Massachusetts’ contentious tactic to fight its opioid crisis: jailing addicts

https://www.theguardian.com/us-news/2019/apr/23/massachusetts-contentious-tactic-to-fight-its-opioid-crisis-jailing-addicts

Eight days into his stay, he said jail was “the best thing that’s probably ever happened to me”.

As Massachusetts struggles against an opioid crisis that kills five times as many people than automobile accidents every year in the state, the placement of civilly committed men in correctional facilities has emerged as one of the most controversial tactics to confront addiction in the state – and one not seen anywhere else in the nation.

To proponents, the section 35 process is seen as lifesaving, putting people in a place where they absolutely cannot get drugs and where they cannot simply walk out. But its detractors say that forced rehabilitation does not work, that putting men in correctional facilities is unconstitutional and that putting patients in prison settings is detrimental to recovery and increases the risk of relapse once patients are released.

Women were once held in correctional facilities in Massachusetts for addiction, but after an ACLU lawsuit, the state ended the practice in 2016.

But the state has ramped up its incarceration of civilly committed men. According to Prisoners’ Legal Services, a not-for-profit that has been a key opponent of the practice, Massachusetts places more than 2,000 men involuntarily committed for substance abuse in correctional facilities per year.

In March, PLS filed a lawsuit against the department of correction and department of public health on behalf of 10 unnamed patients being held at the Massachusetts Alcohol and Substance Abuse Center (Masac), a facility operated by the DoC in the town of Plymouth.

The lawsuit charges that holding the men in correctional facilities is unconstitutional, constitutes unlawful discrimination on the basis of gender and disability and is overall detrimental to recovery. They also describe an abusive environment where patients are “routinely” humiliated by correctional officers (COs) and where patients lack access to opioid substitution medications such as Suboxone.

“These people are being shamed and stigmatised on the basis of a disease that’s acknowledged as a disability,” said Bonnie Tenneriello, PLS staff attorney.

One of the unnamed plaintiffs said officers called patients pussies, bitches, junkies and crackheads while telling him that his “mother is a whore”.

Another plaintiff described how during detox, his roommate urinated and defecated on himself, but that nobody cleaned it up.

Others described being too afraid to call their employers or loved ones as all phone calls coming from the facility inform the person being called that they are receiving a call from a correctional facility.

PLS says patients have been sent to solitary confinement for seemingly minor offences like smoking a cigarette, not answering questions or taking extra milk with their meals.

“All of that is counter-therapeutic, all of that is traumatising, all of that is telling people you are not a full citizen, you are not to be trusted, you are a bad person,” said Tenneriello of placing patients in correctional facilities.

‘It’s a jail mentality’

Joel Kergaravat, 36, was hooked on heroin and crystal meth when his mother petitioned him to be sectioned last summer. They both thought that sectioning him would mean rehab, but instead he was put in restraints and loaded into a hot van for a long drive to Masac.

His experience at Masac appeared to mirror allegations laid out in the lawsuit.

Once he got to Masac, he did not have access to detox medications. “It’s barbaric not to give people that medication, because you’re basically vomiting and shitting yourself for six days,” he said. “That’s what happens. It’s not pretty.”

Inside, he said guards were abusive. He felt the place was unsanitary and unclean and worried about getting sick. Patients would get into fistfights.

“It’s a jail mentality,” he said. “They have you in a prison setting so people act accordingly.”

When he got out, he was traumatized. He got back on drugs and at one point tried to kill himself by overdosing – a result, he says, of his experience at Masac.

“If you’re going to force people into treatment, that’s fine, put them into treatment,” he said. “You can’t just rename a prison or a section of a prison and call it treatment.”

A sheriff champions section 35

The Hampden county sheriff, Nick Cocchi, might be the biggest proponent of section 35 in the state.

Cocchi views his mission as a rehabilitative one. His COs don’t carry weapons of any kind and those on the section 35 wing don uniforms consisting of polo shirts – an attempt to look less guard-like. He keeps a folded, ageing piece of paper in his pocket that lists the names of those that have died at the jail in the 26 years he has been working there. When western Massachusetts residents call him and send him Facebook messages pleading for advice about loved ones who have been trapped by addiction, he invites them to his office, even if it is a weekend. Men who have previously been sectioned call him up when they are relapsing.

Cocchi says that when done right, forced rehab works.

His enthusiasm about section 35 was born out of a desire to provide treatment closer to home for residents of western Massachusetts.

“You serve no purpose taking somebody two and a half hours from home, detoxing them and then saying ‘here’s a bus ticket to get back to where you’re going.’ Where’s the support?” he said. “There’s no support. And when there’s no support, there’s relapse.”

