If it is agreed that opioid addiction is a disease — and there is widespread consensus that it is — then it must be treated as such, even if the patient is behind bars. And that means using the most effective methods of treatment.

U.S. District Court Judge Denise Casper said as much earlier this week when she ruled that an Ipswich man must continue to receive his regular methadone treatment when he enters Middleton Jail, likely sometime next month.

The Essex County Sheriff’s Department, which manages Middleton Jail, does not allow methadone treatment. Sheriff Kevin Coppinger says bringing the drug, an opioid itself, into a correctional facility is simply too dangerous.

“In a prison setting, administering these drugs raises many security, logistical and fiscal concerns, that are not issues for individuals who are not incarcerated,” Coppinger said in a statement after Casper’s ruling. “Many individuals who arrive at our facility also test positive for other illicit drugs including fentanyl, amphetamines, benzodiazepines, cocaine, ecstasy, methamphetamines, and heroin, among others. Clearly this is a complicated issue.”

Casper’s ruling was a preliminary injunction and certainly won’t be the final word on the matter. On Tuesday, Coppinger said the department was considering an appeal. Friday he said the department will comply with the ruling “while reserving all legal rights in the future.” The decision has the potential to set a precedent nationwide, where a quarter of inmates are thought to be dealing with opioid addiction.

Massachusetts officials already recognize the need for change, recently approving a pilot program to allow medication-assisted treatment at some county jails. That program, however, won’t begin until next fall and it won’t include Essex County, meaning it won’t help Geoffrey Pesce.

Pesce faces a minimum jail sentence of 60 days in connection with a charge of driving with a suspended license. That time may grow after he is sentenced for violating his parole on an earlier charge. With help from the American Civil Liberties Union, Pesce filed suit earlier this year in federal court, saying denying him the medication would violate the Americans With Disabilities Act and constitute cruel and unusual punishment.

Pesce has struggled with opioid addiction for years, overdosing at least six times, his life saved by paramedic-administered Narcan. He has gone through four detox programs, according to court documents, and taken buprenorphine and naltrexone without long-term success, losing his job, his relationship with his son and his home in the process.

A daily liquid dose of methadone, prescribed by his doctor, Shorta Yuasa, and administered through a Lahey Behavioral Services program in Danvers, has proven effective when paired with counseling and behavioral therapy. Pesce hasn’t had a positive drug screening since December 2016, and he has a new job as a machinist.

Let’s be clear: No one wants to see an inmate die. Coppinger has made treatment of substance abuse among the jail’s prisoners a priority. The jail has a nationally recognized detox program, has brought in recovery coaches to assist inmates and offers Vivitrol, a once-a-month shot of naltrexone that blocks brain receptors that react to opioids.

What the jail does not offer, however, is methadone. Inmates who used the drug before incarceration undergo forced withdrawal, with medication aimed at easing their symptoms. That can be deadly for some people addicted to opioids.

“In Dr. Yuasa’s experience, ‘there are some people for whom buprenorphine and naltrexone simply do not work, and (Pesce’s) history suggests that he is one of those people,” Casper wrote in her ruling. “According to Dr. Yuasa, without methadone treatment Pesce will no longer be in remission from active addiction and his tolerance for opioids will diminish significantly. Dr. Yuasa has treated numerous patients who have relapsed, overdosed and died after being denied access to (methadone) during incarceration.”

Surely, the state’s jails can find a way to administer a medically supervised methadone program without having the drug fall into the wrong hands. In her ruling, Casper noted methadone treatment “is a common practice in institutions across the United States and in two facilities in Massachusetts.”

In Rhode Island, overdose deaths dropped 12 percent statewide in the first year after methadone treatment was instituted in its jails. And the number of overdose deaths fell 61 percent in 2017 among those recently released from jail or prison, according to a report in JAMA Psychiatry.

If we truly want to tackle the opioid epidemic, we must find ways to treat everyone who suffers from addiction, wherever they may be. And we are learning there is no one-size-fits-all approach. In Pesce’s case, a doctor says the best approach is methadone. It’s up to the Middleton Jail to see that he gets it.


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