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A: There are medical protocols for switching someone from methadone to buprenorphine.  This can be done under medical supervision.  Optimally, this is done at the patient’s request.  Refusal to provide a specific OUD medication based on a jail’s blanket policy, not a medical diagnosis based on an individual’s treatment needs has been found to violate the Americans with Disability law.  See https://www.rsat-tta.com/Files/ADA-opioid_guidance on this website.

However, you may see if the person is amenable to switching medication. Some patients prefer buprenorphine over Methadone because it is easier to access in the community, but others find they do better on Methadone than buprenorphine.

There are alternatives for your jail.  If the person is already enrolled in an Opioid Treatment Program (OTP), the jail can collaborate with the OTP to continue to provide the person’s Methadone. Correctional staff can be sent to a community OTP every day and take custody of a locked container that holds the Methadone needed to treat the individual in jail that day. The staff will then return with the locked box of Methadone to the jail and hand it off to the appropriately licensed medical staff who will dispense it. The community-based licensed and accredited OTP and the jail will, as with other offsite medication units, need to develop a MOU that includes the details how diversion will be controlled, the documentation of chain of custody, secure storage that complies with federal and state regulations and how other regulations will be met.

The medical personnel who dispense the Methadone in the jail must also be either a licensed practitioner, a registered nurse (RN) under the direction of a licensed practitioner, a licensed practical nurse (LPN) under the direction of a licensed practitioner, or a pharmacist under the direction of the licensed practitioner. Each of the correctional staff that transports the locked container of Methadone and medical staff that dispense Methadone also need to be an “agent” of the OTP through a formal written agreement. The term “agent” means an authorized person who acts on behalf or at the direction of the dispenser, which in this case is the community-based OTP.

Or the jail can transport the person to the OTP each day to receive the medication.  The person should be treated like every other patient receiving Methadone. The Essex County jail in Massachusetts did this when a federal court ordered it to provide Methadone for an individual who was scheduled to be jailed for 60 days.  The man sued the jail to continue his daily Methadone treatment when incarcerated. The man had struggled for two years to find effective treatment for his opioid use disorder and found Methadone worked for him.  In fact, his offense that resulted in the jail sentence was driving with a suspended license to get to the OTP when his regular ride fell through.  At the time, the jail offered only Vivitrol. The federal court granted a preliminary injunction, finding the plaintiff was likely to succeed in proving the jail violated the Americans with Disabilities ACT and the 8^th Amendment (Prohibition against cruel and unusual punishment) by not providing the plaintiff with methadone throughout his incarcerate. (Pesce v. Coppinger, 355 F. Supp.3d (2018)).

Both these alternatives will put a strain on correctional officers but avoid the jail having to become its own certified OTP or becoming a licensed satellite OTP, especially if this case is unique and not likely to be repeated in the future.  However, if you expect more people will enter in need of Methadone, the jail may decide to do what the Essex County jail did.  It subsequently established a MAT program offering all three FDA-approved medications to allow persons to continue whatever OUD medication they were on when entering the jail and to allow the jail to induce persons on any of the medications that were medically appropriate if they so requested.