The New York Civil Liberties Union (NYCLU) and American Civil Liberties Union (ACLU) filed a lawsuit against Jefferson County in Upstate New York on April 5. It seeks to compel the Jefferson County Correctional Facility to provide access to methadone treatment for opioid use disorder (OUD).
The lawsuit accuses the facility and the county sheriff of violating the New York State Civil Rights Law, US Constitution and the Americans with Disabilities Act by refusing to allow incarcerated people with OUD access to prescribed methadone. The suit, filed on behalf of a 35-year-old man identified only by the initials P.G., asks the county to rescind its ban on methadone treatment and seeks emergency relief if the county refuses to do so.
“Under the 14th Amendment’s due process clause, there’s a right for people in pre-conviction custody to receive adequate medical care,” NYCLU senior staff attorney Antony Gemmell told Filter. “And so if the government essentially limits someone’s freedom to attain their own medical care by taking them into custody, it has an obligation to provide necessary medical care itself.”
“The argument is essentially opioid use disorder is a serious medical need and by denying the only effective treatment for it, the county is acting recklessly,” he continued, comparing denying methadone to someone diagnosed with OUD to denying someone with diabetes access to insulin.
The suit, first reported by Filter, calls the denial of methadone an “arbitrary and discriminatory denial of medically necessary treatment” and accuses the jail of “trafficking” in stigma against medication for opioid use disorder (MOUD). It says the jail only provides methadone to pregnant people.
The Jefferson County Sheriff’s Office, which has previously offered a different MOUD—naltrexone—did not respond to Filter‘s request for comment. P.G. said that MOUD other than methadone have not proved effective for him.
“Methadone has changed my life. For the first time in years, I have hope for the future, but all of that could be lost if my medication is interrupted.”
“I have been fighting to overcome my opioid addiction for over a decade, and I have tried so many different treatments and programs along the way. Nothing was effective until I was prescribed methadone,” P.G. told Filter. “Receiving methadone treatment has changed my life. I’m drug-free, I have a stable job and I just purchased a home. For the first time in years, I have hope for the future, but all of that could be lost if my medication is interrupted.”
An extensive body of research has proved the medical benefits of MOUD in carceral settings. One study found that increasing access to the three MOUD currently approved by the Food and Drug Administration—methadone, buprenorphine and naltrexone—could reduce post-release deaths by 31.6 percent. Another found that people who received methadone while incarcerated were more than twice as likely as those who experienced forced withdrawal to continue methadone treatment a month after release. Discontinuing methadone increases the risk of fatal overdose.
In addition to the increased risk of relapse and overdose, people who are abruptly cut off methadone can experience a range of withdrawal symptoms, including vomiting, nausea and diarrhea.
“Withdrawal for me was being put in a cell by myself for seven days [to] get over the shit on my own,” Asia Betancourt, a leader of activist group VOCAL-NY’s User’s Union, who experienced forced withdrawal from heroin while she was incarcerated decades ago, told Filter. “They left me not a bath, not a shower. Nothing. It’s being treated like an animal. It’s inhumane … We want people to get the treatment they need when they need it at their most vulnerable time. And behind the wall in prison is the place where it needs to start.”
The Centers for Disease Control and Prevention said more than 81,000 people died of overdose between June 2019 to May 2020—a record number that reflects neither the full death count from that year nor the full effects of the pandemic that had only just begun.
On April 1, the president’s Office of National Drug Control Policy vowed to provide better care for people with substance use disorders. A statement outlining drug policy priorities for his first year in office said the Biden administration would “remove unnecessary barriers to prescribing buprenorphine and identify opportunities to expand low-barrier treatment services” and “expand access to evidence-based treatment for incarcerated individuals.”
“A positive ruling on this would send a message to other jails and prisons that don’t provide this treatment that there’s an obligation to do so.”
In New York, like many other states, available treatments lag behind long-established science. Rikers Island Correctional Facility has offered MOUD since 1987, and researchers have found the program reduces recidivism rates and disease transmission while offering savings on health care. But the practice isn’t extended across the state.
As of August 2019, jails in only 10 of the state’s 62 counties offered methadone (another 13 offered buprenorphine, while 34 offered naltrexone). Only 10 of the 52 facilities run by the Department of Corrections and Community Supervision offer MOUD, according to the agency.
The ACLU has won similar cases in suits in Massachusetts, Washington and Maine, forcing carceral facilities to provide access to MOUD. A ruling on the merits of the NYCLU’s case brought Monday would be the first such ruling in New York.
“We expect that a positive ruling on this would send a message to other jails and prisons that don’t provide this treatment that there’s an obligation to do so,” Gemmell said.
Advocates have unsuccessfully pressured Governor Andrew Cuomo for years to include funding for MOUD treatments in prisons and jails. Last year, Cuomo vetoed a bill that would have removed restrictions preventing Medicaid recipients from receiving MOUD, though he signed a bill eliminating that barrier for people who had private insurance—effectively creating a two-tiered health care system at the expense of lower-income New Yorkers.
A report from nonprofit RTI International found that the removal of prior authorization to receive treatments in New York, as the vetoed legislation proposed, could have saved almost 600 lives and almost $52 million each year. Cuomo defended his decision by stating that the legislation would offer “unfair competitive advantage to one pharmaceutical manufacturer in particular.”
“The governor has repeatedly sent the message that saving people’s lives costs too much money,” Biz Berthy, a drug policy organizer at VOCAL-NY, told Filter. But with Cuomo weakened by a trio of scandals—the sexual harassment and misconduct allegations; his office burying the true toll of COVID in nursing homes; and the reports that he secured preferential COVID testing for family members—activists see a potential opening for finally securing funding for MOUD.
“If the legislature does not make sure that MOUD in prisons and jails is fully funded this year, that is just a testament to the complete lack of political will.”
“It’s also a matter of seeing if the legislature is finally going to stand up against Governor Cuomo for their people that are struggling inside prisons and jails, being forced into torturous withdrawal,” Berthy said, noting that $20 million for MOUD funds amounts to a small proportion of the governor’s $192.9 million budget proposal.
“If the legislature does not stand up and make sure that [MOUD] in prisons and jails is fully funded this year, that is just a testament to the complete lack of political will.”
The Senate budget proposed last month included the removal of prior authorization for MOUD and would require prisons and jails across the state to offer it to incarcerated people. The Assembly budget also contained funding for MOUD in correctional facilities.
But on April 2, VOCAL-NY stated that Cuomo had removed or altered a series of budget proposals so much that they were “meaningless.” The $20 million to provide MOUD to people in prisons and jails, and the removal of prior authorization for people on Medicaid—provisions that Berthy called “the only strong overdose prevention bills in the entire budget”—were among those the governor had reportedly stricken or reconfigured.
A spokesperson for the governor’s office told Filter that the office does not comment on pending legislation or budget negotiations. Neither Assembly Speaker Carl Heastie or Senate Majority Leader Andrea Stewart-Cousins responded to requests for comment.
“They’ve been [hemming] and hawing and lying to us for years,” Betancourt said. “How much worse does it have to get before we decide to do the right thing?”
Photograph via New York Department of Corrections and Community Supervision