Would you let your county sheriff fix your teeth or provide home health visits for a parent? Would you permit him to perform surgery on you or provide psychiatric services? Of course not. Your county sheriff is a man with a badge and a gun. So why on earth would you expect him to provide expert treatment and rehabilitation to those with substance abuse problems? Unfortunately, this is exactly what’s happening right now in Massachusetts.
The Legislature just passed long-awaited criminal justice reforms. An important objective was to keep people with substance abuse disorder out of jail and provide needed treatment. Yet several recent jail projects are already undermining the intent of these reforms. And they show just how inclined we are, as a punitive society, to always look to incarceration as the solution to a social problem.
In Hampden County, MassLive reports, Sheriff Nick Cocchi is rolling out an 86-bed “treatment facility” for opioid abusers in his jail. Cocchi says it’s conceivable another 100 beds will be needed. Within the next 60 days people with substance abuse disorder will be civilly committed under Section 35 and incarcerated in either the Hampden County jail or in the Hampden County Sheriff’s WMRWC Mill Street facility.
Sheriff Cocchi, like many sheriffs in Massachusetts, is now left with “empty beds” in his jail because of drug courts and other diversion programs. In some jails these “beds” are now being filled by ICE detainees and civil commitment is seen as a mechanism for filling others. Cocchi says “he anticipates seeking additional funding from the legislature during next year’s budget” and that “the new programs are for now carved out through savings and reallocations from within the annual Sheriff’s Department budget.”
A new report in MassInc by Ben Forman and Michael Widmer (“Revisiting Correctional Expenditure Trends in Massachusetts”) documents the cost of incarcerating someone at the Hampden County jail at almost $80,000 per year. A 90-day Section 35 commitment would cost almost $20,000. Certainly, more comprehensive and cost effective treatment can be provided outside of jail.
Civil commitment can either be a part of a criminal sentence or (more and more likely) a process initiated by a “spouse, blood relative, guardian, a police officer, physician, or court official.” But if sheriffs and legislators believe addiction is a disease, why then is prison the cure? In Massachusetts there have been a number of lawsuits challenging the incarceration of substance abusers precisely because prisons are not even close to being treatment centers.
In Suffolk County Sheriff Steven Tompkins wants to “partner” with AdCare to run a Vivitrol program at his South Bay jail. The Suffolk County program will target “pre-trial detainees” — those not convicted of any crime. The ultimate responsibility for the safety and effectiveness of a client’s rehabilitation program will rest with a law enforcement official, not a psychological or medical professional. And by outsourcing services to a private corporation — what could possibly go wrong?
Vivitrol is both controversial and currently the the go-to treatment for sheriffs. Vivitrol blocks the “high” from opioids for up to a month. Other Medically Assisted Treatments (MAT) with buprenorphine or methadone are not favored by sheriffs, although Vivitrol is problematic in many ways and may result in fatal overdoses. The drug made news recently because the Trump administration’s opioid treatment plan is typical of his style of crony capitalism — “a single drug, manufactured by a single company, with mixed views on the evidence regarding its use.” Vivitrol will be the only drug treatment given federal prisoners. Through an “Inspiration Grant” Alkermes gave to the National Sheriff’s Association, prison staff and contractors all over the country get a “taste” of the drug, then are allowed to buy more with taxpayer money. No wonder that Vivitrol CEO Richard Pops says “the best days of Vivitrol are still ahead of it.”
Over in Worcester County Sheriff Lewis Evangelidis is building a $20 million “intake” section for his jail, he says, for people with substance abuse disorder. The intake process will also screen for gang affiliation, prior offenses, and determine if those about to be incarcerated are detoxing or need psychological services. But, given the suicide epidemic among county jail prisoners in Massachusetts, legislators ought to be asking why medical issues are not being treated in medical facilities run by real medical professionals.
Some feel the brand-new criminal reform bill is a good start. But Massachusetts could learn something from Portugal, where medical, not carceral, treatment is used for drug addiction. Under Portugal’s 2001 decriminalization law, “anyone caught with less than a 10-day supply of any drug — including heroin — gets mandatory medical treatment. No judge, no courtroom, no jail.”
Prison is an inhumane and ineffective solution for dealing with drug addiction. So why, in a state with some of the best medical care in the nation, can’t we can do better than turning over drug treatment to sheriffs? Why should a sheriff — having no clinical expertise and possibly even unethical relationships to vendors — be permitted to determine treatments for drug rehabilitation? Why not invest in community-based treatment on demand instead of arresting and incarcerating people for low-level crimes committed and driven by their addiction? And why aren’t we taking the tens of millions of dollars used to civilly commit people and instead investing it in health and mental care in our communities?
If we believe substance abuse disorder is a medical problem, let’s put our money where our mouth is — in treatment rather than more investment in jails.