Prison is no place to cure the opioid epidemic

In late September, David McKinley was found hanging from the top bunk bed in his room at a Plymouth treatment center for drug and alcohol dependency. As reported in the Globe, McKinley’s suicide raises important questions about the suitability and management of the unit he was housed in for opioid use.

That’s because McKinley was at the Massachusetts Alcohol and Substance Abuse Center, run by the state’s department of correction. The 29-year-old had been there for three days before committing suicide; it was his third stint at MASAC. The facility is one of five centers in the state where individuals with substance use disorders are sent after they’ve been civilly committed to treatment by a judge, a process known as Section 35. But MASAC is a locked facility surrounded by a tall razor wire fence, and run by correctional officers. Patients arrive in handcuffs and have to wear orange jumpsuits. They even have to wear a badge with the label “inmate.”

And yet these men not only have not been charged with any crimes, but they’re also there for court-ordered detox. A prison-like environment for them is inappropriate at best and counterproductive at worst.

Experts widely agree. Two-and-a-half years ago, Governor Charlie Baker convened an opioid working group to produce short- and long-term solutions, many of which have already been implemented via legislation. Other recommendations have been delayed or flat-out ignored. In its report, the group concluded that “court and jails should not be the primary mode of accessing long-term treatment” and endorsed transferring “responsibility for civil commitments from the Department of Correction to the Executive Office of Health and Human Services.”

“This is not a department of corrections population, it’s a health and human services population,” said Jim Pingeon, litigation director at Prisoners’ Legal Services, a Massachusetts nonprofit advocacy group. “Is this the best we can do?”

At MASAC Plymouth, its leaders defend their practices and regard its prison-like environment as an advantage. Officials say illegal drugs have never been smuggled into the facility and that no one has overdosed. “It’s restrictive because it has to be,” a DOC spokesman said.

Contrast that with the thinking at another state-run center for the same Section 35 male population, the Men’s Addiction Treatment Center in Brockton, which is managed by High Point Treatment Center. The facility is not locked, and patients there actually receive treatment, such as methadone and other medications, to ease withdrawal symptoms. That is not the case at MASAC, where patients are not offered medication-assisted treatment.

To his credit, Baker did end the inhumane practice of sending women civilly committed to involuntary treatment to a center located in a state prison, where women who were undergoing detox were housed alongside pretrial detainees. Men are due the same treatment. The trial of three prison guards in the death of a man with schizophrenia at Bridgewater State Hospital, which ended in acquittal for the guards on Monday, served as a reminder of the dangers of keeping mental health patients in prison settings.

Massachusetts appears to be the only state that sends some of its civilly committed patients to a jail-like setting. Section 35 commitments have increased 85 percent in the last seven years, as the opioid epidemic has raged on. But a “better in prison than dead” mentality is only putting patients at risk. Incarceration without treatment compounds the risks of an overdose: Individuals may remain addicted but lose their opioid tolerance. The state department of public health, under the executive office of health and human services, should take over MASAC immediately.