Treatment for opioid dependence is often accompanied by discrimination

ByDonald L. Leech

Apr 10, 2022

PHILADELPHIA — Danielle Russell was in the emergency room of an Arizona hospital last fall ill with COVID-19 when she made the mistake of answering completely when asked what medications she was taking.

“I said yes, I was on methadone,” said Russell, a doctoral student who was also recovering from heroin use. “The smart thing to do, if I wanted to be treated like a human, would be to say no.”

Even though her GP sent her to the emergency room, she said she was promptly discharged without treatment and given a stack of documents about the hospital’s policies on prescribing painkillers – medication she didn’t ask for.

“It’s getting so absurd, and the stigma against methadone in particular is so strong,” she said, noting that other recovering people have had it worse. “You are blocked from housing resources, employment.”

It’s an issue that recovering drug addicts have dealt with for decades: in addition to the stigma surrounding addiction, people who undergo medical treatment for drug addiction may face additional discrimination, including in supposed medical and legal contexts. help them.

Last week, the US Department of Justice released new guidelines aimed at addressing the issue. They claim it is illegal under the Americans with Disabilities Act to discriminate against people for using prescribed methadone or other drugs to treat opioid use disorder.

The guidelines do not change federal government policy, but they do provide clarification and signal that authorities are monitoring discrimination in a wide range of contexts. The Justice Department’s actions this year also show it is interested in the matter, reaching several legal settlements, filing a lawsuit and issuing a warning letter alleging further violations.

One of the government’s recent deals was for a Colorado program that helps house and employ homeless people. A potential client filed a complaint claiming she had been refused admission because she was using buprenorphine to treat her addiction. As part of the settlement, Ready to Work pays the woman $7,500. Stan Garnett, an attorney for the organization, said Thursday that the organization’s staff are trained to comply with the law.

“It’s terrifying to be told by an authority – whether it’s a judge, a child protection official or a trained nursing facility – that someone who has something you need tells you you need to stop the drug that saves your life,” said Sally Friedman, senior vice president of legal defense at the Legal Action Center, which uses legal challenges to try to end punitive measures for people with health problems, including drug addiction.

Friedman said advocates and attorneys will cite the new guidelines when filing discrimination complaints.

Dan Haight — president of The LCADA Way, which runs addiction treatment programs in the Cleveland area — said a suburb where his organization wanted to put a clinic at one point rejected the idea due to a moratorium in place on new addiction counseling centres.

“We are not considered another medical facility or counseling office,” Haight said. “We are looked at because we are drug addicts.”

The new guidelines suggest such broad denials could be violations of the Americans with Disabilities Act.

Overdoses of all opioids — including prescription drugs containing oxycodone, heroin and illicit, lab-made varieties including fentanyl — have killed more than 500,000 Americans over the past two decades, and the problem only got worse. This has frustrated advocates, treatment providers and public health experts who believe the deaths can be prevented with treatment.

Although the crisis has deepened, there have been glimmers of hope. Drugmakers, distribution companies and pharmacy chains have announced settlements since last year to pay government entities an estimated $35 billion over time and provide drugs to treat addictions and reverse overdoses. Most of the money should be used to fight the epidemic.

It remains to be seen how the money will be deployed, but one of the priorities of many public health experts is to expand access to drug treatments, which are considered essential to help people recover.

But there is still a stigma associated with treatment programs, which use the drug naltrexone or drugs that are themselves opioids, such as methadone and buprenorphine.

Marcus Buchanan used methadone from 2016 to 2018 to help end a decade-long heroin addiction. Meanwhile, he was looking for work near his home in Chouteau, Okla. – mostly in factories – and never could find one.

“I can get an interview. It would be the drug testing process,” when he explained why the results showed he was using methadone, said Buchanan, who is now an outreach coordinator for an opioid prevention program. “Every job, more than 20 probably, in those two years was a door shut in the face.”

Dr. Susan Bissett, president of the nonprofit West Virginia Drug Intervention Institute, said people who go through treatment programs often hide it for fear of losing their jobs.

She said she wanted to reach out to business leaders and encourage them to hire and retain people who use the drugs.

“The next step is to help employers understand that this is an illness rather than a moral failing,” Bissett said. “We don’t think about substance use disorders the same way we think about diabetes, for example.”

One of the places where drug treatment is sometimes restricted or banned is in state drug diversion court programs, which aim to help people fight drug addiction rather than incarcerate them.

Less than half of states have specific language that prohibits judges from excluding people who take the drug from participating in diversion programs or requires that they allow its use in programs. This finding is based on an Associated Press review of legislation, administrative court orders, and drug court manuals that guide state drug diversion court programs.

Some states allow individual courts to make their own rules, while others only include language that says people cannot be excluded. Judges in some states still require defendants to taper off medications and allow diversion programs to decide whether medications are appropriate for each registrant.

The Center for Court Innovation is trying to influence drug courts to create policies and programs that support people taking these drugs instead of nudging them to quit.

“It can be frustrating because no one needs to tell a judge they need to clear someone on blood pressure medication,” said Sheila McCarthy, senior program manager for the Center for Court Innovation. . “But for some, there’s just a disconnect as to what effect these drugs actually have on a person’s day-to-day life.”

Veronica Pacheco was off methadone for nearly a year after taking it for more than six years to treat a painkiller addiction.

She said some people in the medical field – a doctor, a dentist, a pharmacist – seemed to treat her differently after learning she was on methadone. They sometimes assume that she was going to ask for new prescriptions for painkillers.

“I felt like I had a sign on my forehead saying, ‘I’m a methadone addict.’ As soon as someone has your medical records, everything changes,” said Pacheco, who lives in the Minneapolis suburb of Dayton. “Now that I have none, I can see the difference day and night.”