In 2018, Sonya Mosey was on probation in Pennsylvania. Sonya had struggled with opioid addiction for over a decade. (Spotlight PA reported Sonya’s story, as reproduced here). She finally found success entering recovery thanks to buprenorphine, a pharmaceutical treatment that blocks the brain’s receptors for opiate drugs, thereby preventing intoxication, reducing cravings, and easing withdrawal. Medications like buprenorphine—along with methadone and naltrexone—are known as “Medication-Assisted Treatment” (MAT) and are now supported by extensive research as the standard-of-care for treating Opioid Use Disorder (OUD).
Despite its proven effectiveness, much of the stigma against addiction and opioid use extends to MAT. Sonya felt that stigma when court officials decided to ban anyone under court supervision from using MAT under threat of revoked probation. The court’s order claimed—falsely—that MAT is abused “with regularity,” makes “probationers ineffective and nearly impossible to manage,” and “[does] not appear to help the patients in any way to become productive members of society.”
Under this misguided rule, Sonya was forced to stop the treatment that helped her finally overcome her addiction or else risk going to prison. Spotlight PA reports: “[Sonya] tried to wean herself off the drug but soon began to experience withdrawal. She felt sick every day and couldn’t get out of bed,” and she feared that she would relapse and overdose.
The Department of Justice intervened. DOJ found that, under the Americans with Disabilities Act (ADA), the Pennsylvania court system unlawfully discriminated by prohibiting MAT. A substance use disorder may be a disability under the ADA, and as one DOJ official put it to STAT News, “discrimination on the basis of treatment is discrimination on the basis of disability.” Pennsylvania has opposed DOJ’s findings and DOJ sued early this year. The case is ongoing.
For Sonya’s part, DOJ’s initial intervention allowed her to return to MAT under a doctor’s care, and she safely tapered off buprenorphine when she was ready to. As she told Spotlight PA, she now “sees herself as someone her parents can say they’re proud of.”
Unfortunately, the obstacles that Sonya faced remain all too common. Disability discrimination related to MAT generally takes two forms: unfair denials of access to MAT and illegal penalties based on MAT use.
Denials of access to MAT
People with OUD often struggle to access MAT, even though it is the most effective treatment for their addiction. While reliable national data is limited, researchers estimate that only 11 percent of patients with OUD are prescribed MAT. A stark racial and wealth gap results, with white people and wealthier people more likely to obtain the life-saving benefits of MAT than people of color and poorer people.
Stigma has outpaced science. There is significant stigma about opioid addiction and MAT among the general public and among professionals in relevant sectors, including healthcare, housing, and law enforcement. People often think of MAT as “substituting one drug for another,” and do not really believe there is an “effective treatment for OUD.” There is also a common misconception that MAT drugs are excessively misused or diverted into the black market. Because of these negative attitudes, people entitled to MAT are forced to go without.
Recently, however, successful legal enforcement has established that failure to prescribe these medications can amount to disability discrimination. For example, DOJ has entered a series of settlements with nursing homes and primary care practices that violated the ADA by refusing to accept patients who were on MAT. The resulting settlements imposed new policies for accepting these patients and adhering to the standard-of-care for treating OUD, effectively mandating that the providers prescribe MAT.
Similarly, DOJ, advocacy organizations, and private plaintiffs have successfully sued jails and prisons for failing to provide MAT. For example, a federal appeals court affirmed that a jail in Maine violated the ADA by imposing a blanket ban on buprenorphine. Plaintiffs have prevailed in similar cases even where the prison did not impose an outright ban on MAT, but provided only one of the three primary MAT options, denying incarcerated people the treatment chosen by their doctors. In 2019, Maryland became the first state to affirmatively mandate that local detention centers provide MAT; that law will take effect January 1, 2023.
Ultimately, as DOJ officials put it in a recent research paper quoted by STAT News, federal enforcement shows these restrictive policies “are often based on misguided stereotypes and stigmas about [MAT],” but people struggling with addiction have legal protections: “Rooting out such unfounded fears is at the heart of the ADA.”
Penalties against people receiving MAT
Nevertheless, the same stigma that limits prescribing of MAT also leads to discrimination after the treatment is prescribed.
Lawyers with the Legal Action Center cite examples of discrimination based on MAT in people’s personal lives: “a father in recovery who was being denied visitation with his children because he was in methadone treatment,” or “a mother who was being threatened with eviction from a shelter because she was being treated with prescribed methadone.” Such restrictions are illegal disability discrimination. Thus, federal authorities successfully sued West Virginia for denying the application of a couple seeking to adopt their niece and nephew from the state’s custody just because the uncle was receiving MAT.
The issue also arises in employment contexts: for example, at Volvo Group North America’s manufacturing plant in Hagerstown, where Michael Files accepted a job offer. Michael was in recovery from OUD and had not used drugs in over five years. He continued to take buprenorphine as prescribed by his doctor, which he disclosed in a medical examination by Volvo after accepting the job. When Michael arrived for his first day of work, he learned Volvo rescinded his job offer because of his MAT use. Ultimately, the EEOC sued under the ADA on Michael’s behalf and successfully obtained a settlement from Volvo, which included mandatory policy changes to its medical and drug evaluations.
The bottom line—per Kristin Clarke, Assistant Attorney General for Civil Rights at DOJ—is that people with disabilities, including substance use disorders, “should not face discrimination when accessing evidence-based treatment or continuing on their path of recovery.”
In a culmination of this enforcement strategy, DOJ released administrative guidance in April of this year, reinforcing the ADA’s protections for people with OUD.
The attorneys at Brown, Goldstein & Levy have experience representing individuals who have faced disability discrimination. We assist such clients as part of our nationwide disability rights practice, which strives to ensure that people with disabilities from California to Maryland receive the protections of the ADA. If you have a substance use disorder and have faced discrimination, contact us today to discuss your situation.