Treatment of opioid addiction often brings discrimination

PHILADELPHIA (AP) — Danielle Russell was last in the emergency department at an Arizona hospital sick with COVID-19 when she made the mistake of not answering completely when asked what drugs she was taking. Was.

“I said yes, I was taking methadone,” said Russell, a doctoral student who was also recovering from heroin use. “If I want to be treated like a human, the smart thing to do would be to say no.”

Even though her primary doctor sent her to the ER, she said she was swiftly discharged without treatment and was given papers about the hospital’s policies for prescribing pain medications — drugs that She was not asking.

“It gets so absurd and the stigma against methadone in particular is so strong,” she said, noting that others in recovery have made it worse. “You are being blocked by housing resources, employment.”

It’s a problem that people in the addiction recovery community have dealt with for decades: On top of the stigma surrounding addiction, people who are in medical treatment for substance abuse may face additional discrimination – including medical treatment. And there are legal settings involved that should help.

This week, the US Department of Justice published new guidelines aimed at tackling the problem: They claim it is illegal to discriminate against people under the People with Disabilities Act because they are taking methadone or other drugs prescribed to treat opioid use disorder. are using it.

The guidelines do not change federal government policy, but they provide clarification and indication that officials are on the lookout for discrimination in a wide range of settings. The Justice Department’s actions this year also show it has taken an interest in the issue, reaching multiple legal settlements, filing lawsuits and sending out a warning letter alleging other violations.

One of the government’s recent settlements was with a Colorado program that helps homeless people find homes and jobs. A potential client filed a complaint claiming she was denied admission because she uses buprenorphine to treat her addiction. As part of the settlement, Ready to Work is paying the woman $7,500. The organization’s lawyer, Stan Garnett, said on Thursday that the organization’s employees were being trained to comply with the law.

“It’s terrifying to be told by an authority—whether it’s a judge, or a child welfare officer, or a skilled nursing facility—somebody who has something you need is telling you you need to get off that drug.” That’s saving your life,” said Sally Friedman, senior vice president of legal advocacy at the Center for Legal Action, which uses legal challenges to end punitive measures for people with health conditions, including addiction.

Friedman said advocates and lawyers will cite the new guidelines when they are making discrimination claims.

Dan Height, president of the LCADA Way, which runs addiction treatment programs in the Cleveland area, said a suburb where they wanted to have a clinic at one point rejected the idea because of the moratorium on new drug counseling centers.

“We are not seen as just another medical facility or consulting office,” Haight said. “We are seen because we are addicted.”

The new guidelines suggest that such broad denials may be a violation of the ADA.

Overdose of all opioids, including oxycodone, heroin and illegal laboratory-made varieties, have killed more than 500,000 Americans in the past two decades, and the problem is only getting worse. This has frustrated advocates, treatment providers and public health experts who believe deaths are preventable with treatment.

As the crisis deepens, there is also a ray of hope. Drugmakers, distribution companies and pharmacy chains have announced settlements since last year to pay government entities about $35 billion over time and provide drugs to treat addictions and reverse overdoses. Most of the money is required to be used to fight the pandemic.

It is still to be determined how the money will be deployed, but a priority for many public health experts is to expand access to drug-based treatments, which are deemed essential to help people recover.

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

Marcus Buchanan used methadone from 2016 to 2018 to help kick a decade-old heroin habit. During that time, he was looking for work near his home in Chateau, Oklahoma—mostly in factories—and could never find work.

“I could nail an interview. It would be a drug-screen process” when he would explain why the results showed he was using methadone, said Buchanan, who is now an outreach coordinator for an opioid prevention program. “Every job, maybe more than 20, during those two years, was a door shut in the face.”

Susan Bissett, president of the nonprofit West Virginia Drug Intervention Institute, said people who are in treatment programs often hide it for fear they might lose their jobs.

She said she wants to reach out to business leaders and encourage them to hire and retain people who are using drugs.

“The next step is helping employers understand that this is a disease rather than a moral failure,” Bissett said. “We don’t think about substance use disorder, for example, we think about diabetes.”

One of the places where drug-assisted treatment is sometimes restricted or restricted is in state drug diversion court programs, which aim to get help for addiction rather than imprison people.

Less than half of the states have specific language that prohibits judges from excluding people who are taking drugs from participating in diversion programs or requires that they allow its use as part of programs. The finding is based on an Associated Press review of the law, administrative court orders, and the Drug Court Handbook that guides state drug diversion court programs.

Some states allow individual courts to make their own rules, while others simply include language stating that people cannot be singled out. Judges in some states still need to allow defendants to reduce drugs and diversion programs to decide whether the drugs are appropriate for each person enrolled.

The Center for Court Innovation is trying to get drug courts to create policies and programs that support people taking those drugs, rather than encourage them to stop.

“It can be frustrating, because no one needs to tell a judge that they need to allow someone to take blood pressure medication,” said Sheila McCarthy, a senior program manager at the Center for Court Innovation. “But for some, there’s just a disconnect about the real impact these drugs can have on a person’s daily life.”

Veronica Pacheco has been off methadone for almost a year after being on it for more than six years to treat an addiction to pain pills.

She said that some people in the medical field – a doctor, a dentist, a pharmacist – treated her differently when they found out she was on methadone treatment. They sometimes assumed she was going to ask for new prescriptions for pain medications.

“I felt like I had a sign on my forehead saying, ‘I’m a methadone person.’ The minute someone has your medical record, everything changes,” said Pacheco, who lives in the Minneapolis suburb of Dayton. “Now that I’ve got it off, I can see the difference between night and day. Am.”


Mulvihill reported from Cherry Hill, New Jersey.

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