Essex and Suffolk counties plan to join five other counties in a pilot program providing medications to opioid-addicted inmates, a sign that correctional officials’ resistance to the treatments may be yielding to public pressure and legal action in Massachusetts.
A federal district judge last month ordered Essex Sheriff Kevin F. Coppinger to provide methadone to a prospective inmate, saying that failing to do so could violate the Americans with Disabilities Act and the constitutional prohibition against cruel and unusual punishment.
And US Attorney Andrew E. Lelling recently sent letters to at least two sheriffs, reportedly mentioning the ADA as it applies to addicted inmates in the county houses of correction.
But Coppinger and Suffolk Sheriff Steven W. Tompkins both said in recent interviews that their interest in joining the pilot program pre-dated the suit and Lelling’s letter.
“We always wanted to be involved,” Tompkins said. “We weren’t chosen as part of the five.”
Coppinger and Tompkins have asked the Legislature to add them to the pilot program, established by a 2018 law and due to start in September. While the sheriffs could start offering the medications now, participating in the pilot enables them to work with other counties and addiction experts in developing protocols. It also increases the likelihood of getting state funding.
The sheriffs’ request was welcomed by state Senator Cindy F. Friedman, chairwoman of the Joint Committee on Mental Health, Substance Use, and Recovery. Friedman said she suspected the Essex suit was a “driving force” behind the request, but the motivation doesn’t matter. “I’m completely happy about it,” she said.
In the pilot, Hampden, Hampshire, Middlesex, Norfolk, and Franklin counties will provide the two main medications used to treat opioid addiction — methadone and buprenorphine (often referred to by a trade name, Suboxone) — to inmates who had a prescription when they arrived and also to inmates 30 days before release. The drugs stop withdrawal pains, control cravings, and prevent overdoses.
Although methadone and buprenorphine are standard treatments for opioid addiction, most correctional officials in Massachusetts and elsewhere have refused to provide them, saying the medications — both opioids — are too easily diverted for illicit use.
But advocates point out that inmates denied medication treatment undergo excruciating withdrawal pains when incarcerated and frequently die of overdoses after discharge.
The 14 county sheriffs run jails for people awaiting sentencing and houses of correction for inmates with sentences of two-and-a-half years or less. Those with longer sentences are held in the prisons run by the state Department of Correction.
The suit against Essex County, brought by the American Civil Liberties Union of Massachusetts, marked the first time a federal court said failure to provide the medications could violate the ADA and the Constitution.
Coppinger said he intended to comply with the order and had made arrangements to do so, but the plaintiff’s case was continued and he has not been incarcerated.
Coppinger announced that he intended to join the pilot in a statement issued 10 days after the court’s decision in the ACLU case. His legal brief responding to the lawsuit, filed in October, described taking methadone as “simply switching to another dangerous drug.”
But in an interview, Coppinger said, “I was never opposed to methadone.” He said he had considered joining the pilot when it was first discussed in the Legislature, but decided to focus on other issues facing his office.
Coppinger professed a desire to provide appropriate treatment, but said he needs guidance to avoid a costly “logistical nightmare.”
For example, the plaintiff in the ACLU suit, Geoffrey Pesce, will probably stay in a facility that does not have the capacity to store and administer methadone. He would be driven every morning to a methadone clinic to receive his dose, Coppinger said. But in the future, if a methadone patient were a sex offender or an inmate with a serious felony conviction, the security challenges of such transport would be huge, he said.
“This is a fast-approaching new direction for corrections to undertake,” Coppinger said. “We need time to do it right, and we need guidance.”
Coppinger also said that, after receiving the letter from Lelling, the US attorney, the two met to discuss best practices for administering the medications behind bars.
Lelling would not comment on reports that he had sent letters to sheriffs, saying that he can’t confirm or deny an investigation.
But he said: “I’m very supportive of medically assisted treatment. My primary rationale for doing anything in the area of opioid enforcement is fewer people dying. . . . If there is any enforcement approach I can take that will lead to fewer people dying, I’ll do it.”
Middlesex County Sheriff Peter J. Koutoujian, president of the Massachusetts Sheriffs Association, said that Coppinger and Tompkins have been attending the planning meetings for the pilot along with the other five sheriffs.
“Their engagement began months before the lawsuit,” Koutoujian said.