He said the kind of abusive treatment outlined against Masac in the lawsuit brought by PLS doesn’t happen at his jail. He said that there need to be reforms to the section 35 process, but that his facility is “second to none” in the state.

Recently the gregarious sheriff brought the Guardian into the section 35 wing, walking in with a five-month-old bull mastiff puppy named Brooklyn.

“What’s up guys?” he beamed at the patients – or “clients” as they are referred to in the jail administration’s parlance. “I don’t want anyone to panic – this is not a drug sniffing dog!”

The wing appeared clean and orderly. The patients wore a uniform of brown pants and yellow or blue T-shirts with inspiring mottos like “recovery works” and “one day at a time” on them. They appeared friendly with the sheriff and the COs, stopping them to share their thoughts and concerns about their time on the unit.

Several patients eagerly lined up to speak to the Guardian about their experience at the jail, all saying positive things. Many were optimistic that being closer to home, having counseling about their discharge plan and having access to advice after they were out would mean it would be easier to stay off drugs or alcohol once released.

Some had spent time at Masac in Plymouth and said their current surroundings were much better.

Jim, the 29-year-old student who was sectioned after an overdose, said: “The COs don’t treat you like inmates, they treat you like a patient essentially.”

The wing has only been receiving section 35 patients since May, but Cocchi says he is confident that statistics will eventually show that his program has a higher success rate than any other treatment facilities.

“There’s also a group out there that says forced treatment doesn’t work – when you force someone to go into treatment, it doesn’t work,” he said. “That is absolutely false.”

If people trying to put an end to correctional facilities holding civilly committed men are successful, Cocchi says “they will devastate the commonwealth of Massachusetts, specifically western Massachusetts right now … And I will not lay down on that.”

‘Setting them up to die’

But opponents of jailing section 35 patients say that even if the abuses laid out against Masac are not present at a correctional facility, keeping civilly committed men there is wrong and dangerous.

“No matter how well run any prison might be, we’re saying that it’s a disease,” said Tenneriello, the PLS attorney. “Putting people in prison because they have a disease is fundamentally wrong”

Leo Beletsky, an associate professor of law and health sciences at Boston’s Northeastern University is an expert on the opioid epidemic and sits on the state’s section 35 commission.

He points to studies, like one by the Massachusetts department of public health, that show that persons recently released from incarceration are 120 times more likely to die of an opioid overdose than members of the general public.

“By putting people in correctional settings, we’re essentially setting them up to die,” he said.

Physician Sarah Wakeman, an addiction medicine specialist and medical director of the Substance Use Disorders Initiative at Boston’s Massachusetts general hospital, said those leaving forced rehab are at particular risk for overdosing given they did not want to be there in the first place and have lowered their tolerance.

To Wakeman, more focus needs to be placed on making sure that voluntary treatment for substance abuse is more readily accessible.

“The reality is that tough love is not a useful intervention to help a person suffering from addiction,” she said.

Beletsky said the section 35 system remains popular as it is much easier to access than voluntary treatment programs.

“Section 35 in many ways is the path of least resistance for getting into treatment,” he said. “It’s immediate, it’s free, it requires no navigation.”

It “illustrates how broken our systems of care are,” he said. “In many ways it’s easier to put somebody away than have them access normal healthcare.”

In 1917 the DOJ declared that opiate addiction was a CRIME and not a DISEASE and any prescriber treating/maintaining a opiate addiction would be jailed.

So it would appear that that declaration did not bear the weight of law.. or these people would have been jailed and charged with a CRIME.

This program seems to parallel what is – and has been done – with the Civil Asset Forfeiture Act where 85% of the people who have had their assets confiscated and no charges were ever filed and most people are lucky to get MAYBE half of the dollars confiscated and if other assets that were confiscated and liquidated (sold at auction) may get little or nothing of what the assets were actually worth.

There are several states that have involuntary mental health admission – in CALF it is referred to as a 5150 and in FL it is referred to as the Baker Act, but the involuntary mental hold is 72 hrs.

Generally “abstinence rehab” has a 5% success rate because pts who have been provided opiates for a long period of a couple of months and are cut off of their medication – of course – does into withdrawal because their prescriber did not properly wean the pt off their opiates and the fact that they are suffering withdrawal symptoms they are told that they are addicted., and when they are properly weaned off their opiates… they turn out that they were never  actually “addicted”.

I find it interesting that ACLU sued the state over the same treatment for woman and the state loss and the state discontinued this treatment ONLY FOR WOMEN. What happened to EVERYONE IS EQUAL ? and is supposed to be treated equally ?

Filed under: General Problems