Prisons’ Refusal to Provide Adequate Opioid Treatment Is Cruel and Unlawful

Geoffrey Pesce tried everything to overcome his addiction to opioids: detox at least four times, Suboxone, Naltrexone.

In 2016, after overdosing three times in less than 48 hours, he was scared for his life and committed to recovery. That’s when his physician prescribed methadone, a prescription medication approved by the FDA for treatment of opioid use disorder.

For nearly two years, Geoffrey has invested in his recovery, rededicated himself to his young son, rebuilt his relationships with his parents, and found a job that he loves. While he also participates in counseling and therapy, he credits his recovery to his medication-assisted treatment (MAT).

Geoffrey generally relies on his parents to drive him to the clinic where he receives the treatment. But on July 19, his mother was unexpectedly unavailable to drive him, and in fear of a relapse, he drove himself. He was pulled over and charged with driving with a revoked or suspended license.

He currently faces imprisonment at the Middleton House of Correction in Massachusetts, where his medication will not be made available to him. In fact, the Essex County jail denies MAT to prisoners diagnosed with opioid use disorder, including those who arrive with a prescription for such medication and are already in sustained recovery as a result — like Geoffrey.

People with opioid use disorder who are denied their medication suffer painful withdrawal. It disrupts their treatment plan, leading to a sevenfold decrease in continued treatment after release. It increases the risk of relapse into active addiction: Over 82 percent of patients who leave methadone treatment relapse within a year. And, most alarming, patients are more likely to suffer from overdose and potential death as a consequence of forced withdrawal.

For Geoffrey, these aren’t just abstract numbers: His former roommate was sentenced to the Middleton House of Correction for six months. He overdosed and died within weeks of his release.

Geoffrey is a plaintiff in a lawsuit filed last week by the ACLU of Massachusetts. It challenges the policy and practice of denying MAT to incarcerated people who are diagnosed with opioid use disorder,  and asks the federal court to require correctional authorities to provide Geoffrey’s prescribed medication for continued treatment. We’re proud to join other ACLU affiliates in Maine and Washington, who have filed similar lawsuits, in the fight for ensuring adequate medical care for incarcerated people like Geoffrey.

Denying adequate medical care to incarcerated people violates the Eighth Amendment of the U.S. Constitution, which prohibits cruel and unusual punishment. Similarly, the practice violates the Americans with Disabilities Act, which prohibits the disparate treatment of people in substance abuse recovery programs.

Despite the overwhelming medical evidence supporting MAT as the standard care for opioid use disorder, it is not currently available to the vast majority of incarcerated patients suffering from opioid addiction in Massachusetts. The treatment is only available to people incarcerated at two detention facilities in Massachusetts. After the initial implementation of MAT at a jail in Franklin County, the county saw a 35 percent drop in opioid overdose deaths. Based in part on these results, the Massachusetts legislature recently passed legislation to create a pilot program at five county jails, where people who had a prescription before being arrested will continue to be provided their medications during their incarceration.

But that won’t help Geoffrey anytime soon: The Middleton House of Correction is not included in the pilot program, and the legislation doesn’t require implementation of the pilot program before September 2019.

In the midst of an opioid crisis that has claimed an increasing number of lives in Massachusetts, the Commonwealth should do everything it can to support people in their efforts to overcome addiction — not obstruct them.

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Dr. Timothy Leary

His having O.U.D. makes him a member of the J Class of people. Naturally we a supposed to feel sorry for him. If you can't do the time Geoffrey, don't do the crime. Give it a shrug, don't do the drug.

Anonymous

Wow, how incredibly ignorant and insensitive of you, "doctor."

Anonymous

Wow, I'm appalled to know that you were even able to obtain your Doctorate. You're an asshole, sir.

Anonymous

I am going to say thank you Dr. as far as the other that are berating him , maybe he is speaking up cause some of his patients are being denied medications that they need who suffer from Chronic Pain and the ACLU don’t seem to feel that we are being treated unfairly. Unless you were born with the addition you made a choice to do them some of us that didn’t have a choice and are suffering with diseases that have no cure are being cut off because of so many abusing drugs. I say thank you to this doctor.

Anonymous

Not surprised to hear a murdering piece of shit DR. say such things. All they care about is money. Self-righteous, god complex, indoctrinated moron. All of your kind make me sick and need to be thrown out with the swamp cleaning.

Anonymous

Unbelievable how ignorant you are

YOUR MISSING A ...

