Archive for the ‘Law Enforcement Behaving Badly’ Category

Inmate Dies From Withdrawal, FBI will investigate


An interesting article from this week’s issue of Alcoholism & Drug Abuse Weekly caught my eye today. On page 4 is the article, “Video of jail drug-withdrawal death leads to FBI inquiry.” This seized my attention, since I view the awful treatment of U.S. prisoners as one of our nation’s biggest moral failings. I get particularly agitated when patients enrolled in medication-assisted treatment for addiction are denied access to medical care.

This story is heart-wrenching.

In June of 2014, David Stojcevski , 32 years old, was jailed in the Macomb County, Michigan, jail for thirty days for failure to pay a traffic ticket. He was denied access to his usual medications; news sources said he was being prescribed methadone, Klonopin, and Xanax for the treatment of addiction. No mention was made of whether he was a patient of an opioid treatment program.

David died seventeen days into his thirty day sentence. His autopsy listed the cause of death as “Acute withdrawal from chronic benzodiazepine, methadone, and opiate medication,” and also mentioned seizures and dehydration as contributing factors.

A jail nurse, noting his medical condition upon intake to the jail, recommended he be sent to a medical detox unit, but her recommendations were not heeded. Instead, when Mr. Stojcevski began behaving in unusual ways, he was sent to a mental health cell, where he was monitored with video around the clock. He was supposed to have personnel checking on him every fifteen minutes. Apparently his withdrawal symptoms were so severe he declined meals and lost 50 pounds within these eleven days. He had what appear to be seizures as he lay on the jail floor dying.

Understandably, David’s family was livid. In order to illustrate the jail’s indifference to their son’s suffering, they posted all 240 hours of the video monitoring on the internet, where it went viral. David’s family is seeking to change the way prisoners on medications are treated, to avoid senseless deaths like David’s. They have also filed a wrongful death lawsuit against the county and against Correct Care Solutions, the company which was supposed to have provided medical care to prisoners in the county jail.

I have often heard my patients describe the callous indifference jailers have toward them as they withdrawal from legally prescribed medication, but it’s quite another thing to actually watch this man die slowly. I only saw a few clips from the local news program above, and was horrified. It does not take any medical knowledge to see how this man was suffering. He became thinner, wasn’t eating, and didn’t get off the jail floor for the last two days of his life. At the very end, he has some agonal respirations, what looks to me like seizure activity, and then becomes still.

Then jail personnel crowd into his cell.

Too little, too late. He’s already dead and can’t be revived.

Some of the frames were televised on the area’s local news segment and can be seen here:
Be warned this segment is not for the faint of heart.

This man died from a treatable condition, opioid and benzodiazepine withdrawal.

An addiction expert interviewed by the area’s local television statement called the treatment of this man “unconscionable.”

I could quibble about the appropriateness of prescribing two benzodiazepines to a person with addiction in the first place, but since that’s not the point of this blog post, that’s all I’ll say about that.

Just yesterday, local TV news said the ACLU had filed a request for a formal Justice Department investigation of the Macomb County jail, saying prisoners are having their civil rights violated by the actions at the jail. The ACLU has also asked for an investigation into the judge’s decision to imprison David after he was unable to pay his traffic ticket, creating what was in essence a “debtor’s prison.”

A representative of the ACLU said anyone watching the video could deduce there was “Something systemically wrong at the Macomb County Jail.”

Recently, the Justice Department in Washington, D.C. contacted the FBI, asking them to investigate this case for evidence of criminal behavior on the part of Macomb County jail staff.

Macomb County officials steadfastly maintain they did nothing wrong, have nothing to hide, and welcome investigations into David Stojcevski’s death.

What I saw on this video clip appears criminal to me. The neglect, the reckless disregard for the wellbeing of another human is a far more serious crime than David’s traffic ticket. Every person who worked in that jail who turned a blind eye to the dying man belongs on the other side of the bars.

I am grateful to David’s family for their decision to post this painful video. That had to be a hard decision, but David’s graphic suffering causes more impact than written descriptions. I wonder if the ACLU, Justice Department, and FBI would have gotten involved had his family not publicized David’s gradual death, and had it not gone viral.

This behavior on the part of law enforcement is stupid, inhumane, and egregious. Do these law enforcement personnel have no shame, no basic human decency? Are we in a third world country where prisoners have no rights?

