Methadone and Buprenorphine During Incarceration

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I recently got this comment to my blog and I hope the writer won’t mind that I’m highlighting his comment. This comment represents one of my pet peeves: patients in recovery from opioid addiction who dose with methadone/buprenorphine are frequently denied their medication if incarcerated.

“Hello, i was recently convicted of an addiction related crime that happened over a year ago, since the indecent I’ve cleaned up my act, have been taking suboxone for over 12 months, 8mg, 3 times a day and now have to go to jail were I’m going to be denied my medication by jail officials/laws, I’ve been in jail before and i kno they do next to nothing for withdrawing opioid patients? From what i hear, it could take months for that type of dosage to get out of my system? Now being a former i/v heroin user of about 7 years, I’ve done a#on my body and feel my health isn’t exactly top notch, i am legitimately concerned about this withdrawal! Should there be sum kind of law protecting us patients? Aren’t these dangerous withdrawal symptoms? Thanks in advance for your response in this matter!”
I am so sick of hearing about patients on methadone or buprenorphine being denied their treatment while incarcerated! I’d love to see someone sue the excrement out of a jail or prison for denying this life-saving medical treatment.

Most counties jails in rural North Carolina won’t allow patients who are prescribed methadone or Suboxone for opioid addiction to take their medication while in jail. I hear (second-hand) that some jails allow chronic pain patients with opioid prescriptions to take their medication, though this may vary according to the county.

As a health care provider, of course I’m opposed to any refusal to treatment a patient while incarcerated. I think it’s a violation of the 8th Amendment about cruel and unusual punishment, but since I’m no legal scholar, I’ve searched the internet for more information about this situation. I found a great article co-authored by a doctor and a lawyer. They make the point that opioid addiction is a complex illness, and forced withdrawal causes severe physical and psychological suffering. Also, because opioid withdrawal makes people especially vulnerable, they may be coerced into giving testimony that incriminates themselves. They are less able to make decisions. (1)

Prisons are charged to provide as much care as is available to prisoners as general population, yet opioid addicts are denied access to medication-assisted treatments for addiction. These treatments are, as you probably know if you’re a regular reader of this blog, one of the most evidenced-based medical treatments in all of medicine.

Jails face legal implications for the prisoners under their control if adverse health consequences occur during withdrawal. A healthy young person usually won’t die from opioid withdrawal, but a medically fragile patient may die. Then the jail can be sued successfully for wrongful death, as happened in Orange County, Florida. But what a shame that it has to come to that to see any change in jail protocol.

A few years ago, I wrote to both the Tennessee and North Carolina chapters of the ACLU (American Civil Liberties Union), thinking if any legal organization would be willing to take up this issue, it may be them. One person with the NC chapter wrote back that in order to take up a case, they need a specific person with a specific case, and that person needs a local lawyer with whom they can work.

I other words, as a physician, I can’t get something stirred up. It has to be a person who is denied treatment with methadone or buprenorphine while in jail.

That’s what I’m hoping to do with my blog post. My readers know many people. If you are reading this and know someone facing incarceration who will be denied their usual medical treatment of methadone or buprenorphine while incarcerated, encourage them to get a lawyer, and ask that lawyer to ask for outside help.

Here’s the website for North Carolina: http://www.acluofnc.org/

As one might imagine, Tennessee’s chapter of the ACLU has many issues to keep them busy, so check it out at http://www.aclu-tn.org/ On their homepage, there’s an article about Tennessee’s contract with a corrections company that operates facilities in that state. It’s interesting reading, and may help us make sense of some of Tennessee’s horrible decisions around addiction issues (follow the money!). Also check out the TN ACLU’s article of protest against the recent law that makes using drugs during pregnancy a crime instead of a health issue.

I know that AATOD (American Association for the Treatment of Opioid Dependence) works with the Legal Action Center in New York, and they have a great website: http://www.lac.org You can read about their advocacy efforts nationwide, and check out their blog, which has advocacy information about this specific issue of medication-assisted treatment behind bars. I believe that the Legal Action Center works with local lawyers nationwide to serve as a resource. I don’t think the LAC actually takes on the cases of patients in states other than New York, but they also may be able to offer help and resources to other lawyers.

