In the first ruling of its kind, a federal judge has ordered the Essex County House of Correction in Middleton to provide methadone to Geoffrey Pesce while he is in jail. The ruling is novel, determining that withholding opioid treatment medication could violate federal laws and the Constitution.
U.S. District Judge Denise Casper issued a preliminary injunction in November indicating that preventing Pesce from receiving methadone is a violation of both the Americans with Disabilities Act and the Eighth Amendment, which prohibits the use of cruel and unusual punishment. While the ruling applies only to Pesce and the Essex facility, it may have far-reaching consequences.
Methadone and buprenorphine are often prescribed as treatment methods for opioid addiction. While both act on neural pathways similar to opioids, they work in a much safer manner than street drugs and do not result in a “high” if used as prescribed. But most jails in America do not provide methadone or buprenorphine to arrested individuals, even those with a prescription.
Jails are where people are most likely to experience acute withdrawals (as opposed to prison, where individuals eventually go after sentencing). This provides a unique opportunity to intervene. Furthermore, those held in jails are usually still awaiting trial, meaning that they should be presumed innocent until proven guilty. Yet correctional facilities continue to cite security concerns to justify keeping life-saving medications from incarcerated individuals.
With the appropriate safeguards in place, medication-assisted treatment can be safely administered in jails. With medications securely stored and administered, treatment can actually improve public safety by decreasing the black market for drugs behind bars. These benefits continue after release: individuals are less likely to get arrested again.
Critics of medication-assisted treatment argue that one addiction is being traded for another. This argument fails to think of methadone as a medical treatment. It’s important to recognize that addiction is a chronic medical condition and that even people in long-term recovery are not cured.
Pesce’s case is a good example of how effective methadone treatment can be. Drug addiction caused him to overdose multiple times, lose his job and custody of his child; because of methadone, Pesce holds down a job as a machinist and has not tested positive for drugs a single time since starting treatment in 2016.
Individuals who have been prescribed opioid treatments can suffer severely, and even die, when suddenly cut off. Methadone not only blocks the effect of commonly abused opioids, but also prevents withdrawal symptoms for people with opioid dependency. The painful symptoms of withdrawal are a key factor that perpetuates the cycle of addition. Abrupt discontinuation of methadone treatment will result in patients experiencing extensive withdrawal symptoms, increasing the risk of opioid relapse.
Individuals who discontinue methadone use are at increased risk of overdose if they experience a relapse. This is due to decreased tolerance to opioids. Over time the person usually needs more of the substance to experience the same high. Individuals who relapse often do not account for their decreased tolerance, which results in higher risk of overdose.
The increased risk of overdose is clearly demonstrated by studies that follow former inmates who underwent forced withdrawal while incarcerated. Within the first two weeks of their release, former inmates were 129 times more likely to die of an opioid overdose than the average citizen. Maintaining continuity of treatment during and after incarceration doesn’t just curb withdrawals; it saves lives. When given the opportunity to receive treatment, the vast majority of individuals continue through local clinics once released.
The ruling in Pesce’s case is a crucial and powerful first step toward more humane treatment of incarcerated individuals with substance use disorders. The negative impacts of a conviction follow a person long after they have served their time. Individuals whose struggles with addiction are controlled by medications should not face the additional punishment of withdrawal, relapse and potential overdose due to discontinuation of treatment while incarcerated.
Nila Bala is the associate director of criminal justice policy at the R Street Institute, a conservative and libertarian think tank in Washington, and a former Baltimore city public defender. Chelsea Boyd is a research associate in harm reduction at the R Street Institute.