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

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

State is placing persons who are involuntarily committed to treatment – the section 35 process – in jail or prison even though no charges have been levied against them

Sheriff Nick Cocchi, left, on his way to visit men civilly committed for drug or alcohol abuse at the Hampden County Jail in Ludlow, Massachusetts.
Sheriff Nick Cocchi, left, on his way to visit men civilly committed for drug or alcohol abuse at the Hampden county jail in Ludlow, Massachusetts. Photograph: Josh Wood/The Guardian

The scene plays out every day in Massachusetts, thousands of times a year.

A loved one is addicted to opioids. Their life is spinning out of control as they use more and more. Their family panics. Rehab can be unaffordable – and it may require waiting for a spot. But they need to get their loved one somewhere they can’t use before it’s too late.

It’s about now that they might consider section 35, a process in Massachusetts by which persons abusing drugs or alcohol can be involuntarily committed to treatment for up to 90 days after a family member, guardian, law enforcement officer or doctor petitions a judge. Many states have similar laws in place and have turned to them in battling the opioid crisis gripping the nation.

But in Massachusetts, involuntarily committed men can end up in jail or prison even though no charges have been levied against them.

That’s how Jim, a 29-year-old student, arrived at the Hampden county jail in the western Massachusetts town of Ludlow in March after overdosing on opioids. Despite being forced into jail with no charges, he told the Guardian he was glad to be there.

“I’ve never been in trouble with the law, but it was absolutely necessary for a cop to come to the house, put me in handcuffs and take me here,” he said.

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.

The Hampden County Jail wing looks like a jail, but the people here are patients, not inmates, and have been charged with no crime.
The Hampden county jail wing looks like a jail, but the people here are patients, not inmates, and have been charged with no crime. Photograph: Josh Wood/The Guardian

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.

A cell – or bedroom – in the wing for civilly committed men at the Hampden County Jail. While the facility is locked, cells remain unlocked.
A cell – or bedroom – in the wing for civilly committed men at the Hampden county jail. While the facility is locked, cells remain unlocked. Photograph: Josh Wood/The Guardian

‘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.”

Sheriff Nick Cocchi says that done right, forced rehab works. If Massachusetts stops allowing correctional facilities to hold men civilly committed for drug and alcohol abuse, he says it will ‘devastate’ the state.
Sheriff Nick Cocchi says that done right, forced rehab works. If Massachusetts stops allowing correctional facilities to hold men civilly committed for drug and alcohol abuse, he says it will ‘devastate’ the state. Photograph: Josh Wood/The Guardian

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 ?

5 Responses

  1. it seems that ALL people with crippling pain from disease or injury AND physician/surgeon screw ups are now deemed “drug addicts” even if treated with opiate medication VERY successfully, pill counted, illicit drug screened, and have a documented history of a far more “normal” and, productive life yet still forcefully reduced in dosage or unable to find ANY treatment for incurable/intractable pain and I am damn tired of it. It is easy to say “you don’t need opiate medication” IF you do not suffer with pain continuously. I ran a business for 37 years WHILE being treated for CONSTANT pain from a surgeon that screwed my back up with multiple, possibly unnecessary surgeries. I no longer can function and the will of a human can only take so much. Not everyone that uses opiate medication after ALL other therapy, non opiate medications and treatments have failed. I tired of being damned for using opiate medication…RESPONSIBLY. DAMN the experts. They would fair no better than any responsible patient that truly needs medication for pain management but, can NOT get it and we…..the patients know this to be factual!!!!!!!

  2. I didn’t need to get halfway through the article to read Prof Beletsky’s remarks to know that incarceration-based rehabilitation is ill-advised. As Pharmacist Steve correctly notes (5% success rate), abstinence-based rehab is egregiously ineffective, but what’s worse is that this has been WIDELY understood for years.

    When it comes to America’s opioid response, truly the lunatics run the asylum.

  3. I wonder if the jail is billing the taxpayers the standard rehab facility rate of around $1000.00 ? per day, or just the regular offender rate?
    Just follow the money to see why so many people seem to like the program.

    I’m just curious that one day a group of people will be in the incarcerated rehab program and some civil unrest situation will happen and they will just be disposed of? Maybe by gas.
    Just the thought of that would seemingly drive some folks to get themselves treatment by almost any other means.

    I am a chronic pain patient, as some call us and I am wondering if it is, in fact, curious why my thought process would produce this type of reasoning? I have no addiction indications.
    Survival instinct likely…

  4. What about vindictive or betraying relatives, or neighbors? Folks already with an OUD accusation, deserved or not? Folks on Suboxone for OUD? Pol Pot, Stalin and Hitler would say “See??? I was right!” Were they?

  5. I could say about 100 things here just off the top of my head. What happened to releasing non-violent drug offenders?
    “family member, guardian, law enforcement officer or doctor petitions”. Should I take an aspirin? Should I continue to fight for the restoration of opiate pain control for legitimate severe pain patients? Damn, where is all of this stupidity coming from? It’s so powerful. Maybe I should just be afraid like everyone else.
    Are we going to replay Moa’s “Cultural Revolution”? Or will folks finally speak up? With all the other crap that is the U.S. Government going on it’s all starting to like like ONE big mess to me. I thought we decided long ago and recently that less government was better? This is the opposite of that.

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