My patients tell me it’s difficult to find a local lawyer willing to take on the case of medication-assisted treatment behind bars. Often, such patients are seen as “bad” for having the disease of addiction. Some lawyers may not want to risk the working relationships they have with the judges in their area by advocating for an issue that the lawyer may not find compelling.
Additionally, it’s easy to intimidate many patients on MAT because they already feel shame and stigma. They have a legitimate fear of making their situation worse if they protest poor treatment by the criminal justice system.

I understand all of that, and I’d probably feel the same way. But what’s being done to patients on MAT – forced withdrawal from life-saving treatments of methadone/buprenorphine – isn’t right, and it’s an abomination to human rights. Let’s support these patients in every way possible. Get lawyers, ask them to advocate for you. If they won’t, contact some of the above resources and write back to me about what their response was.

If you are a friend or relative of a person in such a situation, make noise. Write politicians, call the jails, and call judges, particularly those that are elected. Tell jailers how appalled you are at the senseless suffering of patients denied their usual medical treatment.

Most importantly for this issue and others: register to vote. Find out your elected officials’ positions on the legal issues surrounding addiction, and vote accordingly. If you are an addict in recovery, vote. If you are a friend or family member of someone in recovery or in addiction, vote. Let politicians know you will vote against them if they fail to make good laws based on science.

As for me, I have a standard letter I’m willing to send to my patients’ lawyers and to the judges hearing their cases, advocating strongly for them to be allowed to continue their evidence-based treatment with methadone/buprenorphine.

And yes, I vote.

1.Bruce RD and Schleifer, RA, “Ethical and Human Rights Imperatives to Ensure Medication-Assisted Treatment for Opioid Dependence in Prisons and Pre-trial Detention, International Journal of Drug Policy, 2008, February; 19(1): 17-23.

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34 responses to this post.

  1. We’ve been able to ensure continuity of medication assisted treatment with methadone in a few TN counties on a case by case basis, but the vast majority of the time treatment is discontinued (illegally) when a patient is incarcerated in the States of TN, NC & GA. Like the NC Chapter of the ACLU has told you (and one of our biggest roadblocks in moving forward with advocacy on these issues), an “effected patient” who has legal standing to bring a lawsuit would first have to be willing to sue…and find an attorney. Then NAMA-R, AATOD, the Legal Action Center, ACLU, etc. can help “coach” and advise the attorney to make sure he/she is well versed in this area of the law. Just like most medical schools don’t cover MAT, most law schools don’t cover the ADA and other relevant laws in detail either. I would strongly encourage any patient in this situation to FIRST file a grievance with NAMA-R via http://www.methadone.org/grievance_report.html so we can advocate on their behalf. Having the grievance allows us to go to other organizations on the patients behalf – it’s sort of like a retainer for an attorney.

    The Legal Action Center (LAC) also has a great policy paper titled the “Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System” that can be viewed/downloaded here: https://docs.google.com/file/d/0B7bluL_LdE9dcEpjZWphelR4eUU/edit?usp=docslist_api

