While working as a physician at our local San Francisco County General Hospital recently, I saw a patient I’ll call Jack. It stood out to me because I had been in the hospital for two months, an exceptionally long time for a hospital admission, as most people are only admitted for three to five days. He had been hospitalized for a stroke and needed post-acute rehabilitation in a skilled nursing facility to help him recover.
Jack also had an opioid use disorder and had been in recovery for over 30 years. He attributed his success to being on methadone, a life-saving prescription opioid used to treat dependence and addiction. His methadone treatment was also the reason why he remained hospitalized while all the nursing facilities in the area refused to accept him.
This practice of facility administrators declining methadone patients is common. It is also unethical and illegal. The Americans with Disabilities Act (ADA) was enacted in 1990 to protect the rights of people with disabilities, ensuring that they receive equal treatment and opportunity in various aspects of life.
According to the ADA, opioid use disorder is considered a disability as a chronic disease. Like Jacks, many skilled nursing facilities across the country decline to serve patients based solely on their methadone prescriptions. A recent study found that more than one-third of patient hospitalizations involved a refusal to refer a patient to another facility because of methadone treatment.
Methadone is a medication approved by the US Food and Drug Administration to treat people with opioid use disorders. It is a proven and effective treatment that allows many people to regain their health, stability and functionality. But the stigma surrounding methadone, coupled with a lack of understanding of the treatment, has led many skilled nursing facility administrators to adopt discriminatory admissions policies.
Patients are forced to choose between continuing their life-saving methadone medication or recovering after hospitalization or illness. Patients who choose to stop methadone risk losing an initial level of treatment stability, leading to a higher risk of returning to serious drug use and fatal overdose. These discriminatory policies also extend to prisons, which deprive individuals of methadone treatment, forcing them to experience excruciating withdrawal symptoms. Research shows that incarceration causes the risk of fatal overdose to skyrocket both behind bars and after release.
These practices create an environment where methadone patients are routinely denied the care they need, ultimately exacerbating health disparities. It is essential that administrators and policy makers in these facilities recognize that their policies and practices must align with the ADA to provide equitable care for all.
Several skilled nursing facilities and prisons are already facing legal action for discriminating against methadone patients. The Department of Justice recently released a statement highlighting how denying admission to people on methadone violates federal law.
Although some facility administrators may argue that they turn away methadone patients because of concerns about the potential for misuse or diversion of the medication to non-patients, these concerns can be addressed through appropriate medical protocols, monitoring and control of the fulfillment
Denying patients for being on methadone is not simply discriminatory; nor does it take into account the holistic needs of an individual. Individuals receiving methadone treatment often have complex health care requirements, and program staff in these facilities and prisons must strive to meet them as they would any other patient.
Furthermore, methadone discrimination is not only a legal issue, it is also a moral and public health concern. Denying people the opportunity to receive adequate care not only violates their fundamental rights, but also hinders progress in substance use disorder treatment and recovery. This comes at a time when drug overdoses are one of the leading causes of injury-related deaths in the country. In 2023 alone, there were more than 100,000 overdose deaths in the US, and the death rate is only increasing.
It is essential that policymakers, health care professionals, advocates, community members, and individuals raise awareness of this issue and take action to ensure that the ADA is complied with in all aspects of the health care system.
It is past time for all stakeholders to recognize their responsibilities and provide equal access to all patients, regardless of their medical condition or treatment.
Individuals and families who face the immediate and acute problem of not being able to find adequate post-hospital care due to methadone treatment can file a complaint with the Department of Justice to open an investigation into the practice. Hospitals and professional organizations of health care workers can also work with nursing facilities to address their concerns and establish guidelines for the care of methadone patients.
The larger community of people taking methadone, their carers and policy makers must come together to address this issue and ensure that the principles of equity and compassion guide their approach to care for each patient
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