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A man serving a three-year sentence in a Kansas federal prison will be able to continue his medication-assisted treatment (MAT) program with buprenorphine thanks to a recent court ruling, but other inmates will not have the same option. The American Civil Liberties Union took up the case of Leaman Crews, 45, who has used buprenorphine for 14 months to manage his opioid use disorder. “It is a rare feat for that long a period,” Lauren Bonds, legal director of the ACLU of Kansas, told The New York Times by email. “It was kind of a success story.”Tylenol With Codeine For Withdrawal SymptomsHowever, when Crews reported to federal prison in Leavenworth, Kansas last week to serve a three-year sentence, the prison refused to give him buprenorphine. Instead, he was given Tylenol with codeine, an opioid, to help control his withdrawal symptoms. Michael V. Pantalon, a senior research scientist in the Yale School of Medicine, said using codeine was likely to make Crews’ condition worse. “He will have codeine to reinforce his opioid addiction rather than the medications that would treat it,” Pantalon said. The ACLU Takes The CaseThe ACLU took Crews’ case, arguing that he would “inevitably suffer and possibly die” without access to buprenorphine. The organization reached a settlement that will allow Crews to get his medication-assisted treatment. However, the settlement applies only to this case, and will not result in widespread policy changes to allow federal prisoners to receive medication-assisted treatment. Many prisons do not allow inmates to be treated with buprenorphine, arguing that because it is an opioid with potential for abuse it can be diverted to other inmates. However, Bonds pointed out that this is not applied universally—some inmates, including pregnant women, are allowed to have medication-assisted treatment using buprenorphine.“We do know that in Leavenworth they offer buprenorphine for inmates in certain situations, usually to help people detox, as opposed to maintaining sobriety,” she said. Taking inmates like Crews off their treatment regimen increases their risk for relapse and overdose, both within prison and when they are released, Pantalon said. “It is not life or death, like you take him off and he dies. It is life or death mainly when he comes out,” he said. Although Crews’ case will not impact inmates more widely, Nadine Johnson, the executive director of ACLU of Kansas, said that more work needs to be done to increase access to medication-assisted treatment in jails and prisons. “We don’t want others to endure the same or similar situations,” she said. “We look forward to seeing a Bureau of Prisons policy that respects what doctors are recommending in these cases.”Pantalon said that the government needs to change its thinking about addiction and medication-assisted treatment. “People who stay on it for one consecutive year or longer do far, far better and stay abstinent for longer,” he said. “It is a chronic disease, so it needs chronic treatment just like people with asthma or hypertension,” he added. “We don’t ask people with hypertension, ‘When are you coming off the hypertension medication?’”