    Zac Talbott
    NAMA Recovery of Tennessee
    http://www.tnmethadone.org

    Reply

    • Posted by Benjamin Keith Phelps on May 13, 2014 at 6:34 pm

      Unfortunately, nobody’s in shape to be able to retain an attorney & do much of ANYTHING when they’ve been abruptly cut off from their medicine – particularly if they have nobody on the outside – like parents – willing to help them work on it. And then afterward, once out of withdrawals, what are you going to sue FOR? If you didn’t die, didn’t have a heart-attack, & made it through okay in general, most people just forget it & move on. Now I agree wholeheartedly that some people need to take this issue on – & I’ve wanted to myself!! But I just don’t have the money to hire an attorney on my own behalf, & then all I could sue for would be the pain & suffering I was put through. That would be more than enough, were I to get an attorney willing to work on contingency. But sadly, I doubt there are many (if any) attorneys willing to take a MAT case on contingency, given the likelihood (or unlikelihood) of actually winning it! Personally, I believe it’s cruel & unusual punishment, just like Dr Burson. Anybody who’s gone through withdrawals him or herself KNOWS it’s cruel & unusual punishment to put someone through it purposely. But that doesn’t make those who haven’t gone through it able to understand how cruel & utterly painful & horrific it is to go through &/or be put through withdrawal. I hear “flu” comparisons regularly. But the flu is an “I don’t feel good” or maybe an “I feel horrible” kind of illness. Withdrawal is an “I hurt so bad, I could scratch my own eyes out or saw my legs off to stop this RLS/akathisia” kind of illness. Those are 2 VERY different things!! I have almost broken my hand & arm from being in such pain that I finally punched a steel jail bunk-bed railing. I was out of my head & writhing around from the RLS/akathisia, & the pain just got to me to the point I couldn’t take it anymore. While it doesn’t make sense to cause yourself MORE pain at that point, the frustration builds until you do something stupid like that b/c you start at so much pain you can’t stand it, but the pain doesn’t stop. Then the pain keeps going til you feel like you might go crazy if it doesn’t stop soon, & the pain keeps going. Then it goes on until you feel like you could DO something crazy if it doesn’t stop, but it keeps going. And it goes on until you feel like you could hurt someone else if it doesn’t stop soon. But it keeps going. So then you start to think you could hurt somebody ELSE if it doesn’t stop soon. But it keeps going. And you twist your feet & your hands until you want to saw them off for relief, but you can’t stop twisting. So you hurt & you twist, & you hurt & you twist, & you vomit, & you hurt, & you twist, & you diarrhea, & you hurt & you twist, & you sit up straight, & you hurt & you twist, & you lie down, & you hurt & you twist, & you sit back up, & you hurt & you twist………………. This, in essence, is withdrawal… Day after day, week after week (from methadone). No sleep to relieve the pain & monotony, no food for the 1st week or slightly more, then you can’t eat enough & in jail, there’s nowhere NEAR enough food to satisfy this, even if you get canteen. You diarrhea until you are sore. If I try to force food down in the 1st week, I vomit; or when I am sleeping at night on about the 2nd or 3rd night in the jail, when the methadone is leaving my system to the point I’m at the edge of withdrawal starting to get bad, my stomach getting nauseous will make me vomit, start to choke, & wake myself up. After that, there’s no more sleep for about a month. My last time in jail, I’d been on MMT for long enough that it took almost 2 months to get back to where I wasn’t so weak I had to pull myself up a flight of stairs using the handrail b/c my legs couldn’t do it alone, & where I stopped writhing around at night & twisting my feet like a mad man. I’ve had the people in my block think that I was a crazy man b/c I would keep lying down & twisting my feet so bad that I’d finally get up & walk a lap or 2 around the block til I was too weak to walk anymore, lie back down & twist some more, & repeat this over & over until I’d finally get completely exhausted & my body would *slightly* settle down & I could rest, though I didn’t actually sleep.

      People just don’t understand or realize, even when they hear about withdrawal, how bad it actually is for a person on a high (or even low, really) dose of opioids – particularly a long-acting one like methadone. It’s genuinely horrible, even though methadone withdrawal IS less intense on a day-to-day basis than short-acting opioid withdrawal, which is more intense by the moment, but is over MUCH quicker. And I just don’t see why – if a doctor deliberately put me on methadone as treatment – a doctor shouldn’t taper me off methadone, rather than just abruptly cutting me off in 1 day!! I understand that many felons end up in prison, & hence, since it’s not yet offered there, they HAVE to taper felons off to get them ready for prison. However, I believe it should be offered in prison, too! It’s not just about “Well, they can’t get to any heroin, so they don’t need methadone”. MMT, to me & many others, is about feeling normal – like Prozac does for a depressed person. Sure, we don’t die if you taper us off it. But our quality of life goes down the toilet!! So why is it ANY less viable to give to a prisoner than Prozac is, or an anti-psychotic like Thorazine is for that purpose? And they do give opioids for pain in prison, though it’s MUCH more sparsely seen… As well as barbiturates & benzodiazepines for epilepsy (& migraines for the former)… So controlled substances ARE more of a pain for them to give out in prison & jail b/c of the extra paperwork required. But that’s NOT a sufficient excuse to do away with MMT, nor the adequate use of opioids for pain, as they’ve done to a big extent. I was in jail with a guy who was shot, & we were both in medical segregation for our conditions. He was being given a SINGLE 5mg Vicodin for his pain, & it was a pretty new injury! This was not with the option to get another 5mg if the pain was bad… It was 5mg, period. That’s being stingy with pain control, & it should be monitored by some outside agency & set straight when jail & prison docs don’t treat illnesses appropriately, in my opinion!

