Judge`s order to provide methadone could change landscape in corrections

A Massachusetts federal court case in which officials at a local jail will be required to continue an offender's methadone treatment while he is in custody could have far-reaching implications for the growth of medication-assisted treatment (MAT) in corrections systems.

In issuing a preliminary injunction last week in the case involving 32-year-old methadone patient Geoffrey Pesce, U.S. District Court Judge Denise Casper suggested that the Essex County Sheriff's Department's refusal to provide methadone treatment to Pesce likely violates the Americans with Disabilities Act (ADA) and the U.S. Constitution's Eighth Amendment prohibition against cruel and unusual punishment.

The county jail does currently offer injectable naltrexone (Vivitrol) to opioid-dependent inmates, but attorneys for Pesce, who has had multiple drug overdoses and detoxes, say he did not do well in the past with either naltrexone or buprenorphine treatment and has maintained a drug-free lifestyle with methadone for the last two years.

Pesce faces jail time on a probation violation for driving with a revoked license; he previously had received a suspended sentence for operating a vehicle under the influence of drugs. A sentencing hearing in his case is scheduled for this week.

“This really is a watershed case,” Sally Friedman, vice president of legal advocacy at the Legal Action Center, tells Addiction Professional. “There hasn't to this point been a court deciding whether withdrawing this treatment is unconstitutional.”

Addressing safety concerns

No male inmates in Massachusetts prisons or jails are currently offered methadone, although several pilot efforts in the state are being launched. Corrections officials generally have cited safety and management concerns around making the drug available behind the walls. Yet these arguments appear to have weakened in light of other corrections systems successfully implementing a full range of MAT options (with New Jersey and Rhode Island being the most prominent examples of this at the state level).

Moreover, some pregnant women in Massachusetts corrections systems already are receiving methadone treatment while incarcerated, which further calls into question the premise that the medication cannot be safely integrated into the prison or jail milieu.

“Prisons and jails can offer these medications, and can address their concerns,” says Friedman. “They will end up seeing fewer inmates using illicitly, and fewer returning [to custody].”

The federal judge stated in last week's ruling that county officials failed to offer any evidence as to why they could not impose reasonable security protocols for use of methadone. She added that they did not conduct any individualized analysis of Pesce's case as required under the ADA.

Pesce, represented in part by the American Civil Liberites Union of Massachusetts, would likely suffer significant consequences for his recovery if he were denied access to the medication that has helped him stay sober, his representatives have argued. Friedman adds that even the injectable naltrexone that the Essex County Jail currently makes available to inmates is given only as individuals' release date approaches, not at an earlier stage of their incarceration.

According to local news reports in Massachusetts, the county Sheriff's Department last week issued a statement after the preliminary injunction was announced, stating that it would be “looking for the best approach to assist inmates fighting their addictions.”

It is not yet known whether the department will appeal the issuance of an injunction in the lawsuit, which was originally filed in September.