobbying for the money and greed. If vivitrol saves one person’s life, I’m all for it. However all options for treatment need to be on the table for the patient to chose. Methadone and suboxone are evidence based treatments. The verdict on vivitrol is still up for debate. Corruption abounds in every aspect of this drug war.

Anonymous

Drugs have been a part of our community for many years. I believe in rehab not incarceration. Its not a trend its an epedemic that should not be ignored. Young and old are being affected by this epedemic. Drugs has no social status, therefore, do not look down at people that are addicted for they are humans.

Anonymous

The point here is, why are we allowing h Private prisons in USA? The people who run them are for profit only. They are only interested in financial investment in the company any not the well- being of the humans at any level of the company or the inmates, or their health and wellness on any level! The investors in GEO Group, for example, include many politicians and world banks.

Anonymous

CCS, the provider of jail healthcare services, in some Wyoming jails, also withholds MAT for all but pregnant women. Inmates have to endure horrible withdrawal symptoms, as even immodium is scarcely provided (yes, I know that drug can be abused, too). On top of it, inmates, who take certain psychiatric medications, are forced to withdraw from their prescribed meds (seroquel, wellbutrin, amitryptaline, etc), without immediate replacement with similar med (they have to beg for a replacement, and wait a few weeks, before they might get one). Inmates who go to the state hospital, and are prescribed one of the forbidden meds, are immediately taken off those meds when they return from the hospital. The immediate medical staff lack the control to make anything better, because CCS is in charge!

Anonymous

I have also dealt with CCS, and everything said above is the complete truth, down to mental health meds! And we wonder why so many people od when they get out! If you have a valid prescription, how can you justify not giving it to someone? If its about the cost, let the families pay for it and bring it to the jail! If you are stable enough to be in a mat program, then you want help! So many people lose their spot with their doctors cause they might get locked up for one reason or another! Being forced to go cold turkey is inhumane! When are we going to wake up? How many more have to die?

Anonymous

Cibola County Correctional Facility. He stated that last week during chow there was food thrown in the trash. Later it was determined that 10 trays were still needed. Bernadette proceeded to instruct him to make trays with the food out of the trash. This is highly unacceptable the treatment in this facility is completely unbelievable. My husband has been there for 9 months and I have made over 8 complaints regarding health care, medical neglect, deliberate indifference from a nurse stating she could not help him “ or give him heroine” not acceptable.
It has been 3 weeks since he has placed a medical call for his tooth. I also told the head of security when I was at a visit. He has still not seen anyone for his tooth. If it is an absess then we all know how dangerous that can be. It took 4 months to be seen for his diabetes. Not to mention that he was forced to withdraw from methadone cold turkey. I made multiple complaints to Corecivc. Nothing has changed.

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