      Reply

      • Posted by dbc901028 on May 13, 2014 at 7:32 pm

        Nice description of methadone withdrawals.. that’s about how it is :o. Note that methadone is probably the worst opiod to withdraw from due to its full agonism and long half-life. Those attributes makes it great for stability during opiod maintenance, but it means your body is super-acclimated to opiods. With short acting opiods, or street use, at least your body experiences *some* periods without the drug, or with less of it. I would agree with Dr. Burson and everyone else that it is cruel and unusual punishment. BUT, like you, after seeing a bit of the system myself, I am not optimistic about the possibility of success. Like you mentioned, they are anti-pain relief in any form. Many feel that prison should be all about pain, the more the better. That’s wrong, but is the attitude you are confronting here.

      • Posted by Benjamin Keith Phelps on May 15, 2014 at 3:51 pm

        dbc901028 – That’s EXACTLY why they refuse to provide it in a nutshell – you said it best!!! People feel like you did something you shouldn’t have, so you deserve whatever pain & inconvenience you get, bottom line. That may be true when it comes to whether or not to provide cable TV & basketball courts, but they DO provide those things, often times! Why would medication be the thing that is viable to cut, but cable TV not so? I’m not saying they should do away with recreational things for prisoners here – they’d have nothing but fights to contend with if they gave them nothing to do all day. But I AM advocating for FULL medical treatment, comparable to what one would receive on the outside, when possible. I realize that they may not be able to provide the same level of cancer treatments one could buy with millions of dollars worth of insurance on the outside (or with cash of that abundance). But even then, if the family is willing to send the money in to pay for the treatments, there are times it can be arranged. Sure, there are challenges to storing methadone stock & dispensing it, but not really anything that they don’t already face when they dispense MS Contin, which I knew several people who took at 1 particular camp I was at in NC, & it was available at any camp. I understand more licenses are required, & there are greater requirements in the way of paperwork, but not so much as to make it more than they can handle. I’m quite sure the DEA is not going to hold them to the same standards as an OTP, when it comes to some things. But dispersible tablets would do away with the need for a pump system, computer, & software. They are easily available, even if they had to use 10 & 5mg tablets to achieve the dose (b/c of the 40mg tablet ban for any place but OTPs), dropped into a cup of juice, like my clinic used to do. The 40mg diskettes are the same size as 4 of the Methadose 10mg tabs, so it’s totally feasible to dose this way. So we’re talking about a very small number of bottles of tablets stored in a small floor safe that is bolted to the floor & only accessible by nurses &/or the doc(s). They already do this for their other controlled substances. A single counselor, I have ZERO doubt, could handle each patient at a particular camp. Or you could put all methadone patients at one particular camp. You break the rules of that camp or get shipped away for any reason, you lose your ability to be in MMT. Although I don’t like that so much b/c I could start a fight w/someone who doesn’t want to fight or cause trouble, but BOTH of us would be sent away for it. So the other person shouldn’t lose a treatment slot b/c of this type of thing. But heck, ANYTHING like this is better than NOTHING of the kind!! There is just NO REASON this is not doable. Not one that I can come up with, & I am quite familiar with clinic guidelines, regulations, & laws, having studied MMT/MAT for about 18 years now & being a certified methadone advocate by NAMA Recovery. I have attended the conferences they do every 18 months, & I am familiar with the state-by-state laws that govern them (though I don’t claim to have all of them memorized for each state…) If there is a single VALID reason this would be a problem, I have yet to come across it. What I HAVE come across are a lot of excuses for why it would inconvenience someone to do it. Paperwork, storage, logistics in general, blah blah blah. These are peoples’ LIVES & wellbeing we’re talking about here; not whether or not to allow them to throw a party with alcohol in prison. I relapsed less than 1 month out of prison (2 & 1/2 years in prison) – that never needed to nor should it have happened.

  2. Posted by dbc901028 on May 11, 2014 at 5:53 pm

    I totally get this situation. I’ve been in jail, when I was 18 (over 20 years ago), charged with sale of marijuana. That felony conviction has affected the remainder of my life. Fortunately, I am skilled in a high-demand profession, else I’d have had to try to explain that conviction to employers… though I can never vote, or visit many countries.

    Anyway, so I’ve seen what county jails are like. They are abysmal. Prisons are much better. County jails get away murder, quite literally. Many continually fail certification and are like dungeons from medieval times. So, to me, the overall conditions of our local jails is a more pressing issue than is bupe/methadone treatment. That said..

    I am very empathetic towards inmates going through forced and unnecessary withdrawals. Unfortunately, society at large has no will to make the lives of ‘criminals’ more comfortable. It’s certainly not an issue a politician will win an election with, especially since felons can’t vote in most states.

