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Jun 25, 2018 5:27 PMPublication: The Southampton Press

Local Doctor Says Prisoners Who Need Addiction Meds In County Jail In Riverside Have Difficult Time Getting Prescriptions

Dr. Allen Fein. VALERIE GORDON
Jun 26, 2018 1:12 PM

At least twice a month, Dr. Allen Fein gets a frantic telephone call from a family member with an incarcerated loved one who is suffering from opioid addiction withdrawal, tormented by symptoms such as anxiety, restlessness and irritability—symptoms that he said are seen all too frequently at the Suffolk County Jail in Riverside.

The Southampton-based Stony Brook Medicine doctor, who has treated opioid use disorder for more than 10 years, argued that many of his patients who have been diagnosed with opioid dependence prior to imprisonment are not given treatment in a timely manner when they are incarcerated, particularly if they wind up in jail on a weekend.

The reason, he said, is there is no full-time pharmacist certified to provide addiction medication to inmates on the weekends—which, according to Dr. Fein, violates the Americans with Disabilities Act—a civil rights law passed in 1990 that prohibits discrimination against individuals with disabilities.

Individuals with opioid dependence whose disability prior to confinement has been identified as requiring medication-assisted treatment—the combined use of FDA-approved medication with counseling and behavioral therapies—are protected by the ADA, according to the U.S. Department of Justice.

“It’s a violation of their civil rights,” Dr. Fein said.

Suffolk County officials, however, maintain that all prisoners are treated according to their needs.

Chief Deputy Sheriff Michael Sharkey said last week that everyone who enters the Riverside facility is screened by health care providers in the jail’s medical unit, which is overseen by the Suffolk County Department of Health Services, and is given the appropriate medical care.

“If they are in need of treatment, they receive it here,” Chief Sharkey said.

He referred all additional questions regarding the treatment of opioid dependence to officials at the Department of Health. Requests to speak to jail medical representatives were not granted.

According to a statement from the department’s public relations director, Grace Kelly-McGovern, upon entry into the jail, inmates are screened for substance abuse history and, based on those results, are assigned to a counselor who specializes in substance use disorders. If the individual is diagnosed with opioid dependence, they are advised to watch a video, which informs them of treatment options offered by the facility, including injections of Vivitrol, a drug used to treat opioid dependence.

“For those inmates who are already part of an opioid treatment program, they are able to continue their treatment while incarcerated,” the statement read.

In a subsequent statement, James Tomarken, commissioner of Suffolk County Department of Health Services, denied Dr. Fein’s suggestion that patients have gone days without treatment due to the lack of a weekend pharmacist, noting that access to medication is not dictated by pharmacy hours.

The pharmacy at the jail is open Monday, Wednesday and Friday, from 7 a.m. to 11 p.m., and Tuesday and Thursday from 11 a.m. to 11 p.m.

According to the statement, “When the pharmacy is not open, most medication, including methadone, Suboxone and Vivitrol, are available through an omnicell, an automated medication dispensing machine, in the jail medical units, and pharmacists can be contacted if a medication is not available.”

Mr. Tomarken said that licensed nurses are also available around the clock to distribute medication as ordered by a provider.

Still, Dr. Fein argues that while his patients are being treated for their disorder, they are not being treated in a timely manner.

“I have patients who are already on treatment with Suboxone for opioid dependence, and they go into the jail, they are not routinely given the medication, and they go into withdrawal,” Dr. Fein said. “They’re treating the prisoners like second-class citizens. They’re not even convicted of anything.”

Dr. Fein pointed to one of his patients, whom he declined to identify, who he said just last month was incarcerated on a Thursday and, for lack of a full-time pharmacist, was without medicine until Monday. The man’s routine medication, prescribed by Dr. Fein, was seized upon entry to the facility out of fear that the medication was fake, he said. The patient plummeted into full-blown withdrawal.

“They use it as a punishment,” Dr. Fein’s patient, who spoke on condition of anonymity, said on Monday. “They tell you that they’re so overloaded and that they don’t have enough people.”

He scoffed at the facility’s screening process, claiming that the staff was not concerned about a patient’s mental health. Asked about the omnicell, he said it doesn’t exist. Rather, a nurse walks around the facility with a medication cart and makes a daily roll call for medications.

“And if you miss it, you don’t get your meds,” the Eastport resident said.

He said the only automated machine is used to make doctor appointments—and even that takes days, four days in his case. “The story was, no one’s here on the weekends,” he said. “Unless you’re about to die.”

Dr. Fein referred to his patient’s case as a perfect example of the jail’s treatment of opioid dependence. “His case really exemplifies the bad care at the prison,” he said. “Twenty-four hours, that should be the limit, but not four days.

“The reality is, the prison in Riverhead failed to meet the patient’s needs in a timely manner, putting them through unnecessary emotional and physical discomfort,” he continued. “It’s inexcusable.”

He accused the facility of operating with a double standard, noting that incarcerated individuals with high blood pressure or suffering from diabetes are given medication without a second thought.

“It’s an inconsistent standard,” Dr. Fein said. “They don’t care enough for the incarcerated patient. Putting people into a horrible opioid withdrawal is not the appropriate care.”

He explained that it only takes three days without medication for patients in treatment for opioid dependence to enter into full-blown withdrawal.

But withdrawal isn’t even the worst part—it’s when they go back on their medication. Many times, when a patient is released from the correctional facility, they get narcotics off the street and die because they’ve lost their tolerance to the drugs.

In fact, inmates released from prison without having been properly medicated have more than 10 times higher risk of dying from overdose in the first two weeks following their release than the general population, according to the New York Society of Addiction Medicine, of which Dr. Fein is a member.