I will follow this story and give updates when possible.

I’d love to see the FBI investigate, and I hope criminal charges are filed. I hope the family sues and wins millions of dollars. I hope something can finally change in county jails across the nation, so that people who are incarcerated are no longer denied medical care.

Healthcare Misadventures


There’s a whole lot of stupid going on right now.

For some reason, I’ve been encountering healthcare “fails” this week, all relating to the treatment of opioid addiction. That’s a shame, because otherwise it’s been a really good week. But this stuff cannot go unreported. I’m changing some of the minor circumstances of each example, in order to preserve patient confidentiality, so if you think you know who I’m talking about, you don’t.

1. A patient I admitted recently into treatment had been doing well on methadone at another opioid treatment program. He needed a minor surgical procedure, and his surgeon refused to operate on him unless/until he got off methadone. This patient was told being on methadone could “complicate” the surgery. The patient tapered off his dose, had the surgery, and was prescribed Dilaudid tablets for post-op pain. Predictably, the patient relapsed and started injecting the medication.

Thankfully this patient didn’t die during the relapse. He came to our treatment program, and was admitted back into a treatment which had worked for him for over three years.

He blames himself for the relapse, and feels like he failed. I blame the surgeon, who apparently has little knowledge about the disease of addiction. The way I see it, this surgeon could not have done a more efficient job of causing this patient to relapse.

2. One of our patients was pulled over for a traffic violation by a county sheriff. He had a naloxone kit in his car. The deputy confiscated it because it was not prescribed for the patient.

I know law enforcement personnel don’t make the laws, but shouldn’t they have at least some rudimentary knowledge about what it illegal and what isn’t?

Two years ago, the Good Samaritan Bill was passed to allow, among other things, access to naloxone without a prescription. It’s common to see stories about naloxone on the television news, in newspapers, and on the internet.

We have Project Lazarus and the Harm Reduction Coalition spending time, energy, and money to make sure overdose prevention kits containing naloxone are available to every citizen who may come into contact with a person suffering from an overdose.

And right behind them, this sheriff’s deputy confiscates them.

I don’t need to say more. That speaks for itself.

3. CVS is trying to ruin my life.

I’ve had a few patients say that their CVS pharmacy has been giving them a hard time about filling buprenorphine prescriptions. Patients get a little nervous, understandably, about running out of medication early, because of the physical suffering this would bring. Many patients like to call their pharmacies in advance, just to make sure their medication is in stock.

Several patients over the last three weeks have told me they get scolded by the pharmacists for doing this, as if the patient is scheming to get an early prescription. Yet if patients wait until the day they are due, the pharmacy often says they are out of the medication and it must be ordered, which will take a day or two. I’ve heard this from eight or ten patients over the last two weeks, and all of them go to a CVS pharmacy.

A few months ago, one of my patients called, asking for help with her pharmacist. This patient worked out of town on some weeks, and she and wanted to pick up the monthly prescription on a Monday morning. The pharmacist refused, saying she wasn’t due to pick it up until Monday evening.

Huh? This sounded weird even for CVS, so I called. Sure enough, this pharmacist told me that she could not release the new prescription even with a doctor’s order until Monday evening. I told the pharmacist that this patient was doing very well and had been stable for over a year, but I was talking to a brick wall.

We solved this problem. I canceled the prescription at CVS and called a new one in to another pharmacy, where my patient was able to pick it up on her way to work out of town.

Last week, after I wrote a prescription for a buprenorphine brand, the pharmacist called my office and spoke to Daniel, my Health Services Manager. The pharmacist said it was “new state law” that doctors had to write on the prescription what the diagnosis was and whether it was for pain or addiction.

Daniel gave me the message between patients, and he saw me sigh deeply and roll my eyes. He said, “I’ll handle it. The “X” number you write on the prescription is only used for addiction, right? So there’s no need to write anything else.”

Yes, he was right. He has no pharmacy experience and has worked part time in my office for about three months, but he knew that much. So I kept seeing patients and he called the CVS pharmacist back.

Apparently she was insistent, and claimed it was a brand new state law. She didn’t know Daniel has a great deal of intellectual curiosity. After he got off the phone, he scoured the internet, determined to find out who was right.

