New York Sheriffs Tried to Kill Jail Opioid Treatment Law

“The New York State Sheriffs’ Association OPPOSES this legislation, which would require that local correctional facilities provide medication-assisted-treatment (MAT) services,” the memos read. “The decision whether to offer MAT is one that resides, and should remain with, the Sheriff.”

Opioid use disorder is generally considered a protected condition under the Americans with Disabilities Act. The medications, which cut opioid cravings and manage withdrawal symptoms, have been shown to prevent people with opioid addictions from relapsing and overdosing. Many civil suits have argued that failure to treat the disorder constitutes a violation of federal law. In 2018, a wide-reaching federal case resulted in an injunction ordering a Massachusetts jail to offer methadone to an incarcerated man.

Despite the sheriffs’ efforts, the law passed in 2021 and went into effect last year. All New York jails are now required to provide MOUD. But implementation is often left in the hands of sheriffs who didn’t want the regulations in the first place — leaving it up to them to decide what kind of care incarcerated people receive.

Sebastian Solomon, who helped draft the law while with advocacy non-profit Legal Action Center, said that the sheriffs’ resistance to the programs should have disqualified them from being the sole stewards after the law went into effect.

“Substance use disorder is an illness, and we should be treating all illnesses with what is considered the gold standard of care,” said Solomon, now an associate director of policy with the Vera Institute. “The fact that they weren’t doing it on their own tells you there’s no reason it should be in their hands. They were refusing to do it.”

Even with the law in place, early data suggests that the jails aren’t doing everything they can to connect people with MOUD.

Reports obtained from the State Commission of Correction show that the jails failed to evaluate many thousands of incarcerated people for MOUD: 9,525 people in the state’s jails received evaluations between October and December 2022, while the average jail population on any given day was over 15,000. Of those who were evaluated, fewer than one in three were enrolled in a medication program.

In an interview, the Sheriffs’ Association’s associate counsel Alex Wilson insisted that sheriffs broadly support medication programs, but wanted them rolled out in a timeframe that would be easier to accommodate. Eleven of New York’s 62 counties — one out of six — received waivers from the MOUD requirements because there wasn’t a methadone program close enough to provide any, according to the Office of Addiction Services and Supports. Five of the counties still had waivers as of October 4.

“We’re always looking out for the best interests of our members, and we didn’t want to see them be put in a position where they had a legal obligation to provide a service that they just logistically couldn’t provide,” Wilson said.

While the Sheriffs’ Association recognized the benefits of providing medication, the group worried that the medications would impact its members’ abilities to maintain order. Suboxone, a common form of opioid treatment medication, was one of the most common types of contraband in the state’s jails, the memos said. The sheriffs feared that treatment programs would fuel internal black markets for the medication.

“Sheriffs are necessarily concerned about the potential diversion of opioid-based medication in their facilities. It is common for inmates to attempt to smuggle opioids into the jail, and Sheriffs are wary of introducing a controlled substance into a correctional setting as a result,” the memo said. “A Sheriff’s decision to implement MAT, or any type of inmate program, is always influenced by, and generally subordinate to, the practical safety and security concerns that are innate to running a correctional facility.”

Diversion is unlikely to harm opioid users. A year after Rhode Island established the nation’s first statewide MOUD program in 2016, a study found that no one had been hurt by diverted medications. At best, diversion actually reduces the risk of overdose. The overwhelming majority of people who purchase diverted buprenorphine (the ingredient in Suboxone that cuts cravings) use it to prevent withdrawal.

Even the jails that do want the programs to succeed are facing a major shortfall in funding. The 2023 state budget set aside about $8.9 million to cover the programs, in addition to group and individual counseling, withdrawal management services, peer support services, discharge planning, and re-entry support.