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Ruling in Massachusetts opioid treatment case could affect New Mexico

December 16, 2018

A federal judge’s decision enforcing opioid addiction treatment in a Massachusetts jail has proponents excited about a potential ripple effect in New Mexico.

The ruling stems from the case of Geoffrey Pesce, 32, whose addiction to opioids cost him his job, his parental rights and more, according to a lawsuit he filed against the Essex County sheriff and the superintendent of the county jail. After at least six overdoses and various attempts to kick his habit, Pesce found a treatment that helped him get clean: methadone.

For almost two years while he’s been taking the prescribed medication, his lawyers say, he’s been free from illicit drug use and has been able to get his life back on track.

Here’s the rub: Pesce is about to be sent to jail to serve mandatory time for driving himself to the methadone clinic without a license. And the jail he’s likely headed to doesn’t allow methadone use.

The American Civil Liberties Union, on Pesce’s behalf, sued officials in Essex County on the basis that denying him the medication violates the Americans with Disabilities Act and the Eighth Amendment, which prohibits cruel and unusual punishment.

Denying him the medication, his lawyers contend, would not only force Pesce to go through severely painful withdrawals, it also could lead to relapse and overdose — a risk that spikes for people with opioid-use disorder upon their release from jail, research shows.

Pesce’s case hasn’t been decided yet. But in late November, U.S. District Judge Denise Casper issued a preliminary injunction, ordering the jail to give Pesce the medication if he becomes incarcerated before the case is closed.

Advocates of medication-assisted treatment in New Mexico and across the country have hailed the injunction as a catalyst for expanding access to opioid treatments, which have been slow to catch on in detention facilities.

“I think it’s an incredible ruling,” said Emily Kaltenbach, state director of the Drug Policy Alliance in New Mexico. “It opens the door for humane treatment for people who are entering jails and prisons and may be suffering from an opiate disorder. I hope jails in New Mexico will take note.”

For the most part, New Mexico jails and prisons do not offer access to medications to treat opioid-use disorder.

Several types of medication-assisted treatment have been approved by the U.S. Food and Drug Administration and the Substance Abuse and Mental Health Services Administration to treat opioid dependency, including methadone, buprenorphine and naltrexone.

Methadone and buprenorphine — often known by the brand name Suboxone — are opioid-based medications with the potential for abuse; they require a prescription or strict supervision. Naltrexone, a newer, nonopioid medication, blocks opioid receptors in the brain, preventing a person from getting high from opioids.

Earlier this year, the American Correctional Association recommended that jails and prisons consider allowing a person on a prescribed treatment regimen to continue taking the medication after they become incarcerated.

Albuquerque’s Metropolitan Detention Center was a national leader in adopting that policy more than a decade ago and has been heralded as a national example for effective jailhouse methadone treatment.

The rest of the state doesn’t follow suit.

The New Mexico prison system does not offer methadone or buprenorphine treatment for opioid-dependent inmates; nor do most of the state’s two-dozen jails, with the exception of allowing the treatment for pregnant women.

Dr. Bruce Trigg, a former New Mexico physician who now works out of state as an addiction consultant, thinks the Massachusetts ruling could force officials to make changes.

“This is an incredibly important statement and event, and it’s definitely going to have serious implications,” Trigg said. “They’re either going to [provide medication-assisted treatment] on their own, or they’re going to do it because people are going to sue.”

Grace Philips, general counsel for the New Mexico Association of Counties, isn’t so sure.

While the Massachusetts decision is an important development to consider, she said, it doesn’t have a binding effect on New Mexico. And, she said, there are previously established federal cases that went the other way.

The Association of Counties encourages its members to practice the community standard of care in their areas, Philips said. In some rural parts of New Mexico, where there may not be any methadone clinics or enough buprenorphine providers to treat jail inmates, establishing a medication-assisted treatment program could be incredibly difficult — and costly. Philips estimated counties already spend an average of 33 percent of their budgets on detention facilities.

“I think there are financial implications and logistical implications,” Philips said. “There are not methadone clinics in the four corners of the state, and it’s not something our jails are licensed to [provide]. You’re talking about transporting people. … If you had to do that with everybody, the cost and contraband challenges that would pose would probably be crippling.”

Philips does think county jails have worked to help mitigate the opioid epidemic by offering naloxone, an overdose reversal medication, and in some cases providing naltrexone.

The Santa Fe County jail is somewhere in the middle of New Mexico’s extremes.

Inmates do not have access to methadone or buprenorphine there, like they do at the Metropolitan Detention Center in Albuquerque, but they do have access to naltrexone.

That means, for example, if a Santa Fe County resident enrolled in methadone treatment at New Mexico Treatment Services, a clinic on Rodeo Road, were picked up by police on a warrant for an unpaid traffic ticket, he wouldn’t be allowed access to that prescription while in jail, likely prompting painful withdrawal symptoms.

However, after the initial withdrawal, an inmate can ask jail staff for naltrexone, which has been shown to decrease cravings.

Kaltenbach thinks jails should be providing “a complement” of medication-assisted treatment options.

“This ruling in Massachusetts really highlights that withholding people’s medication, whether that’s methadone, buprenorphine, insulin or heart medication, is unconstitutional and inhumane,” Kaltenbach said. “We shouldn’t be treating methadone and buprenorphine any differently than we are the other medications that are allowed when someone comes into the system with a prescription.”

She’s hopeful that Democratic Gov.-elect Michelle Lujan Grisham will help make that happen, perhaps by backing legislation that demands a wider range of opioid treatment services in jails and prisons.

In an email last week, Lujan Grisham transition director Dominic Gabello said the governor-elect supports using medication-assisted treatment but isn’t making any promises about implementing it in jails or the prison system.

“Use of [medication-assisted treatment] in correctional facilities raises unique issues of safety and cost that the Governor-elect believes can and should be addressed before implementing such a program,” Gabello said. “She will work with the legislature and other stakeholders to design and fund appropriate treatment for opioid addiction in New Mexico’s prisons.”

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