The pharmacist was wrong. No such state law exists. Perhaps it is a new CVS law, but it’s not a state law. Because, as intended, an “X” DEA number is used only when treating patients for addiction.

Daniel wanted to fax the pharmacist a copy of the pertinent section of North Carolina law for pharmacies, but I asked him not to, as it would be fruitless.

“Oh,” he said, “She’s fact-resistant.”

I love that phrase. I’ve started using it.

May we never be fact-resistant.

A Letter to Law Enforcement About Medication-assisted Treatments


Dear Officer Zealous:
First of all, thank you for patrolling our streets and highways and your efforts to keep them safe. I know you have a hard job and I deeply appreciate your willingness to take on this responsibility.

However, please stop arresting my patients for whom I’ve prescribed methadone and buprenorphine (better known under the brand names Suboxone, Subutex, or Zubsolv). You mistakenly think all people taking these medications have no right to be driving, and you are wrong. I’m writing this letter to give you better information that you can use to do your job better.

Our nation is in the middle of a crisis. Opioid addiction is an epidemic, and too often its sufferers die of overdoses. Medication-assisted treatment with methadone and buprenorphine works very well to prevent overdose deaths, and it’s been proven to help patients have a better quality of life in recovery.

I doubt you’ve been provided any information about medication-assisted treatment, so I want to help you learn some facts. Methadone has been around for fifty years and has a proven track record. It’s been studied more than perhaps any other medication, and we know it does a great job of treating opioid addiction. Buprenorphine has only been available in the U.S. for about 13 years, but has been used in Europe for decades.

With both methadone and buprenorphine, the proper dose of medication should make the patients feel normal. Patients should not feel intoxicated or high, and should not feel withdrawal symptoms. Methadone and buprenorphine are both very long-acting opioids, and they both give the opioid addicts a fairly steady level of opioid, compared to short-acting opioids usually used for intoxication. Therefore, using methadone to treat opioid addiction is not “like giving whiskey to an alcoholic,” as has incorrectly been asserted. The valid difference lies in the unique pharmacology of methadone. Opioid addicts can lead normal lives on this medication, when it is properly dosed.

In addition, both of these medications block other opioids at the opioid receptor. When a patient is on an adequate dose, she won’t feel euphoria from another opioid. Both methadone and buprenorphine deter use of other opioids for the purpose of getting high.

Treatment of opioid addiction with methadone and buprenorphine is endorsed by the CSAT (Center for Substance Abuse Treatment) branch of SAMHSA, by the U.S.’s Institute of Medicine, by ASAM (American Society of Addiction Medicine), by AAAP (American Association of Addiction Psychiatry), and by NIDA (National Institute of Drug Addiction. In study after study, methadone has been shown to reduce the risk of overdose death, reduce days spent in criminal activities, reduce transmission rates of HIV, reduce the use of illicit opioids, reduce the use of other illicit drugs, produce higher rates of employment, reduce commercial sex work, and reduce needle sharing. Medication-assisted therapy is also high cost effective.

Indeed, the current debate of government officials at the highest levels has been how best to expand medication-assisted treatment with methadone and buprenorphine, not to make it less available. So please don’t do anything which may discourage opioid addicts from receiving life-saving treatment.

Over the years, many studies have been done on methadone and buprenorphine to see if patients are able to drive safely on either of them. In study after study, data show patients on stable doses of both medications can safely drive cars, operate heavy equipment, and perform complex tasks. Please see the list of references at the bottom of this letter if you wish to investigate for yourself.

I’m not saying, however, that patients on methadone or buprenorphine can’t become impaired. Impairment can occur if patients are given too high a dose of methadone or buprenorphine, which most often occurs during the first two weeks of treatment. For that reason, patients are warned not to drive if they ever feel sedated or drowsy.

Patients on medication-assisted treatment can also become impaired if they mix other drugs or medications with their methadone or buprenorphine. In fact, benzodiazepines (like Xanax, Valium, Klonopin) and alcohol act synergistically with maintenance opioids. They can cause impairment with smaller amounts of alcohol or benzos than expected. And of course, patients can still become impaired with other drugs, such as marijuana.

As you probably know, a urine drug screen isn’t adequate to detect impairment. The urine screen only tells you if the person has taken a given drug or medication over the last few days to weeks. Drugs are detectable in the urine long after the impairing effect wears off, so you must demonstrate the presence of drugs with a blood test at the time of the questioned impairment.

