A friend of the court brief filed by the Drug Policy Alliance on behalf of Cameron Douglas and signed by an impressive list of addiction treatment authorities is essentially a plea for methadone treatment behind bars. Because the case is under review by a federal appeals court, it could lead to legal recognition for the need for such treatment and the incongruity of incarcerating people because they have the medical condition of addiction, without providing any treatment for that condition.

Douglas, the heroin-addicted 33-year-old son of actor Michael Douglas, is serving a five-year sentence for drug distribution; the brief doesn’t take issue with that sentence. But in December, Judge Richard M. Berman of federal district court in New York City added four-and-a-half years to that sentence because Douglas was found with heroin and Suboxone in his cell. Believed to be the harshest sentence ever for such an infraction, this punishment approaches incarcerating someone for having a disease, something that is “abhorrent” to the American criminal justice system, the brief says.

Earlier this month, Douglas’ lawyers filed an appeal of Berman’s sentence to the United States Court of Appeals for the Second Circuit. Treatment advocates who signed on hope that this appeal will help create a legal foundation for methadone treatment behind bars.

A story sympathetic to Douglas, who has been getting drugs while in prison but has not been given any treatment, was published in The New York Times May 20.

Douglas started using heroin at age 20, was dependent by age 25 and ingested heroin five to six times a day in the five years before his arrest. He was under the influence of heroin at the time of his arrest at the age of 30 for drug distribution. His bail was revoked because he continued to use heroin, and he was incarcerated and charged with heroin possession.

Douglas’ actions were “the classic, textbook behaviors of someone suffering from untreated opioid dependence,” the DPA brief states.

Lack of access

“We signed on to the brief because of the lack of medication-assisted treatment in the criminal justice system,” said Sally Friedman, legal director of the Legal Action Center. Douglas was never offered methadone, buprenorphine or any other form of treatment, she said. “There’s a pervasive lack of access to medication-assisted treatment throughout the criminal justice system, and a lot of facilities don’t offer any kind of treatment at all.”

One problem is that many judges “don’t believe in” methadone, Friedman told ADAW. The problem exists in the family court system as well, she said. “The point of this effort is to educate a very influential court about the nature of opiate addiction and the nature of treatment with methadone and buprenorphine,” said Friedman. “We’re hoping the court will make a comment in its decision, something that could be cited.”

Cameron Douglas “has a treatable condition,” said Robert G. Newman, M.D., a scion of methadone treatment and the man behind some of the largest methadone programs in the world. “When someone has the signs and symptoms of a disease, to say ‘I’m going to sentence you to four-and-a-half years in prison’ — it’s hard to imagine that a judge would do this,” Newman told ADAW.

“As a physician concerned about people with medical conditions who are denied the help they need, I’m outraged,” said Newman. “But as a citizen, the thought that taxpayer dollars are going to spend many thousands of dollars to incarcerate this man — it’s difficult to understand this.”

People who are addicted to opioids should be able to have methadone or buprenorphine in prison, said Newman. “Some enlightened facilities provide methadone for detoxification, but it would be even better to give people maintenance treatment,” he said. If Douglas had been provided methadone or buprenorphine, he would not have had to self-medicate his opioid addiction in prison, he said.

At the least, people should be given the option for methadone maintenance before they leave prison, he said, noting that there is a high risk of overdose for former addicts upon leaving prison because they are no longer tolerant. But this wouldn’t have helped Douglas, who was in the middle of a long sentence.

The Rikers Island jail in New York City does have a methadone program, which has been “enormously successful,” said Newman, who signed on to the brief.

Treatment in community

Howard Josepher, a former heroin addict and convict who is founder, president and CEO of the community-based treatment program Exponents, which signed on to the brief, doesn’t necessarily think that treatment behind bars is the best solution. “It’s questionable what kind of treatment you are going to get when the people who are treating you have a higher priority — to see that you finish your sentence and to maintain security in the prison,” he told ADAW. “They’re just going to be punished and for all we know come out of prison more hardened and with less opportunity to avoid a wasted life.”

A heroin addict for seven years in his 20s, Josepher was arrested multiple times and eventually got treatment at Odyssey House. He tried to get into methadone treatment — Marie Nyswander and Vincent Dole had just started their program — but couldn’t because “they only wanted people who were really hardcore — 10 years of addiction and a minimum of 10 arrests,” he said.

The brief includes a medical presentation about opioid dependence, medication-assisted treatment, the consequences of not treating it and “the incongruity of responding to opioid relapse with incarceration.” The brief cites the work of addiction researcher Redonna K. Chandler, Ph.D., showing that chronic opioid users need treatment even if they have been under enforced abstinence during incarceration (see ADAW, Dec. 5, 2011).

The signers of the brief filed by the DPA are a who’s who of the country’s prominent addiction academics, clinicians and researchers: the New York Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the California Society of Addiction Medicine, the American Association for the Treatment of Opioid Dependence, the Center for Prisoner Health and Human Rights, the Osborne Association, the National Alliance for Medication Assisted Recovery, Exponents, the Legal Action Center, International Doctors for Healthy Drug Policy, Robert G. Newman, M.D., Beny Primm, M.D., David Lewis, M.D., Josiah D. Rich, M.D., Joshua Lee, M.D., MS, Ernest Drucker, Ph.D., Joyce H. Lowninson, M.D., Sharon Stancliff, M.D., Peter Banys, M.D., Bruce Trigg, M.D., Carl Hart, Ph.D., Daliah Heller, Ph.D., and Herman Joseph, Ph.D.

There is no predicting when the appeals court will issue a ruling, said the Legal Action Center’s Friedman. However, Douglas’ defense team as well as the methadone treatment field hope that it will bring hope to the thousands of inmates who are behind bars because of their addiction.

For a PDF of the brief, go to http://bit.ly/Ltkgmv.