    Further, no state will want to pay the cost associated with these medications, no matter how minimal it may be… But if you can make a case that the state will save money through opiod dependence treatment, that is something the politicians will listen to. It’s all about money to them, as you have astutely pointed out.

    I think a reasonable compromise would be to allow short-term opioid dependence treatment with an aggressive tapering protocol. This would protect the states from liability over withdrawal related deaths and suffering, and give dependent prisoners some relief. Make sense to you?

    Reply

    • It would save jails money to provide treatment. But no, it doesn’t make sense to me to make a person taper off medication if they are doing well on it.

      Reply

      • Posted by dbc901028 on May 12, 2014 at 12:59 am

        No, it doesn’t make sense, but I offer it as a preferable option to full and immediate discontinuation. I honestly see the chore of trying to force counties to comply with the existing law and human rights as near impossible, again mentioning potentially more egregious violations of the 8th amendment. As a foot note, the US has the highest per-capita incarceration rate in the world by far, higher than the Soviet Union even has had, even during it’s prison camp era. (http://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate)

    • Posted by Benjamin Keith Phelps on May 13, 2014 at 6:00 pm

      dbc901028 – Felons actually CAN vote in most states, but it almost always requires that they either wait until after prison, or until after probation/parole is over before they get that right back. And even then, you have to RE-REGISTER or you won’t be able to vote. If you were registered prior to a felony conviction, you are NOT still registered once you get off probation/parole or out of prison! You MUST re-register – there’s no way around this currently. Here’s a website that gives a state-by-state rundown of felon voting rights (or lack thereof, in a few cases…):

      http://felonvoting.procon.org/view.resource.php?resourceID=000286

      Reply

  3. Posted by kevin on May 11, 2014 at 7:21 pm

    Question..If someone is in jail and they are suffering from withdrawl, do you mean something has to happen like a heart attack or the such to be able to do something. The sleepless nights restless arms and legs, palpatations, care that u need outside of a jail. For instance. When I was in Mat last time and I came off 200mg at 10 mg a day and told I would be fine. I wasn’t I had to lay in hot water to make my arms and legs to stop moving like rubber bands. I would lay on my stomach with my arms under me and still they would force there selves out. I had to go find lortabs to make it stop. I don’t believe someone comeing off that much can do it without anything or anyone. Going this all that is not enough to sue a jail for letting someone suffer with out medical treatment to make the symptoms stop. And any doctor that knew what they were doing would not send that person back. They would admit the patient

    Reply

    • I don’t know. That’s a legal question. I think intentionally inflicting suffering by withholding medical treatment should be as illegal as it is immoral. But that’s just me.

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  4. If the ACLU would take on this case, that would be great, but I do have some ideas about other attorneys that might possibly be interested, and if you would like to discuss this, please e-mail me at LBERGER@SFMSLAW.COM.

    Reply

  5. Reblogged this on Journeys with Zac.

    Reply

  6. Our organization is proud to provide methadone maintenance treatment in a correctional facility, just as a patient would receive in the community. We struggled to get our program approved through multiple agencies but now we have been providing the service for over 4 years and our outcomes have been objectively proven by a university study. Read more here:

    http://www.recoverynewmexico.com/treatment-in-jail.html

    Please feel free to contact, have a great day!

    Reply

    • Thank you for this great info. I checked out this website and your information shows the benefits of offering MAT to the incarcerated. I will be using your data in the future.

      Reply

  7. Posted by Diana Goodwin on May 13, 2014 at 7:36 am

    I have been engaged in a battle with the Federal Bureau of Prisons since last summer over their refusal to provide MAT to prisoners, including my son. I have involved Human Rights Watch and various members of Congress. I have not found any organization that is willing to provide legal help. It is a long and tedious process for a prisoner at the federal level to be able to initiate a lawsuit against the BOP. While It appears that there may be some upcoming changes to policy with regard to MAT in halfway houses at the federal level, the fact remains that my son and countless others do not have access to these medications, And the current health services director at the Bureau of Prisons, RADM Newton
    Kendig, does not view them as medically necessary. Anyone interested in learning more about my efforts or joining in with me should contact me through Twitter: @justicereformer

    Reply

    • Thanks for writing. I’m interested in what you have experienced. Which organizations have you talked with that can’t or won’t help?

