A person with a substance use disorder may be jailed for relapsing while on probation, the state’s highest court ruled Monday, disappointing public health advocates who had hoped the case would discourage courts from incarcerating defendants as they recover from addiction.
The Supreme Judicial Court unanimously ruled that judges, while they should consider the challenges of drug addiction, “must have the authority to detain a defendant” who has violated probation by using drugs.
“Such decisions should be made thoughtfully and carefully, recognizing that addiction is a status that may not be criminalized,” Justice David A. Lowy wrote for the seven-member court. “But judges cannot ignore the fact that relapse is dangerous for the person who may be in the throes of addiction and, often times, for the community in which that person lives.”
The 27-page decision centered on the case of Julie Eldred, who in 2016 was sentenced by a Concord District Court judge to 10 days in jail after she tested positive for fentanyl.
Eldred, then 27, was on probation for stealing jewelry to pay for a drug addiction that began when she was a teenager.
In a lawsuit, Eldred contended that the court had violated her constitutional rights by ordering her to remain drug-free because her substance use disorder made it “virtually impossible” for her to abstain through sheer will.
The Massachusetts Medical Society, the American Academy of Addiction Psychiatry, and dozens of doctors filed briefs in support of her argument. In her complaint, Eldred cited findings by the Surgeon General that addiction drastically reduces one’s ability to make decisions about drug use.
The SJC made little mention of the research cited by Eldred’s lawyers, except to say that the claims rested “on science that was not tested.”
Lisa Newman-Polk, one of Eldred’s lawyers, called the decision a “massive blow” that would place the court “on the wrong side of history.”
“The SJC had the opportunity to do something groundbreaking in view of the science in the surgeon general’s report on substance use disorder and instead rubber-stamped the status quo, dysfunctional way in which our criminal justice system treats people suffering from addiction,” she said.
Eldred’s unusual challenge drew national attention and took aim at the longstanding practice of ordering offenders to remain drug-free as a term of probation and imprisoning those who violate the condition.
Martin W. Healy, chief counsel for the Massachusetts Bar Association, said a ruling in Eldred’s favor could have led to thousands of defendants contesting detentions on the grounds of drug addiction.
That would have forced the state, which relies on jails and prisons to treat defendants struggling with addiction, to invest more resources into community drug treatment programs, he said.
The decision “shows that the courts are not comfortable embracing new theories of defense or new issues that are being accepted by the medical community,” Healy said. “It’s left a lot of people shaking their heads. Where was the discussion regarding substance use disorder? It was a missed opportunity.”
Prosecutors with the state’s attorney general’s office had argued the Concord judge may have saved Eldred’s life by sending her to jail, sparing her from a potential overdose.
Lowy noted that the judge detained Eldred after learning there were no available inpatient treatment beds.
“We are pleased the Supreme Judicial Court today affirmed a court’s ability to take an individualized approach to probation that encourages recovery and rehabilitation to help probationers avoid further incarceration,” said Margaret Quackenbush, a spokeswoman for the attorney general’s office.
But a number of medical specialists said they were frustrated by the court’s dismissal of what they described as well-established science.
“All of [the] leading scientific medical experts definitively say that addiction is a chronic disease that impacts the parts of our brain that control choice, reward, and motivation,” said Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital who filed an affidavit supporting Eldred’s claim. “Of course there are disagreements. There are people that don’t believe in vaccines and people who don’t believe in climate change either.”
Dr. Alain A. Chaoui, president of the Massachusetts Medical Society, said the decision to “jail a person for a relapse goes against evidence-based medicine.”
“Penalizing those battling a chronic disease because they have exhibited a symptom perpetuates stigma and undermines efforts to foster empathy and recovery,” he said.
Supporters said the decision will help protect defendants by giving them clear motivation to remain drug-free.
“We believe this decision will save lives both of innocent citizens . . . but also save the lives of defendants who will be guided to abstinence by judges using this discretion,” said Michael W. Morrissey, the Norfolk district attorney.
Sally Satel, a Washington, D.C.-based psychiatrist who works part time at a methadone clinic and was among four specialists who wrote the court in support of prosecutors’ position, said that “even a brain that’s on drugs can respond to rewards and sanctions.” Still, she disagreed with the judge’s decision to send Eldred to jail.
“The whole point is to make [punishment] swift and certain, but not severe,” Satel said.
Lowy wrote that in Eldred’s case, the judge was faced with the choice of releasing her and risking she might overdose or putting her behind bars.
“Trial court judges . . . stand on the front lines of the opioid epidemic,” Lowy wrote. “In circumstances where a defendant is likely addicted to drugs and the violation in question arises out of the defendant’s relapse, judges are faced with difficult decisions that are especially unpalatable.”