My family and I drive these roads too, and I don’t want impaired drivers on our highways any more than anyone else. I just think you have mistakenly targeted patients on medication-assisted treatment for the disease of opioid addiction.

I know you have formed bad opinions about methadone and buprenorphine patients from seeing both drugs misused on the street. I hate that, because you probably rarely get to see more typical patients on medication-assisted treatments.

The vast majority of my patients have jobs, families, and responsibilities that they meet, despite having this potentially fatal illness of opioid addiction. If you are fortunate enough to encounter one of my patients on a random traffic stop, please don’t give them a hard time. Please congratulate them on having the courage to find recovery from addiction, and tell them to do what works for them. In some patients, that’s medication.

Thanks for reading this long letter and thanks for all you do in the name of keeping our roads safe. If you want to know more about how we treat opioid addiction at our facility, please call our program manager at xxx-xxx-xxxx and we would be happy to provide you with an after- hours tour and lots of information.

Jana Burson M.D.
Member of the American Society of Addition Medicine
Board certified in Internal Medicine
Certified by the American Board of Addiction Medicine

P.S. And please don’t attempt to intimidate patients from coming to get help for this fatal illness of opioid addiction by parking your squad car just outside our facility’s entrance. Some of these patients may have old warrants, but by stalking them where they come for help, you discourage people who want to escape addiction and want to better their lives. If you do park near us, you should expect a staff member to approach you with a smile, a cup of coffee, and a pile of information about opioid addiction and its treatment.


Methadone and Driving Article Abstracts
Brief Literature Review
Institute for Metropolitan Affairs
Roosevelt University 2/14/08

When a comparison was made within specific age groups, it was learned that the accident and conviction rates were about the same for methadone maintenance clients as for a sample of New York City male drivers within the same period. The findings from other related studies discussed in this booklet are consistent with the results in this study.

2. The effects of the opioid pharmacotherapies methadone, LAAM and buprenorphine, alone and in combination with alcohol, on simulated driving.
Lenné, M., Dietze, P., Rumbold, G., Redman, J., & Triggs, T. (2003, December). Drug & Alcohol Dependence, 72(3), 271.
These findings suggest that typical community standards around driving safety should be applied to clients stabilized in methadone, LAAM and buprenorphine treatment.

3. Maintenance Therapy with Synthetic Opioids and Driving Aptitude.
Schindler, S., Ortner, R., Peternell, A., Eder, H., Opgenoorth, E., & Fischer, G. (2004). Maintenance Therapy with Synthetic Opioids and Driving Aptitude. European Addiction Research, 10(2), 80-87
Conclusion: The synthetic opioid-maintained subjects investigated in the current study did not differ significantly in comparison to healthy controls in the majority.

4. Methadone-substitution and driving ability
Forensic Science International, Volume 62, Issues 1-2, November 1993, Pages 63-66
H. Rössler, H. J. Battista, F. Deisenhammer, V. Günther, P. Pohl, L. Prokop and Y. Riemer
The formal assertion that addiction equals driving-inability, which is largely practiced at present, is inadmissible and therefore harmful to the therapeutic efforts for rehabilitation.

5. Methadone substitution and ability to drive. Results of an experimental study.
Dittert, S., Naber, D., & Soyka, M. (1999, May).
It is concluded that methadone substitution did not implicate driving inability.

6. Functional potential of the methadone-maintenance person.
Gordon, N., & Appel, P. (1995, January). Functional potential of the methadone-maintenance person. Alcohol, Drugs & Driving, 11(1), 31-37.
Surveys on employability and driving behavior of MTSs revealed no significant differences when compared to normal population. It is concluded that MM at appropriate dosage levels, as part of treatment for heroin addiction, has no adverse effects on an individual’s ability to function.

Opioid Addicts in Indiana Contract HIV

aaaaaaaaaaaaindianaThe New York Times ran an article 5/5/15 about a small town in rural Indiana that is facing a relative epidemic of new cases of HIV.

Austin, Indiana, a town of only 4200, has more than 140 people just diagnosed with HIV. The town is struggling to understand what to do about this epidemic, since the area has had a low HIV rate in the past.