      Reply

      • Posted by Diana Goodwin on May 13, 2014 at 1:24 pm

        Good morning! It’s mostly “can’t” vs. “won’t”. Won’ts: ACLU at National and WV state levels, a few University-associated legal clinics, several independent pro-bono legal clinics. Can’ts: DOJ Disability Rights (and several other federal gov. agencies), as they can only get involved in state-level issues (odd, isn’t it?), state-level federally funded disability rights organizations (same reason as DOJ Disability), Legal Action Clinic (can help only in NY state), and others. This is an unpopular/lesser known issue with low “curb” appeal, making the struggle for access even more difficult. I have made some good contacts and think I have been responsible for some “chatter” going on at the BOP and in the halls of Congress, but the bottom line is that my son continues to suffer. Untreated illness leads to relapse, which in prison leads to punishment. It’s government sanctioned torture.

  8. Posted by William Taylor, MD on May 13, 2014 at 7:22 pm

    I agree with your position, and I have talked to hundreds of previously incarcerated patients who uniformly describe a horrible experience of abrupt withdrawal.

    However, I have some sympathy for the other side of the argument, when you consider the practical challenges of storing, dispensing, verifying outside dosage, assuming liability, accounting for every dose, drug screening, etc. etc., in a correctional facility, when even the best run OTP’s find these challenges difficult. All you need is one inmate who fools the system, overdoses on methadone, and dies, and the correctional facility (and, of course, the taxpayer) will be facing enormous liability.

    Reply

    • Posted by kevin on May 14, 2014 at 12:24 pm

      Then why not have them sign a waver. If you continue on with your maintenance while you are locked up and break the rules you will lose the privelidge, just like at your own clinic. If you overdose from the medication they are not liable. If I’m honest on the outside I’m gonna be on the inside. And I’m obviously not gonna get extra inside so not gonna od. They usually put u by yourself when on medication.

      Reply

    • Posted by Benjamin Keith Phelps on May 15, 2014 at 5:03 am

      Dr Taylor, I don’t see where this is sufficient to justify the cruel & unusual punishment they put us through by abruptly cutting us off. They are able to handle dosing other patients on every other medication. Why is this a problem then? And drug screening?? They don’t drug screen anybody else in jail – usually b/c PRISON is where drugs get in illicitly, not jail. I suppose there’s the aspect of other inmates selling/giving away their meds, but okay, fine – do a drug test once monthly like a clinic does. If maintenance is not feasible, at the very LEAST a taper should be! There’s no excuse for putting a human being through what they put us through when we were INTENTIONALLY raised up to have a tolerance & dependence on methadone by a doctor in a legitimate treatment setting. The argument that someone shouldn’t have gotten into trouble doesn’t hold water, b/c many a person who is found not guilty goes through the justice system. I was ordered by a judge to be on MMT a few years ago, then I was released 3 days early by mistake from the jail to start. A few months later, my probation officer tells me I have to go do those days, & the jail doc refused to maintain me over the 3 days. That was NOT my fault in ANY way, shape, or form, & I had takehomes I could bring with me. They store every other controlled medicine there almost – why is storing my takehomes a problem? They are sealed, so tampering would be evident. This is just bad practicing of medicine no matter how you look at it.

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      • Posted by kevin on May 15, 2014 at 12:39 pm

        Very much true. I agree. This is a good blog. Got a lot of people talking about this. We have got to stand up for our rights

  9. Posted by William Taylor, MD on May 15, 2014 at 10:31 pm

    I did an eye-opening search using “opiate withdrawal death incarceration” as search terms. There were quite a few references to fatal outcomes when opiate dependent persons are incarcerated. Esophageal rupture, electrolyte imbalance, and suicide are some of the ways people die.

    One additional practical issue is that jail physicians are not licensed to prescribe or order methadone, and I’m sure very few of them are certified to prescribe suboxone.

    One special kind of inmate usually gets treated, though; the jails will usually find a way to treat pregnant inmates, because of the enormous risk to the fetus of uncontrolled withdrawal.

    Reply

    • Posted by kevin on May 16, 2014 at 12:54 am

      How does the esophagus rupture due to withdrawl?

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    • Thanks Dr. Taylor. You probably found those two cases in Orange County Florida, where the family sued the jail and won something like $3 million. Eventually that county did work out an arrangement with a local OTP to keep dosing patients already in MAT.