Michael Delman, president of the society, said this week that it’s not uncommon for individuals with opioid dependence to be denied access to medications upon entering department of correctional facilities.

“The problem with the jails is that they are run by the sheriffs and, depending on the sheriff, that’s what determines the care,” Dr. Delman said.

As of last month, Dr. Delman brought Dr. Fein’s concerns to the attention of the Legal Action Center—a New York City non-profit organization dedicated to providing legal services on issues involving discrimination—though he declined to offer any specific details regarding the investigation.

When reached last week, Sally Friedman, the legal director for the center, was unaware of any investigation regarding the Riverhead Correctional Facility.

Dr. Fein said that he has spoken to the Riverhead facility’s nursing staff multiple times about the delayed treatment for opioid dependence, noting that they are just as frustrated with the situation as he is. He explained that the nurse he spoke to told him that the nursing staff routinely gets angry phone calls from family and friends regarding inmates suffering from withdrawal.

Nurse practitioners at the jail are not authorized to administer the withdrawal medications, Dr. Fein said.

“Making them go off medication is completely not acceptable,” he said. “If your loved one gets sent to prison, good luck.”

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Don't do the crime if you cant do the time.
By chief1 (2554), southampton on Jun 29, 18 11:46 AM
3 members liked this comment
These people have simply been jailed, and they are not doing time because none have been convicted of any crime. Even people who are arrested and jailed have rights to timely medical treatment, covered by federal law (ADA). It is not only the right thing to continue their regular medications, unless certain issues arise, but other prisoners, prison staff are being placed at risk for injury by increasingly agitated prisoners who are inappropriately denied their medication. The benefit of doubt by ...more
By allenfein (66), Southampton on Jul 2, 18 10:03 PM
1 member liked this comment
So these criminals are suffering from anxiety cause they got caught and spending time in jail? Should we also give them a blow-up mattress for their cell
By Win sky (24), Southampton on Jun 29, 18 11:52 AM
They have been simply arrested and detained. They are not criminals as none of the calls that I receive are from convicted people. And even if they were to be criminals, continuing medication as prescribed often by expert specialists is wise, until reevaluation by prison medical staff recommends alternative treatment. What happened to my patient is that he was arrested on a Thursday morning....I got a call Friday evening after work from a prison pharmacist, and confirmed my patient's many medications ...more
By allenfein (66), Southampton on Jul 2, 18 10:21 PM
1 member liked this comment
So you prefer to pay for their incarceration rather than treat them for addiction? Not me. Do you see a knucklehead in the mirror?
By harbor (371), East Hampton on Jun 29, 18 12:37 PM
My 21 year old son had schizophrenia diagnosed by the county and physicians with delusions, voices, disabled judgement-- violated probation for selling an ounce of marijuana to EH Village's off-duty police chief (true), then by self-medicating with weed found in his urine by Riverside probation officer and, sentenced to 4 months by EH Judge Cahill (later ordered to pay back $1 million of misappropriated funds by State Supreme Court) and an assistant DA who adjudicated that he "knew right from wrong." ...more
By AndreaGurvitz (4), on Jun 29, 18 12:57 PM
Thank you for sharing your son's story with us and I'm sorry for our collective failure to treat his health problem outside of the criminal justice system.
By Fore1gnBornHBgrown (4610), HAMPTON BAYS on Jun 29, 18 1:33 PM
1 member liked this comment
wow at long last a light is being focused on this sad situation.The department of Substance abuse Services is one Department that needs to be investigated.The Methadone Clinics that provide this treatment modality fails its patients when they are incarcerated,daily medication is required.
By watchdog1 (488), Southampton on Jun 29, 18 7:54 PM
1 member liked this comment
Methadone isn’t medication. It’s heroin just spelled differently. If you’ve been incarcerated it’s so you can be rehabilitated.

Rehab is the opposite of what this guy is talking about.
By even flow (801), East Hampton on Jul 1, 18 7:22 AM
1 member liked this comment
Once again, you have proven your ignorance.
By johnj (911), Westhampton on Jul 2, 18 10:50 AM
1 member liked this comment
Methadone is also for patients with severe chronic pain. So not all patients on methadone are taking it for addiction. The relapse rate for people with opioid use disorder is over 90%, so current standard of care for the majority of patients is lifelong treatment, as rehab works well on a minority of people. By the way the vast majority of my patients are doing great, not getting high, and they have one or more legal jobs. They are are neighbors and come from every profession. Not at all what the ...more
By allenfein (66), Southampton on Jul 2, 18 9:55 PM
2 members liked this comment
That guy looks a little old to be incarcerated. What's he in for?
By SlimeAlive (1016), Southampton on Jun 30, 18 8:31 AM
The photo of that old guy! I’m 66 and quite free. I have however been inside various prisons at sad times as an investigating coroner (Quebec) and years ago to visit my friend (now free) George Guldi All the calls that I have received from Riverhead jail are for people simply arrested. None had been convicted. To force them off their psychiatric and pain medications, and medication for well controlled opioid use disorder amounts to patient neglect and even chemical torture when patients are ...more
By allenfein (66), Southampton on Jun 30, 18 11:49 AM
This comment has been removed because it is a duplicate, off-topic or contains inappropriate content.
By even flow (801), East Hampton on Jul 1, 18 4:54 AM
Maybe you should let the doctors do the doctoring.
By Fore1gnBornHBgrown (4610), HAMPTON BAYS on Jul 1, 18 7:14 AM
This comment has been removed because it is a duplicate, off-topic or contains inappropriate content.
By mtkfishman (54), montauk on Jul 1, 18 4:56 PM
1 member liked this comment
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