A startling North Carolina Department of Health and Human Services (NCDHHS) report in February showed a 22% increase in overdose deaths in 2021, claiming 4,041 lives and contributing to the highest number of overdose deaths in a single year recorded in the state.
North Carolina’s Office of the Chief Medical Examiner confirmed that 2022 showed no signs of those numbers decreasing.
Now two organizations, Disability Rights North Carolina (DRNC) and Vital Strategies’ Overdose Prevention Program, have announced two initiatives to protect the right to health care for North Carolinians with substance use disorders in jails and health-care settings.
Staff at these organizations say that efforts to reverse the opioid crisis are too often interrupted by rampant illegal discrimination in health-care settings against people who use drugs and an aversion from law enforcement to distributing life-saving medications for opioid use disorder (MOUD) to incarcerated people with substance use disabilities (SUDs).
DRNC and Vital Strategies’ recent press release announced their joint initiatives to prevent opioid overdoses in North Carolina by combining DRNC’s extensive reporting on overdose deaths in local jails and Vital Strategies’ anti-discrimination protection enforcement for people who use drugs.
“In the worst overdose crisis in history, it’s really unconscionable at this point that health-care providers are routinely discriminating against people who use drugs and that jails continue to force individuals off life-saving medication,” Derek Carr, legal technical advisor for the Overdose Prevention Program at Vital Strategies, told Queen City Nerve.
Discrimination in health care
As part of these new initiatives, DRNC will incorporate strategies to address illegal opioid discrimination in health-care settings such as creating Know Your Rights materials, monitoring health-care facilities, providing education on where and how discrimination takes place, offering direct legal assistance to discriminated individuals and instituting a litigation strategy targeting systemic drivers of opioid discrimination.
Many people with substance or opioid use disorders receive substandard care in emergency rooms after a nonfatal overdose or are denied admission to skilled nursing facilities for taking prescribed opioid use disorder medication, Carr explained.
He said he’s seen the discrimination lead to patients disengaging from care and returning to use with a heightened risk of opioid overdose after being detoxed and left with a low tolerance.
In his experience working in treatment centers, Dane Mullis, lead substance use disorder advocate for both DRNC initiatives, said people are often turned away and given the excuse that they need a higher level of care without a referral as to where to go.
“There’s this idea that if a person is currently using illegal drugs that they are not entitled to any protections whatsoever and that’s not the case,” Carr said. “Federal law does provide those protections in health-care settings.”
Carr believes there is a lack of understanding among affected populations, health-care providers and the legal community about what protections exist for people with SUDs, which is why one of the major goals of the newly announced project is to raise awareness of what protections exist.
According to NCDHHS, communities of color are more vulnerable to the opioid crisis, with percentages of overdose deaths increasing by 53% for white people, 117% for American Indians and 139% for Black people in 2021 compared to previous years.
Along with Know Your Rights resources, DRNC will create other materials driven by the needs and desires of directly affected communities, with a focus on more susceptible marginalized populations.
Accessing medication in jails
Treatment is as necessary inside of jails as it is outside, and legally jails and detention centers have the same duty to provide health care as the facilities that are built to do so.
Along with discrimination in health-care settings, DRNC’s initiative will protect the right to medications for opioid use disorder access for incarcerated people in North Carolina’s jail facilities and detention centers. The initiative will create a report of the facility’s current policies and practices related to MOUD access, provide Know Your Rights resources and offer legal assistance to incarcerated people seeking access to MOUD.
Luke Woollard, a staff attorney on the Criminal Justice Team at DRNC, said the goal of the initiative is to map out what MOUD services are already offered in North Carolina jails and pool resources to standardize MOUD access statewide.
Mullis is working on constructing a survey for criminal justice facilities to get an idea of what facilities offer MOUD and what access looks like within the facility.
So far, it’s not great. MOUD is currently only available in 20 of the 107 jails in North Carolina and still remains limited even in those 20 where it is present, Mullis said.
Carr told Queen City Nerve that there’s a direct connection between being denied life-saving medication and the risk of fatal overdose that wouldn’t happen with any other prescription.
“Someone with diabetes doesn’t come into jail and [is] told that they have to come off of their insulin,” he said. “That’s the stigma around these conditions.”
Because MOUD isn’t offered in all jails and detention centers in North Carolina, inmates with SUDs are taken off of their prescribed medication upon admission. Forget about the chance to start MOUD amid withdrawal symptoms after being forcibly detoxed, Woollard said.
He believes the goal of any incarceration should be to give the person opportunities to become better while incarcerated, not risk their health.
“By denying folks access to these meds while they are in these facilities, you are certainly putting their lives in danger, not only [of] personally damaging relapses, but also death,” Woollard explained.
DRNC’s 2020 Deaths in Jails Report noted that the majority of substance use-related deaths (overdoses and withdrawals) happened within the first two to four days of admission.
Even in the weeks following release, recently incarcerated North Carolinians are 40 times more likely than the general NC public to die from an overdose, said Kate Boulton, senior legal technical advisor at Vital Strategies, in the press release.
Without access to MOUD during and after incarceration, people with SUDs experiencing withdrawal will try to find other means either within the jail or in other substances to stop their symptoms, Woollard said.
“Anywhere people are incarcerated … [has] a duty to provide medical care,” he said. “It’s become pretty clear in the last few years … that MOUD is the best practice in terms of medical care for a lot of opioid use disorders.”
The decision on whether or not a jail offers MOUD, Woollard pointed out, is dependent on which county it’s in and past the minimal jail safety rules provided by the U.S. Department of Health and Human Services, jails tend to run on the bare minimum.
Because jails are almost completely run by the county sheriffs and funded by local county commissioners, one of the goals of the project is to uncover impact litigation cases that have the potential to cause positive systemic change and establish legal precedent case laws that ensure future protection for people with SUDs in health-care and jail settings across the state, Carr said.
Although the initiatives only started up this month, Mullins told Queen City Nerve he is preparing himself and his team for the frustrating and exciting journey ahead: “It wouldn’t feel as good when we get things done if it wasn’t challenging, right?”
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