      That’s the thing – jails don’t have to be OTPs, only be willing to work with the patient’s own OTP. For example, once in a blue moon we have a patient in Wilkesboro for whom we can get approval to dose while in jail. Two nurses drive to the jail and give the dose, so the patient is still getting observed dosing by OTP personnel. Or, if the patient has take home doses, the jail can store and give the medication to the patient once daily. They do this for other controlled substances, at some jails. There’s so much variability, even between different counties. One county brought the person to the OTP every day to be dosed, which was very nice for the patient and the OTP, but I’m sure it took time from other law enforcement duties.
      In other words, there are ways to dose patients while in jail without the jail docs having to be licensed as OTPs. I’m sure we could find creative solutions if jails & OTPs worked together.

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  10. Posted by Carlos on May 27, 2014 at 11:03 pm

    I wonder if an American with Disabilities Act case can be made if one can find a creative and cleaver enough attorney willing to look further at this case. There are several comment made in on the ADA regulations. 1 The only time that an illegal user have right under the ADA is to receive medical and Substance use treatment. And 2 Suboxone and methadone meets criteria under the ADA as a person with a disability with enough substantial impairment.

    Reply

  11. Posted by Carlos on May 27, 2014 at 11:07 pm

    The case in Orlando the Methadone Authority was very much involved. I believe to be all over the state. When I was on methadone in the 90s I was in jail for over 6 month and the clinic was bringing the methadone to the jail.

    I also believe was available to patients that were on the Counties Methadone Program. About the only good thing they were doing as they were ignoring and frequently doing the reversed of what the State Methadone Treatment Guidelines were protocoling.

    Reply

  12. Posted by Carlos on May 27, 2014 at 11:16 pm

    I also believe that the State of Pennsylvania, has a program inside the prison system. They also arrange with methadone clinics upon the persons release from prison.

    Reply

    • If Pennsylvania has such a program, that’s great,but that would be a program for state prisons and not county prisons. As recently as a few years ago, a person that I represented was incarcerated in a county prison in Pennsylvania and was denied methadone treatment for the duration of her time in the prison. This withholding of treatment was not only cruel, because of the suffering which it caused during the time of incarceration, but it also caused her lasting harm, which extended long after the time of incarceration.

      Reply

  13. Posted by Mike on June 30, 2014 at 3:41 pm

    I’m a supervisor at a large jail. We are building a new jail now and I’m wanting to include a suboxone drug replacement therapy program along with aa and na. I have the powers that be convinced of the benefits of a program like this, not just honoring existing prescriptions but partnering with a local suboxone Dr to provide intervention and continuous care after release if such a thing is even possible. My problem is that I can’t find any jails that currently have programs like this. Rather than reinvent the wheel, does anyone know of a jail anywhere in the world that offers a program like this? I’ve looked at Rikers Island methadone program, but licensing for methadone seems more difficult than suboxone and with the affordable care act requiring medicare/ medicaid to cover DRT, it shouldn’t be prohibitively expensive. Any advice would be great.
    Thanks.

    Reply

  14. Posted by Rachel on July 29, 2014 at 5:02 am

    I am currently 9 weeks pregnant and am facing jail time for a misdemeanor larcony charge in Orange County NC. This çharge is my FIRST ever and was not a result of active addiction but starvation after my fiance was laid off AND the officer purchaced the $8 worth of food I tried to steal for me and gave me resources for help with food. The DA denied my request for a prayer for judgement and i guess want to make an example of me. I have been on suboxone for two years! I am terrified for my child (even tho this was not a planned pregnancy I am very much in love with this being inside me and cannot bear thinking about what withdrawl will do to him/her) If I wasnt pregnant, I dont think I would be this terrified but I probably should. I have a seizure disorder, hepatitis C, SVT (a heart condition), and I think there is a real possibility that withdrawl could kill me…add this innocent baby to the mix and I am scared my family will be planning two funerals if I dont get some help advocating for myself and my unborn child. I have made an appointment with my doc to discuss this but I am not sure how much help this is going to be. Any suggestions and advice would be helpful (and no we cannot afford a lawyer).

    Reply

    • I hope your doctor can help, but you really do need legal advice too. Can’t you get a court-appointed lawyer? Yes, opioid withdrawal can be harmful to the fetus, and increase the risk of miscarriage, so it’s essential the court gets the information that you will have to be dosed while in jail. In NC, I’ve had patients get transferred to Raleigh, where they can be dosed while incarcerated, but that was with methadone, not sure if that can be done with buprenorphine too.
      But you need legal help!!

