A New York-based public interest law firm has filed a nationwide class-action lawsuit against the Salvation Army, accusing it of violating federal anti-discrimination laws by barring from its recovery programs people who take medications for opioid addiction.
The suit was filed Friday in the US District Court in Boston on behalf of Mark Tassinari, who was ejected from the Boston Adult Rehabilitation Center in Saugus in 2018 after he started taking doctor-prescribed buprenorphine to manage his long-standing addiction to opioids. Last week, the program refused to accept him back even though a bed was available, because he was taking buprenorphine, the suit states.
Buprenorphine is among three medications that are considered standard treatments for opioid use disorder; it quiets cravings, prevents overdoses, and often frees people from the compulsion to take illicit drugs. But the Salvation Army, an evangelical Christian denomination, prohibits anyone who takes such medications from participating in its 143 adult rehabilitation centers around the country, according to the suit.
A Salvation Army spokesman said in an e-mail that the group does not comment on pending litigation, but stated, “We remain dedicated to our mission of meeting human needs without discrimination, which includes offering programs that promote stability to anyone in need in accordance with our capacity to help.”
The lawsuit is another example of a continuing clash between those who hold decades-old beliefs in drug-free recovery and advocates of medications like buprenorphine and methadone — a controversy that is especially salient in the criminal justice system.
A judge had ordered Tassinari into the Salvation Army program as a condition of his probation.
But drug courts and probation officers often require people leaving prison to forgo the medications, said Dr. Jessie M. Gaeta, chief medical officer of the Boston Health Care for the Homeless Program.
“There is a culture shift under foot, and culture shifts don’t happen overnight,” Gaeta said. (Tassinari received his buprenorphine prescription from an unnamed doctor at the homeless program, but Gaeta said she does not know Tassinari and was unfamiliar with the suit.)
Many addiction programs, particularly those involved with reentry from incarceration, continue to equate addiction with moral failing and favor the “purity” of recovery without the aid of medications, Gaeta said.
That’s despite “a boatload of high-quality research” showing that buprenorphine and methadone prevent overdose deaths and also reduce HIV infections, criminal activity, commercial sex work, and suicide, Gaeta said. “The science here is robust,” she said.
“It’s a really unfortunate relationship between the Salvation Army and the courts and prison system,” said Lucy B. Bansal, a lawyer with Justice Catalyst Law, a nonprofit law firm founded in 2018 to fight social and economic injustice, which filed the suit along with the Civil Rights Education and Enforcement Center, a nonprofit membership organization in Nashville.
“And this is a bad situation,” Bansal continued, “where somebody has to pick, ‘Should I stay in jail and have access to medication-assisted treatment or go to the Salvation Army and potentially lose access to my best chance of recovery?’”
The Salvation Army’s policy “puts thousands of people at increased risk of death, relapse, severe illness and homelessness,” according to the lawsuit. The suit alleges that the policy against medications violates the Americans with Disabilities Act, the Rehabilitation Act, and the Fair Housing Act, which all prohibit discrimination against people with substance-use disorders.
The suit asks the court to order the Salvation Army to reverse its policy and to compensate Tassinari and thousands of other people who have been denied access to medications to treat addiction while participating in a Salvation Army rehab program or who were excluded from the program because they took such medications.
The lawsuit states that Tassinari, who suffers from anxiety, depression, and post-traumatic stress disorder, is currently being treated at Arbour Hospital in Jamaica Plain and has no permanent address. Bansal said Tassinari was not available for interviews.
According to the complaint, Tassinari, 35, started using painkillers as a teenager “in part to cope with the trauma of being removed from his home and placed in the foster care system, and to relieve other stress and anxiety.” He developed an opioid use disorder that led to numerous overdoses and hospitalizations.
Several attempts to overcome his addiction failed until, at age 25, a doctor prescribed buprenorphine and he felt “like he could sit comfortably in his own skin for the first time in his life,” according to the suit.
Tassinari maintained his sobriety for the next four and a half years, during which he had a driver’s license and car, housing, employment, and a “meaningful relationship.”
In 2017, “a devastating break-up from a long term partner” triggered a relapse and led to his arrest and prosecution for three nonviolent offenses, including possession of pills. In 2018, after he spent a month in the Essex County jail on a probation violation, a caseworker gave him a choice of completing the rest of his one-year sentence, or attending the Salvation Army’s 180-day rehabilitation program.
He chose the latter. But after a month without his psychiatric medications and his anti-addiction medication, he sought help from his doctor at the Boston Health Care for the Homeless Program. The doctor refilled his prescriptions and prescribed buprenorphine.
When a mandatory urine test revealed Tassinari was taking the medication, the Salvation Army expelled him from the program. He became homeless, “suffered a damaging relapse,” and needed prolonged hospitalization, the suit says. Eventually the court ordered him into a program that provided medications for addiction, and he was released from probation in October 2019.
The Salvation Army’s Adult Rehabilitation Center in Saugus is not licensed by the state as a substance-use disorder program. But after the Globe inquired, officials at the state Bureau of Substance Addiction Services said they would check to see if the program provides services that require licensure.
State-licensed programs are prohibited from denying admission to patients “solely because the individual uses medication prescribed by a physician outside the licensee’s service or facility,” according to state regulations.