Locally, the opioid epidemic claimed 255 lives in 2017 alone, killed 1,207 Orange County residents between 2011 and 2015, and contributed to 7,457 costly emergency room visits during this period. Opioids are a class of highly addictive drugs including street heroin and pharmaceuticals like hydrocodone, codeine, morphine, etc. Addiction results in a loss of self-control, and it often ensues in behavioral problems and incarceration.
Inmates in the Orange County Jail—whether booked before release, held awaiting trial, or sentenced and serving time—receive medical care administered by Orange County Health Care Agency and the county Sheriff’s Department. These agencies do not yet employ the best medical practice for treating opioid addiction: Medication Assisted Treatment (MAT).
MAT treats opioid addiction with a combination of counseling and FDA-approved drugs such as buprenorphine/Suboxone and Methadone, which help mitigate painful withdrawal symptoms and deter relapse. Buprenorphine acts as a partial agonist, easing cravings, and an opioid antagonist, blocking other opiates from reaching the opioid receptors. Used responsibly in treatment, these drugs act on the opioid receptors in a helpful way. Both federal policy and the medical community recognize MAT as the standard of care for treating opioid addiction.
All inmates have state and federal rights to receive treatment for their physical and mental health conditions, including opioid addiction. By local policy, however, only a pregnant inmate can access Methadone upon booking, to avoid potential risk to the fetus. Federal courts have held that a policy of limiting MAT access to only pregnant inmates violates the Americans with Disabilities Act. Orange County’s MAT policy in jails violates the ADA, as this legal brief explains. Current policy and practice unnecessarily and unlawfully inflicts painful withdrawal symptoms on inmates while increasing their likelihood of relapse, recidivism, and death.
Orange County Health Care Agency Director Rick Sanchez has publicly agreed with promoting MAT access in jails, but he has protested the issue of cost. While presenting to the Select Committee on Orange County Chronic Homelessness on November 5, 2019, Director Sanchez explained that his agency cannot spend federal CalOptima or state Mental Health Services Act dollars on providing mental healthcare to inmates. “The issue is that we can’t use money in the jails,” he said.
However, the county government has a clear legal duty to provide healthcare to inmates in its institutional care, notwithstanding the impact on the county’s budget. Moreover, the County of Orange should use best practices to stop the hemorrhaging of local resources on a cycle of hospitalization and incarceration driven by opioids. The Board of Supervisors should vote to authorize local funds on providing inmates access to MAT.
Amidst a costly opioid epidemic, the Board of Supervisors’ best business practice is simply to employ best medical practices.
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Mohammed Aly is a lawyer and executive director of Orange County Poverty Alleviation Coalition.
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