      Reply

      • Posted by Benjamin Keith Phelps on July 31, 2014 at 5:14 pm

        Dru Burson, to be clear, in case anybody misunderstood – Raleigh ONLY doses those on methadone who were a) in a clinic already, & b) pregnant. If you are neither, you are but off abruptly, & half the time they forget to bring your clonidine (which does virtually NOTHING, I know, but every little thing helps), & other meds, such as Bentyl/dicyclomine for stomach & such. I find that anti-histamines intensify withdrawals, so no Benadryl or Vistaril for me, & that includes tri- or tetra-cyclic antidepressants, like Elavil/amitriptyline or Pamelor/nortriptyline, Sinequan/doxepin, imipramine, etc, as they are POTENT anti-histamines. This may not affect you that way, but trust me, if you find it the hard way that it does, you will regret the day you were born until the effects of that drug wears off!!!! It makes the leg movements (kicks) 10X worse, in my experience, & I had to pace, but was so weak, I could barely pace twice before having to lye back down on the bed. Then it was back to packing within 3 minutes or less. It was HELL for a few hours, & each time on each of these medicines. No, antihistamines are NOT the answer for me during sickness from opioids, & THAT INCLUDES PHENERGAN for nausea, as it is an anti-depressant, as well. You can TRY & this is from research currently being conducted or just wrapped up, doses of Zofran (anti-nausea medication) – it may not help, but it won’t hurt you for sure. And if it helps, hallelujah!! If not, keep searching. I hate to advocate for this, but one thing you can do to ease your withdrawal pain is to tell them you are a drinker, which means they’ll give you super-doses of benzos like Librium or Ativan (we’re talking 1mg Ativan or 15mg of Librium). Now I’m NOT a fan of lying, but when you are suffering & the doctors won’t do ANYTHING for you, you do what you have to do. It may only last 10-14 days, & that’s not going to cover the whole run of withdrawal, but it will make those first 10-14 days SO MUCH more tolerable! It’s a TOTAL shame to have to do this in jail to get help, but telling them you’re a benzo addict won’t get you tapered, & that’s dangerous. And even though we’re (most of us) not benzo addicts – like me – I know that a benzo gets rid of the WORST part of the w/drawals – the RLS/akathisia – but nothing else will (tried trazodone, SSRI’s, tri-cyclics, tetra-cyclics, anti-psychotics, & a range of other meds to help – none did. so I merely claim I can’t stop drinking, & voila, they put me on a low-dose benzo over 10-14 days, which helps me TREMENDOUSLY & even lets me sleep a tiny bit, where otherwise, no sleep whatsoever. Now Please understand, I don’t like lying, I don’t want to lie. But when nobody will put into place a procedure to help us comfortable withdrawal (if we have no methadone access or bupe access), then I don’t feel guilty for doing what it takes to be able to live until I can get either back into my maintenance program or tapered altogether. God bless you all, & good luck! And Dr Burson, I apologize for writing about lying in jail to get help, but stopping benzos abruptly can be dangerous & often is, as you know, & most, if not all jails have no policy for withdrawing benzo addicts, as I found out when I was hooked on Lunesta & they stopped me overnight. Thankfully, I had enough sense to be put on the Ativan taper for alcoholism (even though I HATE the stuff – that & marijuana), which got me through a dual detox – methadone 120mg/day & 21mg of Lunesta every 24 hours. Just the Lunesta alone was causing heart palpitations & vomiting like crazy upon abrupt cessation. So I’m glad I did what I did – it coule easily be the reason I’m alive today to be living a life of recovery now. That was in 2011, & I’ve not returned to Lunesta since except a 1-time slip up for a small number of tabs, which I got 7 at a time over a week’s period before getting a refill. That was my 1 relapse, & I have not done so since, & have no plans to return to it. I enjoy being drug free w/the help of methadone, & I enjoy paying $0/day for it in DC ESPECIALLY!!!! So I hope you are well – that is my life currently in a nutshell. You take care, & write me a brief message when you get a moment to do so.

        ONE LAST QUESTION: I asked this before, but never got an answer, which isn’t like you: if dopamine is a “pleasure chemical”, then why isn’t it a controlled substance? Why isn’t it addictive? It seems like injecting it or using it in ANY form would cause euphoria like crazy, rather than movement disorders. Do you know the answer to this, by chance? Any help is ALWAYS appreciated!!!! Thanks, Dr Burson, & have a splended future!!
        Sincerely,
        Benjamin “Keith” Phelps

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