Over the 44 years Sheriff Bill Elfo has spent in law enforcement, the United States is in the midst of the worst opioid crisis he has ever witnessed. Cheaper heroin has increased overdose deaths, and law enforcement officers have to adapt in the field.
Elfo and the Whatcom County Sheriff’s office are defendants in a class-action suit filed by the American Civil Liberties Union of Washington Foundation on June 6. Their concern over the growing need for addiction treatment in Whatcom County is echoed wholeheartedly by the ACLU class-action suit.
According to the ACLU, the suit relies partly on evidence given by opioid addicts in the Whatcom County court system.
The complaint alleges that Whatcom County jails withhold necessary medications from non-pregnant opioid addicts in jail. The medications that curb the symptoms of opioid withdrawal include buprenorphine and naloxone – a blend more commonly called suboxone.
According to the ACLU of Washington, the suit brings the local realities of a national crisis to the forefront. ACLU claims Whatcom County jails are breaking the Americans with Disabilities Act.
Jessica Wolfe, justice works fellow for ACLU of Washington, said in a written statement on the ACLU website, “The Whatcom County Jail’s categorical refusal to provide people with opioid use disorder the treatment keeping them in recovery violates federal law.”
She said the jail’s actions are unsafe and discriminatory.
The Americans with Disabilities Act prohibits discrimination on the basis of disability which, according to the ACLU suit, includes opioid addicts.
However, chapter four of the ADA states a current drug user is not considered a person with a disability and is not protected under the same anti-discrimination policies regarding employment or medical assistance. The ACLU suit claims addicts are considered disabled individuals with opioid-use disorder and should be provided the same medical protections while incarcerated.
Under the Code of Federal Regulations, drug addicts and alcoholics are not considered to be disabled – and therefore do not receive the same benefits and care options – unless they would still be considered disabled when sober. Casual and habitual recreational drug users are not protected by the ADA.
According to the social security website, inmates may apply to enroll in Medicaid while incarcerated, but Medicaid will not cover medical treatment while the person is in jail or prison under the federal inmate exclusion policy.
Without support from private insurance and federal healthcare systems, the ACLU suit claims county jails have a responsibility to provide options for incarcerated individuals with opioid use disorders such as offering access to medically-assisted therapy.
According to the National Institute on Drug Abuse, providing buprenorphine to one patient with bi-weekly visits costs $5,980 per year. Annual care expenditures for individuals with diabetes and kidney disease – conditions for which incarcerated individuals receive medical care – cost $3,560 and $5,624.
Suboxone and withdrawal
The ACLU suit is built on compiled data found in many research studies about opiate addiction and the cycle of criminality. The suit is founded on the stories of two men addicted to heroin currently in the Whatcom County criminal justice system. These men both had success staying clean with access to medically assisted therapies.
According to American Addiction Centers, suboxone curbs the side effects of opiate withdrawal including severe headache, vomiting, diarrhea, mood swings, anxiety and depression. The narcotic can produce a euphoric high, but is minimal compared to the high regular heroin users experience. The substantive high provides prescription and recreational opioid addicts relief from debilitating withdrawal symptoms.
According to an article in Vox, the abrupt transition from regular drug use to forced detoxification upon incarceration leads many addicts to relapse. The article claims incarceration does not provide adequate support for drug users to stay clean without access to medication-assisted treatments like suboxone.
The article references a 2007 study from The New England Journal of Medicine that states a drug addict is at the greatest risk of a fatal overdose after they are released from incarceration –129 times as likely as the general public.
According to American Addiction Centers, the withdrawal from suboxone can be worse than withdrawal from heroin. If an individual has inconsistent access to suboxone, they are more likely to revert to opiates to avoid the withdrawal symptoms, often resulting in overdose if their tolerance has lowered while in jail.
Stigmatization and cost
According to the National Institute on Drug Abuse, in 2013, $78 billion was spent on opioid use disorders and overdoses nationally; $2.8 billion, or 3.6 percent, was for treatment and prevention. The remaining budget was spent dispatching law enforcement and emergency services for individuals under the influence of opioids, relapse or overdose leading to hospital stays, relocating children, further healthcare dependency, caring for opioid-dependent babies, etc.
In Whatcom County jails, Elfo claimed one of the logistical issues with providing suboxone is space. He said they must separate inmates to avoid sharing and selling drugs like suboxone and prevent violence and assault.
Elfo said the county’s medical director is familiar with the injectable and more controllable narcotic Vivitrol, but Whatcom County jails are not medically equipped to provide such services. He said the only place in the jail available to dispense medication is in the booking area where there is a constant flow of human traffic, noise and no privacy.
Elfo said the county is searching for alternatives to arresting drug addicts, such as providing treatment in care centers. According to Sheriff Elfo, the county will open a 16-bed substance abuse treatment center by March 2019 in coordination with the health department. Sheriff Elfo claims this project was in progress long before the ACLU suit.
Dr. Marvin Wayne, Whatcom County Emergency Medical Services’ director, said the number of overdoses to which emergency services respond in the county is “not insignificant” and many more overdoses occur than are reported. Law enforcement may revive an overdose victim with Narcan and emergency services may never notified. Wayne said there are substance abuse programs “in the works” in Whatcom County.
According to Elfo, issuing Narcan to deputies has reduced the number of overdose deaths. Elfo said developing treatment centers like the one set to open next March is a way Whatcom County will “strive to adopt the best practices.”