Two Pa. jails likely discriminated and violated federal law by denying addiction treatment medications, feds say

Jails that limit access to addiction treatment medications are likely discriminating against disabled people and violating federal law, Philadelphia’s top federal law enforcement official says.

A lawsuit brought by a Delaware County man who was allegedly denied his prescribed methadone in the county’s jail has the support of Jacqueline Romero, the U.S. Attorney for the Eastern District of Pennsylvania. In court filings this week, she said jails must improve access to medication treatment options for opioid addiction.

This marks the second time in recent weeks the federal government has said it will enforce laws against Pennsylvania jails that don’t offer comprehensive addiction treatment.

The Allegheny County jail last month agreed to pay $10,000 to a man who allegedly was also denied his prescribed methadone treatment while jailed, according to a statement by the U.S. Attorney for the Western District of Pennsylvania. The jail has also promised to provide all forms of opioid addiction medications to anyone who needs them.

In a state where addiction treatment in jails is piecemeal and often inadequate, advocates say the Justice Department’s actions here signal a renewed push for jails and prisons to properly care for people with addiction.

“If I were a jail, what this is telling me is that the writing is on the wall,” said Kate Boulton, a senior legal technical advisor at Vital Strategies, a health organization working to cut overdoses in the state. “It is medically and legally indefensible to restrict or deny access to these medications.”

Both the Delaware County and Allegheny County cases hinge on what kind of addiction treatment jails must provide for people incarcerated there.

In 2021, Shaun Strickland sued Delaware County and the GEO Group, a corporation that contracted with the county to run operations at the jail. Strickland’s lawsuit said he had been prescribed methadone to treat his opioid addiction for 18 months, had steady housing and a job, and was feeling “hopeful for the future for the first time in his 25-year battle with opioid addiction.”

But when he was arrested and jailed in August 2021 after missing a court hearing in another county, staff at the Delaware County jail told him that methadone was only available for pregnant people, he claimed in court documents.

He was forced to enter withdrawal, suffering “bone and joint pain, aches, vomiting, diarrhea, nausea, anxiety, depression, difficulty concentrating, insomnia, and uncontrollable cravings for opioids,” he said. Withdrawal from opioids also decreases a person’s tolerance for the drug, putting them at a higher risk for a fatal overdose if they use again, said Sarah Bleiberg Bellos, an attorney representing Strickland.

In court filings, Delaware County officials said the lawsuit was asking the courts to set an unreasonable precedent that “unless you have every available drug treatment program known to the medical community, you are deliberately indifferent to medical needs and are professionally negligent.”

A county spokesperson declined a request for an interview on the lawsuit.

On Monday, Romero filed a statement of interest in the case, writing that jails that keep these medications from incarcerated people are violating the Americans with Disabilities Act.

Her court filings say people in state jails have a right to all three medications federally approved to treat opioid addiction: methadone, buprenorphine, and naltrexone.

Methadone is an opioid that can help people with addictions stave off painful withdrawal symptoms. It is heavily regulated by the federal government and can be dispensed only from specially licensed clinics.

Buprenorphine, another opioid, has become more popular in recent years and can be taken at home. Restrictions around who can prescribe it were lifted last year, making it easier to access.

Naltrexone is not an opioid; rather, it blocks opioid receptors in the brain to prevent people from experiencing a high even if they take opioids.

Methadone also was denied to a man in jail in Allegheny County, according an investigation that the Department of Justice launched after receiving a complaint from an incarcerated man who had a prescription for it. As in Delaware County, the jail only provided methadone to pregnant people at the time the man was held there.

In November, Allegheny County agreed to pay the man who was allegedly denied methadone $10,000 and start working within the next six months with a health care provider who can offer methadone, buprenorphine, and naltrexone to all inmates in the jail.

The Pennsylvania Institutional Law Project, which is representing Strickland in Delaware County, sees Allegheny County jail’s agreement as an example for other jails in the state to follow, said Bleiberg Bellos, a staff attorney at the nonprofit advocating for the rights of incarcerated people.

“It’s a really positive change for a jail to be providing these medications for everyone who needs them. But our position is that’s what’s legally required,” she said.

Addiction treatment in county jails varies wildly across the state. That’s in line with trends around the country, which suggest that more than half of the people in state prisons and local jails are dealing with drug addiction, but very few receive treatment for it.

A 2017 study that looked at data between 2007 and 2009 found that 58% of people serving time in state prisons and 63% of people serving sentences in jails had some kind of substance use disorder. According to the National Institute on Drug Abuse, 5% of addicted people in state prisons receive medication to treat opioid use disorder while incarcerated.

A 2022 report from PILP found that some Pennsylvania jails offer no addiction medications at all. Some only provide those medications to people who already had prescriptions for them. At the time of the report, just three allowed people to start addiction medication while in jail.

Philadelphia’s jail is an exception. It has allowed people to continue on their methadone prescriptions for about 20 years, city officials say, and also allows new and continuing prescriptions of buprenorphine and naltrexone. About 2,500 people a year start a buprenorphine prescription in city jails.

The city does not currently allow people to start methadone in jail, as Allegheny County will be required to do, but jail officials are discussing the possibility.

Since the Strickland lawsuit was filed, Delaware County has cut ties with the GEO group and now runs the facility itself. The jail now allows people incarcerated there to continue prescriptions for all three opioid medications; 58 people have been able to continue their methadone treatment in jail in the last year.

The jail does allow new prescriptions of buprenorphine and naltrexone, and issued 127 new prescriptions for buprenorphine in the last year.

Allegheny County jail now allows incarcerated people to continue prescriptions for all three FDA-approved opioid addiction medications, and anticipates being able to start prescriptions for methadone by next October, a county spokesperson said.

In state prisons, incarcerated people still cannot obtain a new methadone prescription unless they’re pregnant, said Steven Seitchik, Pennsylvania’s coordinator for medication assisted treatment. People who are already on methadone or buprenorphine can continue their prescriptions. They can also start taking naltrexone, without a prior prescription required.

Lack of funding and adequate staffing have made it difficult to ensure full access to all opioid addiction medications, Seitchik said. But he and other state officials are watching the Department of Justice’s actions in Pennsylvania closely.

“I do think that now it seems that this might be a tipping point,” he said.