BOSTON — In Massachusetts, men suffering from drug addiction can be sent to prison even if they have not committed a crime — even where access to treatment is limited and sometimes more damaging for recovery — according to prisoner rights' advocates.

The commonwealth is the only state in the country where men with substance use disorders who are not charged with a crime can be civilly committed by a judge. Women cannot be incarcerated for treatment.

And, according to Alex Sugerman-Brozan, an attorney with Prisoners Legal Services, the Massachusetts Department of Correction has not provided effective treatment to drug-addicted inmates. More than half of all prisoners in the state have substance use disorder, Sugerman-Brozan wrote in an email.

"The DOC needs to greatly expand the availability of programs, and to make sure that the programs offered are evidence-based and effective," he wrote.

In 2018, the Massachusetts Legislature passed a major criminal justice bill. It specifically loosened sentencing laws, which could help people with smaller drug offenses on their record receive necessary treatment outside of the prison system.

"We don't incarcerate people simply because they have a disease," he wrote. "SUD is no different."

The DOC announced in November that it will allocate more than $1 million to treat opioid use disorder, which supports its recently launched opioid treatment and prevention initiative. An estimated 1,500 of the 8,300 inmates in Massachusetts state prisons are diagnosed with opioid disorders.

"The goals of the project are to reduce crime and violence, associated costs, and recidivism rates by improving prison safety and promoting the health of inmates with opioid use disorders prior to their release," the news release said.

The state's 14 counties maintain separate houses of correction and five of them were participating in a pilot treatment program launched last year. Bristol County Sheriff Thomas Hodgson opted out of the program, telling Southcoast Today that inmates sometimes hide and sell the medications, and hiring staff to oversee administration could be costly.

"I know everybody is anxious to find an answer, but we want it to be the right answer," he said.

Current solutions

A current bill, which has been discussed on the Senate floor, would prohibit incarcerating people suffering from addiction in the event of a relapse by requiring less frequent drug testing.

The bill, entitled "An Act relative to treatment, not imprisonment," will support people suffering from addiction more effectively, said state Rep. Lindsay Sabadosa, D-Northampton, adding that she believes treatment for substance use disorder needs to be community-based.

"We need to have treatment in real facilities where people are constantly treated with dignity and respect," she said.

She emphasized that relapsing is a part of recovery, and the passage of this bill could help reduce the stigma surrounding drug abuse.

In testimony to the Legislature's Judiciary Committee in October, Dr. Peter Friedman, president of the Massachusetts Society of Addiction Medicine, said that substance use disorder should be viewed as a "chronic brain disease."

"Incarceration does not effectively address substance use disorder," he said. "And persons with this disease deserve evidence-based, patient-centered treatment, not stigmatization and punishment."

Sabadosa said the fact that other medical patients aren't sent to correctional facilities for treatment speaks to the heightened stigma around addiction.

"There are still these ideas idea that anybody who uses opioids is somehow a criminal," she said. "While the use of opioids may be illegal, this is a disease — it is addiction at the heart."

She said it is important to treat these people with compassion instead of sending them to prisons because of the empty beds available.

The representative pointed out that in Western Massachusetts, a region that sees some of the highest number of opioid-related deaths, there are a limited number of treatment facilities.

In the city of Northampton, 26 people have died from the epidemic over the last five years, according to the Massachusetts Department of Public Health.

Hampden County Sheriff Nick Cocchi has a designated a wing of his prison to men civilly committed for substance use charges. Cocchi has reported success and satisfaction from these men, with less than 5 percent having to reenter the program.

Bonnie Tenneriello, a staff attorney with Prisoners' Legal Services, and other opponents have criticized Cocchi's model, which largely takes place in a jail setting, saying no matter how nice a facility is, a prison environment is not conducive to treatment.

"The shame and stigma around addiction are an enemy to treatment," she said. "We only compound that when we send people to prison."

Community approach

Sugerman-Brozan agreed, writing that sending these men to prison perpetuates "unwarranted and negative stigmas. It undermines effective treatment and reinforces the perception that they are second-class citizens."

He and Tenneriello agree that people with SUDs who have not committed a crime should be treated in the community through programs in a health care setting that offer adequate behavioral and mental health services.

She also said that trauma plays a major role in prisons, as they are designed to control and punish people. This makes it harder for addicts to open up about their experience and recover.

"For most people, it's counter therapeutic," she said. "In other words, [prisons] are not a therapeutic environment."

Prisons also isolate people from the outside world, which can cause them to lose connections at a time when they are most vulnerable, Sugerman-Brozan wrote in his email. "Civilly committed people who are incarcerated can and have lost their jobs and their housing, making them even worse off when they reenter the community."

The drug court solution

The Massachusetts court system has attempted to address the issue with 25 drug courts across the state, which aim to address the issues underlying criminal behavior, such as drug or alcohol substance use disorder and/or mental illness.

District Court Judge Mary Beth Heffernan, a former Secretary of Public Safety and Security in the Deval Patrick administration and an attorney who worked in the health care industry, has been on the bench for six years, in Newton and as a drug court judge in Quincy.

Heffernan said she sees her purpose as saving people's lives and helping them get the tools they need to recover and being good contributors to society.

The drug court serves people on probation who have a long history of overdose. It is a four-phase treatment program that starts out with residential treatment and concludes with integrating people back into the community and eventually to their homes.

Heffernan said she considers a person's overdose history and recommendations from probation officers before determining whether or not to send them to prison.

When it comes to incarcerating someone, Heffernan said she also weighs how much this person disrupts public safety, particularly if they have a history of stealing or breaking and entering.

"Sometimes, the only thing to do is to incarcerate the person," she said. "They're out of control on the street; they've resisted or refused any medically assisted treatment."

In response to criticism of the drug court, Heffernan said she thinks it is a viable treatment option because of the many medical services it provides, including access to trauma therapy.

"Many events in their lives have led them to abuse and use drugs," she said. "If you don't deal with that underlying issue, you're never going to have success at stopping."

While the probationary period is supposed to last only 18 months, oftentimes the process takes closer to a few years, which could be longer than a prison sentence.

However, Heffernan said it is compelling when people value the drug court framework which could help them from abusing drugs.

What can Massachusetts do

Sabadosa said it speaks volumes other states do not use their jails as a place that amounts to medical care.

"I also think it is particularly poignant that women cannot be sent to houses of correction for treatment," she said. "We have this funny distinction."

In order to treat addiction successfully, Sabadosa believes a holistic, health care approach is necessary, which should include a long-term sustainable plan for people to enter and stay in recovery.

"It's also about creating a new mindset, talking about meditation and exercise and healthy eating habits and ways," she said. "Those types of models are far more successfully."

Sugerman-Brozan wrote that locking people up for a disease is a step backward in the battle against eliminating stigma around addiction.

"Massachusetts needs to invest in providing adequate treatment facilities and beds in the community so that no family is forced to make the choice between getting their addicted love one treatment and keeping them out of a prison."