The new cases of HIV were intravenous opioid addicts, and Opana was specifically mentioned by the opioid addicts in the article.

As in many small towns, needle exchange has been met with resistance from citizens who feel giving free needles to addicts only serves to encourage them to use more drugs.

Fortunately, the Indiana governor has authorized a needle exchange program for the area where addicts were sometimes using the same needle as many as three hundred times. Unfortunately, the needle exchange is not being run according to best practices. People must sign up for the service. Obviously, many opioid addicts who could benefit from free new needles are hesitant to register with anyone, due to the shame and stigma associated with addiction in this country.

To add to the difficulty, local police still arrest any addict found with needles, unless they are enrolled with the needle exchange. In other words, if one addict signs up for needle exchange and distributes these new needles to other drug users, those users could still get arrested if the police find their needles. Police say they are doing this to force addicts to register with the needle exchange.

We already know, from decades of studies, that actions like these by the police erode trust in the whole needle exchange program. Studies show needle exchange works best when people aren’t asked to register, and are allowed to procure free needles for other people who won’t come to a needle exchange. These type programs are very effective at halting the spread of HIV

The article only tangentially mentions treatment; it says some intravenous drug users have gone to a residential treatment center about 30 miles away, and others remain on a waiting list.

Sadly, no mention is made of medication-assisted treatment of opioid addiction with buprenorphine and methadone.

I did my own research: residents of Austin can drive to an opioid addiction treatment center less than a half hour away, in Charlestown, Indiana Also, there are at least two OTPs in Louisville,, only a few minutes farther, in Kentucky.

I hope someone is telling all the opioid addicts about this option. We know that after an opioid-addicted person enters medication-assisted treatment, the risk of contracting HIV drops at least three-fold. Thankfully HIV can now be treated, and is more like a chronic disease than the death sentence it was twenty-five years ago, but wouldn’t it be better to prevent HIV in the first place?

I fear Austin, Indiana is a harbinger of things to come in other small towns in our nation. Let’s stop with the politics, and get patients into medication-assisted treatment. Let’s do unrestricted needle exchange, and let’s hand out naloxone kits!

Criminally Pregnant In Tennessee, Part II

pregnant caucasian woman portrait attached with handcuffs isolated studio on white background

Today my guest blogger Dr. Fedup weighs in on my last entry, “Criminally Pregnant,” with his own unique point of view. He gives counterpoints to my arguments, as he feels Tennessee’s law is a good idea. I’ll let him explain his reasoning. His political leanings are somewhat right of center, as you will read.

“I applaud Tennessee’s new law, which makes it a crime to expose a pre-born baby (I don’t believe in using that word fetus, since life begins at conception) to drugs. Too many babies are born with neonatal abstinence syndrome, so obviously Tennessee has grown too soft on crime for this to be happening.

“Bill number 1391, already passed by the state’s legislature, needs only the governor’s signature to become law. In short, this bill says a mother can be prosecuted for “an assaultive offense or homicide if she illegally takes a narcotic drug while pregnant and the child is born addicted, is harmed, or dies because of the drug.”

“Their governor, Bill Haslam, goofed last year when he passed that Safe Harbor Law, which eliminated criminal charges for pregnant women who went into treatment. This new law corrects and cancels that law. Some people have said that’s inconsistent, and not enough time passed since the Safe Harbor Law to see if it was going to work or not.

“I say it’s OK to be inconsistent so long as you are putting people in jail.

“There’s nothing in the new bill to prevent pregnant, opioid addicted women who are in methadone or buprenorphine programs from being prosecuted as well, though bill 1391 does say, “Illegally take a narcotic drug while pregnant.” Women who enter such treatments have already taken illegal narcotics while pregnant, or they wouldn’t need treatment.

“My only problem with the new bill, SB 1391, is that it doesn’t go far enough. We should put the drug addict babies in jail, too.

“Think about it. You know those little suckers enjoyed the drugs they were getting through the placenta, and they need to be punished for that. They’re born addicts. Start punishing them right out of the womb. That way, the state can teach them right from wrong as they grow up, right there in the prison system, like we do with all other inmates in Tennessee jails.

“Some people criticize my idea. Some people say we already put too many people in jail. But I say if U.S. history teaches us anything, it’s that taxpayers are always happy to spend more money on jails.

