Opioid Treatment on Probation

Federal Judge said this week that a Massachusetts man facing a jail sentence could not be denied access to treatment for his opioid addiction believing that such a refusal violated the Americans with Disabilities Act and was cruel and unusual punishment.  Here in Travis County, Defendants can be denied medication in jail or be deemed ineligible for probation if they are receiving treatment.

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Some experts have estimated that up to a quarter of those incarcerated have opioid-use disorder. But most jails and prisons around the country do not give inmates access to methadone or buprenorphine, two medications that many experts consider to be the gold standards for treatment of opioid-use disorder.

The Travis County Jail routinely denies narcotic medication to inmates even if the defendant has been taking the medication by prescription for years.

In one of our cases, a district judge refused to put a client on felony probation unless he weaned himself off of Clonazepam.  The client had been taking this medication by prescription for years successfully controlling his impulses and mood disorder.  He was able to hold down a job, maintain friendships, and manage the stressors in his life.  Without medication the client was known to literally bang his head against the wall and sometimes put a fist through the sheet rock.

When we asked the court to reconsider, the judge refused and said there were non-narcotic medications the client could take.  According to the court’s probation officer, the client was ineligible for community supervision unless he could get himself off his prescription medication.

We provided letters from two doctors.  One doctor wrote that the client “was taking Clonazepam as prescribed and that it is not interchangeable with other medication.”  The doctor wrote that the client should continue his current medication regiment to stabilize his condition.  Medication change is not advised.”

Another doctor wrote the client was suffering from moodiness, insomnia, anxiety and panic attacks.  He wrote that the client had been stable on his current medication regime for years.  The client could taper off one of his medications over a three month period but he would likely experience withdrawal symptoms.  The doctor reviewed the record on the Texas Department of Public Safety Prescription Access in Texas website.  It showed all prescriptions of controlled medications prescribed to the client.  There was no record of the client getting early refills or getting controlled medications from multiple prescribers.  This doctor wrote that because client is stable on his current medications, “I see no reason to change them.”

With persistence and multiple court settings, we persuaded the Judge to reconsider.  One concern was the adverse consequences that might befall the County should the substitution of medications be linked to the court’s order.  Another consequence was the risk of poor performance in satisfying the conditions of probation when the substitute medications effectively fail to control the Defendant’s behavior.  The court finally relented and “made an exception” in this case.  It should never have had to come to that.  In all their wisdom, Judges do not have medical degrees and should not be substituting their opinion for the advice of medical doctors in consultation with their patients.

A study by the Massachusetts Department of Public Health found that those released from jail or prison were much more likely to die of an overdose than the rest of the stateʼs adult population. A similar study in North Carolina concluded that former inmates were more likely to die from an opioid overdose in the first two weeks after being released than those in the general population. In Rhode Island, where inmates are treated for their addictions, researchers found a 61 percent decrease in post-incarceration deaths in the first six months after the state started its program.

The Texas legislature should consider passing a bill that creates a pilot program to offer methadone, buprenorphine and naltrexone to inmates.