Treatment for opioid addiction often brings discrimination

Danielle Russell was in the emergency department at an Arizona hospital last fall, sick with COVID-19, when she made the mistake of answering completely when she was asked what medications she was on.

“I said yes, I was taking methadone,” said Russell, a doctoral student who also was in recovery from heroin use. “The smart thing to do, if I wanted to be treated like a human, would be to say no.”

Even though her primary doctor had sent her to the ER, she said she was discharged swiftly without being treated and given a stack of papers about the hospital’s policies for prescribing pain medications — drugs she was not asking for.

“It becomes so absurd and the stigma against methadone especially is so strong,” she said, noting that other people in recovery have had it worse. “You’re getting blocked out from housing resources, employment.”

It's a problem 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 can face additional discrimination — including in medical and legal settings that are supposed to help.

This week, the U.S. Department of Justice published new guidelines aimed at dealing with the problem: They assert that it's illegal under the Americans with Disabilities Act to discriminate against people because they are using prescribed methadone or other medications to treat opioid use disorder.

The guidelines don't change federal government policy, but they do offer clarification and signal that authorities are watching for discrimination in a wide range of settings. The Justice Department's actions this year also show it's taken an interest in the issue, reaching multiple legal settlements, filing a lawsuit and sending a warning letter alleging other violations.

One of the government's recent settlements was with a Colorado program that helps house and employ people who are homeless. 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. Stan Garnett, a lawyer for the organization, said Thursday that the organization's staff is being trained to comply with the law.

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

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

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

“We’re not looked at as another medical facility or counseling office,” Haight said. “We’re looked at because we do addiction.”

The new guidelines suggest that such broad denials could be violations of the ADA.

Overdoses from all opioids, including prescription drugs containing oxycodone, heroin and illicit laboratory-made varieties including fentanyl, have killed more than 500,000 Americans in the last two decades, and the problem has been growing only worse. That has frustrated advocates, treatment providers and public health experts who see the deaths as preventable with treatment.

Even as the crisis has deepened, there have been glimmers of hope. Drugmakers, distribution companies and pharmacy chains have announced settlements since last year to pay government entities about $35 billion over time plus provide drugs to treat addictions and reverse overdoses. Most of the money is required to be used to fight the epidemic.

It's still to be determined how the money will be deployed, but one priority for many public health experts is expanding access to medication-based treatments, which are seen as essential to helping people recover.

But there's still a stigma associated with the treatment programs, which use the medication naltrexone or drugs that themselves are opioids, such as methadone and buprenorphine.

Marcus Buchanan used methadone from 2016 through 2018 to help end a decadelong heroin habit. During that time, he was looking for work near his home in Chouteau, Oklahoma — mostly at factories — and could never land one.

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

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

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

“The next step is helping employers understand this is a disease instead of a moral failing,” Bissett said. “We don’t think about substance abuse disorder the way we think about diabetes, for example.”

One of the places where medication-assisted treatment is sometimes restricted or banned is in state drug diversion court programs, which are intended to get people help for addiction rather than incarcerate them.

Fewer than half the states have specific language that prohibits judges from excluding people who are taking the medications from participating in diversion programs or requires that they allow its use as part of the programs. That finding is based on an Associated Press review of legislation, administrative court orders and drug court handbooks that guide state drug diversion court programs.

Some states allow individual courts to make their own rules, while others only include language saying people can't be excluded. Judges in some states still require defendants to taper off the medications and allow the diversion programs to decide whether the medications are appropriate for each person enrolled.

The Center for Court Innovation is trying to steer the drug courts into creating policies and programs that support people taking those medications instead of incentivizing them to stop.

“It can be frustrating, because nobody needs to tell a judge they need to allow someone to take blood pressure medication,” said Sheila McCarthy, a senior program manager for the Center for Court Innovation. “But for some, there is just a disconnect about the real effect these medications have on a person’s daily life.”

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

She said some people in the medical field — a physician, a dentist, a pharmacist — seemed to treat her differently after they learned she was on methadone treatment. They sometimes assume she was going to ask for new prescriptions for pain medications.

“I felt like I had a sign on my forehead saying, ‘I am 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 been off it, I can see the night-and-day difference.”

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Mulvihill reported from Cherry Hill, New Jersey.