Rough recovery: Courts, jails slow to adapt to best-practices for addiction treatment

  • In US
  • 2021-09-26 16:50:00Z
  • By The Record-Eagle, Traverse City, Mich.

Sep. 26-TRAVERSE CITY - Cyrus Patson, 20, of Grawn, is in recovery for addiction to opioids.

The meaning of the word "recovery" varies depending on who you ask, though it is often depicted metaphorically as a road.

Medical, court and law enforcement records show despite his youth, Patson's road to recovery has been both rough and winding.

"Right now, I'm just totally focused on that," Patson said. "I don't really do anything that's not related to recovery."

He's currently out on bond, awaiting sentencing in 13th Circuit Court for felony tampering with an electronic device.

Patson had been fitted with a tether after serving three months in Grand Traverse County's jail for an attempted resisting arrest charge and use of a controlled substance.

Patson, who has been diagnosed with substance use disorder, also has a misdemeanor conviction for domestic violence, records show.

Patson openly acknowledged his criminal offenses - crimes he said he committed while using.

"Now I go to meetings every night, I see my doctor regularly, I have a therapist, I'd like to work - I used to build stone patios," he said. "I would like to do something like that again. It's nice to do something and be proud of it."

He agreed to share his experiences with the Record-Eagle in hopes, he said, of improving the public's understanding of addiction, treatment and incarceration.

"There's millions of people who are affected by this every year," Patson said. "If nobody will put their name to it, and say anything about it, then nothing will change. I don't know, I guess I'm just trying to get the word out."

The change Patson and his attorney, Jesse Williams, say they are seeking is for Grand Traverse County, its courts and its jail, to implement MAT - medication-assisted treatment - for those, like Patson, diagnosed with a substance use disorder.

"What I find most concerning in the district court is the lack of understanding of what's happening in their own house," Williams said. "People with opioid use disorder are not getting their medications in the jail. In my opinion, that's wrong."

MAT refers to the use of buprenorphine, methadone or naltrexone, which when prescribed by a physician and used in conjunction with counseling, has been repeatedly found in clinical trials to be effective in treating opioid addiction.

MAT in Michigan prisons

In 2019, the Michigan Department of Corrections announced it would offer MAT in three of its prisons as part of a pilot program.

MDOC spokesperson Chris Gautz said the department's goal is to make MAT available in all the state's 31 correctional facilities by the end of 2023.

"It was a cultural shift for our staff to get used to," Gautz said. "They wanted to know why we'd prescribe something people frequently tried to smuggle in. We showed them the science."

Gautz said the majority of those smuggling in Suboxone - the branded form of buprenorphine - weren't using it to get high. They were using it to treat a use disorder. Once MDOC made it available legally, Gautz said, the amount of contraband corrections officers were finding went down.

Effects of Suboxone

Suboxone is a partial opioid agonist, approved by the U.S. Food and Drug Administration and accepted by Medicare and Medicaid for long-term and even lifetime use.

Critics say it substitutes one drug for another and can be abused, especially in an environment like a county jail or a state prison - a contention Gautz and Patson dispute.

"You don't get high off Suboxone," said Patson, who currently takes the drug legally as prescribed by his physician. "It just makes you feel normal. It takes away the urges to use."

Until, that is, you stop taking it. Which Patson did in June, though not by choice.

Patson was lodged in the jail for a bond violation and received Suboxone for one day, medical records show. The next day, medical staff with Wellpath, the jail's healthcare contractor, stopped giving it to him and he began detoxing.

His medical records, shared with the Record-Eagle, show his symptoms peaked four days later, and lasted for weeks.

"You're restless," Patson recalled, "but every time you move, it hurts. Your bones - it's like they're bruised. You're sweating and freezing at the same time. You can't sleep. Your anxiety is just insane. You have no appetite, just diarrhea and vomiting. It kills."

Not the future he said he imagined for himself when he was 13, and he and a friend swiped a relative's prescription Morphine. Taking the pills just felt good, and he liked it.

He said as a teen he didn't know they'd make him sick, or increase his odds of dying from an overdose.

A local version of a national issue

Today, the recent criminal charges lodged against Patson, and his willingness to waive confidentiality and allow his medical records to be discussed in open court, has highlighted the local instance of a national issue.

"That's a problem with jails across the country - the level of care for the people incarcerated is not what it needs to be to keep them healthy," said Scott Burris, a Temple University law professor and director of the university's Center for Public Health Law Research.

"Then when you begin to discuss this type of medication, there are attitudes that say they (drug users) should just stop," Burris said. "That they should hit rock bottom. And these attitudes are based on a selective understanding of how substance use disorder works."

A diagnosis of SUD requires evidence not of just drug use, Burris said, but of use that becomes a negative force in a patient's life - they miss work or lose their job, for example, their relationships end and they can't pay their bills.

Or, like Patson, who now lives with his grandmother, Vickie Patson, they come to the attention first of law enforcement and then the court system.

"He hasn't been an angel, but he is focusing hard on trying to stay clean, while also battling major depression which runs in my family," Vickie Patson said.

"He's bright, he's smart, but his self-esteem has been effected terribly by the treatment of the judicial system in Grand Traverse County," Vickie said.

Her voice breaks when she recalls a video visit she had with Cyrus, while he was in jail and going through the worst of his detox symptoms.

"The jail isolated him, he was all alone and the judges never seem to focus on what he's accomplished," she said. "The courts and the police seem to have no understanding at all of mental health."

The court and the jailTwo judges in 86th District Court - Judge Robert Cooney and Judge Michael Stepka - included directions in their sentencing orders for Patson or in court transcripts, stating Patson continue all physician-directed medical treatment while incarnated, records show.

That didn't happen.

Wellpath's medical staff stopped his Suboxone, provided paper cups of orange Gatorade as treatment during his detox and prescribed substitutes for his other medications, records show.

Williams then fought the issue in court.

In August he filed a motion asking the court to either enforce what he called a judge's medication order or release Patson on bond to the care of a recovery residence, where he could receive his medication.

Cooney heard arguments on Williams' motion, then twice ruled local judges have no say over the day-to-day operation of the jail and Patson continued to go without Suboxone. Until right before he was released, records show.

"Pt (patient) will restart Suboxone prior to leaving jail," a handwritten note, dated June 16, in Patson's jail record shows.

Patson's next court date is a sentence hearing, on charges of tampering with a monitoring device, scheduled in 13th Circuit Court for Oct. 15 in front of Judge Kevin Elsenheimer.

Patson said he's anxious about it, but tries to think positively.

"I'm an addict and I always will be," Patson said. "How I decide to control that is up to me. And I'm doing everything I can, you know, to walk the right path. My family wants me to live."


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