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Doctor pushes for NM to require lockups to provide substance use treatment

File photo of a secure patient treatment room at a correctional health care facility
Rich Pedroncelli
File photo of a secure patient treatment room at a correctional health care facility

People incarcerated in New Mexico have limited access to medication-assisted treatment for opioid use disorder. A bill expected to be introduced in the upcoming legislative session would change that by making it state law for all corrections facilities in the state to consistently provide it. Assistant Professor of Family and Community Medicine at the University of New Mexico Health Science Center Dr. Nathan Birnbaum treats patients returning home from prison and jail and has been working to get the bill in front of lawmakers.

NATHAN BIRNBAUM: There is one major detention center that does medication addiction treatment consistently, and that's the Metropolitan Detention Center here in Bernalillo County. And what's important to note is that MDC is larger than any prison in the state and furthermore it is a dynamic environment, yet at this point they are providing methadone treatment as well as buprenorphine treatment.

KUNM: Do we have a sense of the scale of this? Like how many people incarcerated in New Mexico have a substance use disorder?

BIRNBAUM: What we know from national statistics is that about 2/3 of individuals either currently have or at one point had a substance use disorder. And the estimate is 12.9% of New Mexico's drug overdose deaths in the year 2020 were among people who were recently released from an institutional setting. So, we know that this is disproportionate. With regards to opioid overdose deaths, the rate in individuals recently released from New Mexico corrections is estimated to be 11 times higher than the general population in the state of New Mexico.

KUNM: Most New Mexico correctional facilities don't provide medication-assisted treatment for opioid use disorder, though the U.S. Constitution requires prisons to provide adequate medical care to those in their custody. So, help me understand this — Why is this treatment not considered constitutionally mandated?

BIRNBAUM: As a physician, what I can say is that individuals should not be deprived of the standard of care for the treatment of their medical conditions. The American Society of Addiction Medicinespecifically says that medication for addiction treatment is the standard of care for individuals with substance use disorder in correctional facilities. I am not a lawyer, so I cannot speak directly to the legal framework by which you would say, 'This violates the Constitution.' But what I can say is that there have been cases filed by U.S. attorneys and other organizations that have held that individuals being deprived of this treatment violates the Americans with Disabilities Act.

KUNM: Yeah, so in terms of those legal protections for inmates with opioid use disorder, the Department of Justice released guidance earlier this year clarifying that they may be protected under the Americans with Disabilities Act, since drug addiction is considered a physical or mental impairment under the ADA. Do you know if the DOJ has found a prison in violation of the ADA for withholding this treatment?

BIRNBAUM: In April of 2022, the U.S. Attorney's office in Boston announced that it had completed a review to ensure that state and county correctional facilities maintained all medications for people already on treatment for opioid use disorder. So, they had entered into a cooperative agreement with the Worcester County Sheriff's Office and sent letters of resolution to the Department of Corrections of Massachusetts.

KUNM: And now, you are part of an effort to get a bill introduced in January's legislative session that would improve access to addiction treatment medications in New Mexico correctional facilities. What would that look like?

BIRNBAUM: All individuals who enter correctional facilities in the state of New Mexico would be screened for substance use disorder and have access to all FDA-approved medications for addiction treatment while they are incarcerated. And quite importantly, efforts would be made to link those individuals to treatment in the community so that people can remain stable and begin to put their lives back together.

KUNM: What's the status of that bill getting drafted at this point?

BIRNBAUM: We have a co-sponsor in Rep. Day Hochman-Vigil and I am working with individuals in the Senate in order to introduce this during this upcoming legislative session.

KUNM: And are you hopeful?

BIRNBAUM: I am hopeful that this will get done. It is the right thing to do. Medication for addiction treatment will save lives. It will reduce crime. It will reduce overdose and help these individuals rejoin their families and communities.

The Your New Mexico Government project is a collaboration between KUNM and New Mexico PBS with support from the Thornburg Foundation.

Nash Jones (they/them) is a general assignment reporter in the KUNM newsroom and the local host of NPR's All Things Considered (weekdays on KUNM, 5-7 p.m. MT). You can reach them at nashjones@kunm.org or on Twitter @nashjonesradio.
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