“We must be willing to incarcerate more people, because U.S. citizens are more evil and criminal than people in other parts of the world. They must be, because we put more people in jail per capita than anywhere else. Circular logic? I don’t care, as long as it puts bad people in jail.

“It was a happy day when the U.S. could finally brag that we incarcerate more people per capita, than even Russia or Rwanda. We’re Number One! We put 716 people out of 100,000 into jails or prisons, and Russia only puts 484 out of 100,000 in prisons. We’re beating them almost two to one! [1]

“Lots of bleeding heart liberals will complain about how Tennessee jails aren’t set up for infants. I say we can fix that. After all, aren’t play pens just jail cells, only prettier? These addict babies don’t deserve anything too pretty, and they’ll get used to the bars soon enough.

“No measure is too severe if it will fix the drug problem. My critics point to all the information collected since the 1950’s which indicates incarcerating addicts does nothing to help addiction rates. But I’m telling you that this new send-an-addict-baby-to-jail program will work.

“While we are on the topic of evil pregnant women who harm their babies, let’s discuss nicotine addiction. There’s more medical evidence to show tobacco smoking harms babies than there is to show cocaine harms babies. Let’s put all those mothers who smoke into jail, too, since they are intentionally harming their pre-borns.

“Then let’s take this train of thought to its logical conclusion. In the latest issue of the Journal of the American Medical Association, there was a great article about the harm maternal obesity does to the fetus. This article reviewed all of the studies of how obesity affects fetal death and infant death. The conclusion was, “Even modest increases in maternal BMI were associated with increased risk of fetal death, stillbirth, and neonatal, perinatal, and infant death.” [2]

“Sounds to me like it’s time to build jails for the fatties, too. Because the state of Tennessee believes that jail time corrects bad behavior.

2. Aune, et al, “Maternal Body Mass Index and the Risk of Fetal Death, Stillbirth, and Infant Death: a Systematic Review and Meta-analysis,” JAMA, 2014; 311(15):1536-1546.

Smuggling Suboxone

I was intrigued by an article I saw on my internet homepage. It was titled: “When Children’s Scribbles Hide a Prison Drug”

 This article describes unique ways Suboxone is being smuggled into jails. Law enforcement officials associated with both state and county jails from Maine and Massachusetts were interviewed. They say prisoners and their accomplices make Suboxone into a paste and smear it over the surfaces of papers sent to prisoners from their families. The article mentions the paste being spread over children’s coloring book pages, and under stamps. Suboxone films have been placed behind stamps or in envelope seams. Correctional officers now have to inspect material coming in the mail to prisoners much more closely.

 I had several thoughts. First, yet again, I’m struck by the creativity and cleverness of addicts. If only they could channel this energy in the right direction, amazingly good things could come to them, instead of the continued hardships brought by addiction.

 Then I felt sad that such actions described in the article would taint the reputation of a medication that has the potential to save lives, when used appropriately. Such illicit use of Suboxone gives ammunition to those who would prefer that office-based treatment with Suboxone didn’t exist.

 Then I wondered, how many of these prisoners have a legitimate prescription for Suboxone, but are denied their medication by prison officials? How many are legitimate patients of methadone clinics, also denied their medication while imprisoned, who know that Suboxone will alleviate some of the opioid withdrawal they are feeling? How many of these people are addicted to opioids, not in any kind of treatment, but who know Suboxone will treat their withdrawals?

At least one study supports the idea that many people use Suboxone illicitly not to get high, but to prevent withdrawal. Dr. Schuman-Olivier studied 78 opioid addicts entering treatment. Nearly half said they had used Suboxone illicitly prior to entering treatment. Of these people, 90% said they used to prevent withdrawal symptoms. These addicts also said they used Suboxone illicitly to treat pain and to ease depression.

Many law enforcement personnel and members of the legal community have strong biases against medication-assisted treatments. They don’t understand that addiction is a disease, and that methadone and buprenorphine are legitimate, evidence-based treatments. They have difficulty letting go of their idea that addiction is a choice that deserves blame, and have a punitive stance towards addicts. They have low opinions of addicts who are using drugs, but often have no better opinion of a recovering addict who has sought treatment and is doing well on replacement medications, like methadone or buprenorphine.

 But no matter what law enforcement personnel think they know, when they deny prescribed, life-saving medications, I believe they’re practicing medicine without a license.