Without espousing to much of my contempt for all the addicts. I Profess these claims.
1) addicts do not have a disease. You do not get to “get clean” , or “withdrawal” from a DISEASE, when at some point you or others around you have decided that dealing with your BS is to much or your gonna end up dead. I have a disease. And it’s gonna kill me. It has ravaged my life. Stolen from me the person I was and had worked so hard to become. Stolen from my husband the wife he deserved. And stole from my children the type of mother I was before I started to deteriorate. I do NOT get to chose at ANY point that enough is enough or that I have caused to much pain to my family as well as my self to continue having my disease. I do not get to CHOSE to not die from my disease. That’s reality. Stop handeling these weak people with kid gloves. It’s disgusting to those of us who live with true diseases.
2) having had to rely on opioids as part of my actual DISEASE (go figure 14 years and not a junky) (yep the doc gave em to me) (yep I felt all warm and fuzzy inside for the first week or so)(nope didn’t lie to doc and say I needed more or higher doses when I didn’t) for 14 years now and I understand the misery of withdrawal (for people with real diseases and real pain, sometimes throughout the course of treatment the doctor decides to change opioids. When done by a trained doc they will have you slowly wean off of the current opioid before starting the new opioid so as to see any effects) (( WEANED OF FENTANYL IN 20 DAYS)(STOP FEEDING INTO ADDICTS SHIT and the “rehab” centers lies, as well as big pharma who has convinced the government and the public that swaping out an street opioid for a pharma opioid with no end of actual cessation of the opioid so that big pharma can collect on said Pharma opioid (methadone,suboxone,) all the while big insurance companies coffers overrun with gov tax dollars to pay for the “good” doctor prescribed pharma opioid to help you get off the other opioid that they never actually take you off of. Like WTF???!!!! )TELL THE ADDICTS EXACTLY WHAT THEY ARE))Even in my disgust for the what these people HAVE BROUGHT UPON THEMSELVES as well as those in society who keep this addiction disease lie alive in perpetuity. I cannot in any form or fashion purport that allowing these people or any person to go cold turkey, or at best, be given a Benzo for withdrawal effects, is or ever will be acceptable. This is And should be regaurded as absolute torture. I don’t care what kinda scum you are. That level of torture should be reserved for those in Hell.
3) In all your great ACLU wisdom you have either completely missed or intentionally ignored a giant part of this whole issue. You’ve put all you energy into researching and writing about inmates that are addicts and how unfair and inhumane they are beating treated in regaurds to their addictions and the hell/torture they go through having to withdrawal or come down in a prison system that won’t treat their condition adequately.
PLEASE,
PLEASE,
show me where in that article you once let your bleeding heart consider, acknowledge, and/or bring to light what fucking hell it is for people, usually very sick or chronically ill or dying , people have to go through if they happen to end up in the slammer? You know....The people the opioids were actually intended for. The people who have followed every doctors instruction, used one pain doc, one pharmacy, have submitted to and been forced to pay for continuous drug screenings at their pain clinics. As well as random pill counts and the continuous experience of condemnation by any new doctor who takes 1 look at our scripts list and decides right there we must be pill seeking . All this with out ever viewing the literal mile long medical case file and perfect script history presented to them by patients like me who just want fucking answers as to what is wrong. Why am I I’m so much pain, why am I dying. That’s all I want from the doctors. I don’t go there for or even ask for pills of any kind yet over and over I cannot her adequate treatment because I can’t get past the initial visit where I realize the doctor for no reason and having viewed none of my medical history decides I must just want drugs. Whose fault is that? Where should I lay the blame for that? Huh?
Those of us who live in agony because of our real diseases,now, because of ADDICTS, we literally BEG our doctors to not leave us in pain. We have seen our doctors break down in tears because they know us and are now forced to limit or even cease our medications all in the name of Saving some fucking addict. With my tax dollars paying for it to boot! Did you bother to even think of us?
Because let me fill you in sweet heart. a god damn addict only has to suffer the hell of withdrawal. Any true pain paitient caught in the penal system would not only go through withdrawal but then also be subjected to the unending unrelenting unforgiving miserable horrible excruciating make you wanna kill yourself pain for the entirety of their sentence.
No. You, like the rest of this god damn country, wanna put your energy into saving an addict. Not just your energy, but my tax dollars as well. I, along with so so so so so so so many am totally fucked because some assholes had no self control no self respect no discipline no honor no integrity no humanity and no soul. This speaks to the addicts as well as those who continue this ridiculous farce that it’s some genetic, physiological predisposition at fault for their rapid physical and mental dependence on opioids. That’s bullshit. Are addicts predominantly products of poverty? Yes

Is the percentage of comorbidity of mental disease/dysfunction exceptionally high among addicts? Yes

Did they CHOOSE to lie to their doctors either when the pain was gone or adequatly being Controlled to ask for more pills or higher doses? Yes they did
Do addicts CHOOSE to return to that fuzzy feeling during the time when they are not yet physically dependent, this causing an eventual physical dependence? Yes they do

Do addicts CHOOSE to continue to use and up their dosage to obtain their high while fully knowing all the consequences? Yes they do

Could all addicts get off their drug of choice by having discipline and ethic and take less and less each day until their physical dependence is literally nil and then CHOOSE to enter into the mental health system to deal with all the bulshit that made them so weak in the first place? Yes, they can.

I am tired of watching this country fight for and pay for addiction recovery.

I am tired of hearing the opioid crisis has claimed blah blah blah. Numbers that are in no comparison to deaths caused by
Alcohol
Gun violence
Cancer
Diabetes
Just to name a few
I am disgusted that this nation has allowed itself to be so concerned with saving these people. Yet the nation has yet to notice, acknowledge, or give a shit about the people who live in ungodly pain and who have NO CHOICE but to take opioids so that they can save what ever they can of the life they used to have because of a disease they did not cause, or contribute to. Nor do they have the god damn option of “rehabbing” themselves to save themselves from their pain and eventual death.
HELLO PEOPLE OF AMERICA
THEIR ARE PEOPLE THAT EXIST AMONG YOU WHO LEGITIMATELY HAVE TO RELY ON PAIN MEDS TO BE ABLE TO LIVE LIFE AND DO THE THINGS YOU TAKE FOR GRANTED WVERY SINGLE DAY.
FOR A TRUE PAIN PATIENT THEIR IS NO DIFFERENCE IN THE NECESSITY OF OPIODS( at least at this point) AS TREATMENT FOR THEIR PAIN TO ALLOW THEM TO BE VALUABLE AND BENIFICIAL MEMBERS OF SOCIETY OR THE NECESSITY OF INSULIN FOR A DIABETIC OR STATINS FOR HEART PAITIENT.

So please, take your bleeding heart and your PHD and expand your energy and knowledge on people who actually matter and have no choice whatsoever in the disease that will kill them.

Dr. Timothy Leary

How long have you been using amphetamines?

Anonymous

Your reply was fantastic! I hope you are fighting in the Chronic Pain Patient (CPP) community because your story needs to be heard!

Anonymous

I find this diatribe offensive and wildly inaccurate

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