The article mentions one woman who, with the aid of the Maine Civil Liberties Union, sued because her Suboxone treatment had not been continued while she was in jailed for a traffic violation. She settled out of court, but her lawyer made the excellent point that if inmates are denied their medications, they will try unlawful means to get it.

Other patients and their families have brought successful lawsuits against the jail facilities. In at least two cases, in the same Orange County, Florida jail, patient/prisoners were allowed to go through withdrawal for so long that they died. The estate of one person won a three million dollar judgment against the county. (1, 2)

I’m glad to see these lawsuits. I’ve heard appalling stories from many methadone patients, who were denied their medication while incarcerated. I’ve heard tales of jailers taunting these prisoners, when they became sick. There is no defense for such cruelty.

Orange County now works with local methadone clinics. If a prisoner is a current patient of a clinic, his clinic will send a week’s worth of medication in a locked box via courier. Nurses at the jail have the key to the box, and administer each day’s dose. The jail doctor consults with the medical director at the methadone clinic. Prisoners still have to pay out of pocket to get the medication, so the only cost to the jail is the time required for personnel to administer the medication. It’s certainly much cheaper than paying three million to the estate of a dead prisoner, not to mention much more humane.

I wish the county jails around the methadone clinic where I work would approach the problem of opioid addiction and treatment in a collaborative way. Sadly, only seven state prison systems offer medication-assisted treatment with methadone or buprenorphine.

Rikers Island, in New York City, gives us another example of how such a system could work. There, opioid-addicted prisoners charged with misdemeanors or low grade felonies can be enrolled in a program known as KEEP (Key Extended Entry Program). This program treats opioid addicts with methadone and counseling. Upon release from Rikers Island, these patients are referred to methadone treatment centers in the community. Seventy-six percent have followed through with their treatment, post-release. The results of this program show significant reduction in reincarceration and significant reduction in criminal activity. (3)

Drug courts trying to save money would be well-advised to look at the Rikers Island program. Studies have shown a cost savings of at least four dollars for every one dollar spent on methadone treatment. This money is saved because methadone patients require fewer days of hospitalization and other healthcare costs, and also because of reduction in criminal activity and incarceration costs. (3, 4)

I know from comments written to this blog that there are many more people abusing Suboxone than I previously imagined. For sure, some of the prisoners getting smuggled Suboxone are misusing it. But I don’t think the majority are using for anything other than prevention of withdrawal, since they are usually not offered any other effective treatment for this medical condition.

  1. “Outrageous: the death of Susan Bennett raises serious questions about the competence and quality of the jail’s nursing staff” Orlando Sentinel, editorial, March 27, 1998.
  2. Doris Bloodsworth, “Inmate begged for methadone” Orlando Sentinel July 12, 2001.
  3. Par`rino, Mark, “Methadone Treatment in Jail,” American Jails, Vol: 14, 2000, issue 2, pp 9-12.
  4. California Department of Drug and Alcohol Programs, 2004, California drug and alcohol treatment assessment (CALDATA) California Department of Alcohol and Drug Programs. California Drug and Alcohol Treatment Assessment (CALDATA), 1991-1993 [Computer File]. ICPSR02295-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2008-10-07. doi:10.3886/ICPSR02295


Pain Pill Addiction: Prescription for Hope

Finally, here’s the cover of my book about pain pill addiction and its treatment. It’s available at or you can order it from Amazon, and soon from Barnes and Noble.

My book contains much of what I’ve been blogging about. I wrote the book because there are so few sources of reliable information about the treatment of opioid addiction (pain pills). It seems  that abstinence-based programs don’t like to talk about medication-assisted programs, and some methadone clinics don’t let their patients know about other options. Methadone and buprenorphine can be life-saving when used appropriately, but they have some drawbacks, as well.

There’s not one single right answer for all opioid addicts. Some treatments work for some patients, but no treatment works for all patients. In my book, I present the data supporting treatment methods, so opioid addicts and their families can chose the best course.

If you like this blog, you’ll like my book. I also have a chapter in the book about the unjust stigma patients face when they are treated with medication-assisted methods. It takes a strong person to stay on a treatment that helps them, despite criticism from friends, family, law enforcement, and even unenlightened medical professionals.


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