s this country battles yet another drug epidemic, medical authorities and the federal government continue to promote “medication-assisted treatments” like methadone as the most-effective frontline defense against the ravages of opioid addiction. The Rehabilitation Act of 1973 and the bedrock Americans with Disabilities Act protect these patients from being discriminated against for their prescriptions.
Yet too often, parents managing addiction under doctor’s orders with methadone or similar medications are set up for failure in the nation’s foster care courts. Problems exist to some extent across the country, according to recent lawsuits, federal investigations and interviews with more than a dozen court officials, parents, advocates and disability rights activists.
“It’s against the law to hold it against people, but the courts don’t understand that,” said Montgomery County Juvenile Court Judge Anthony Capizzi of Ohio.
Capizzi is among those concerned that misinformed hospital employees, social workers, and even his fellow judges are part of the problem. Against all sound medical advice, he said, too many players in the child welfare system pressure parents to quit medication-assisted treatment, known as MAT, under the threat of losing their children to foster care.
He pointed to a 2019 resolution approved by the National Council of Juvenile and Family Court Judges, which advises the 30,000 professionals it serves that “denying access to the use of safe and legal MAT to persons in need is a violation of federal anti-discrimination laws.”
Yet Judge Capizzi — the council’s past president who trains court officials on medication-assisted treatment — said most judges still consider it a sign of active addiction that poses a risk to children.
“Clearly the majority don’t have the education,” he said. “They believe the only way to succeed is abstinence.”
Discrimination concerns in multiple states
The full extent of such conflicts with the law is not currently known.
Lawyers, social workers, judges and advocates in California, New York, Texas, Ohio and West Virginia described bias in the child welfare system against medication-assisted treatment as regularly occurring, despite the federal protections.
“These are not just life sustaining, but life-saving medications,” said longtime methadone patient advocate Abby Coulter, who founded the grassroots organization Methadone Maintenance Treatment Support & Awareness. Yet “people actually have to fight to have their own kids in their lives just because they’re on methadone.”
Federal agencies have also weighed in. In the past seven years, officials have intervened in three states after identifying discrimination against parents or caregivers offering to care for foster children.
Among the cases:
- An ongoing federal lawsuit in upstate New York involves a mother who was investigated by CPS in the hospital and at her home after the birth of her newborn due to her use of Subutex, a brand name buprenorphine medication. In an amicus brief, the U.S. departments of justice and health and human services concluded that such scrutiny violated federal anti-discrimination laws:
Hospital staff who called CPS and temporarily separated Nicole Costin from her newborn followed a blanket policy that “discriminates on the basis of disability by targeting pregnant people taking medication for opioid-use disorder for disparate treatment — specifically drug testing and CPS scrutiny,” federal officials wrote to the court.
The experience upended what should have been a joyous moment, Costin told The Imprint. “The focus was taken off of me being pregnant and the baby, and it was now on this biased vision that they had,” she said. “They were being very discriminatory. They saw me in a certain light, and they were sticking to that and treating me accordingly.”
- In Pennsylvania last year, an agreement announced by the U.S. Department of Health and Human Services’ Office for Civil Rights ensured the state cannot discriminate against prospective foster parents receiving medical treatment for substance use disorder. The agreement stemmed from a complaint that the Northumberland County child welfare agency discouraged a woman from applying to become a foster parent based on her use of methadone.
- In 2020, federal officials also called West Virginia to task, following a similar complaint filed by an aunt and uncle who had been barred from fostering their young niece despite a favorable home study. The oversight agency determined that social workers denied the placement “based on the uncle’s being in recovery from opioid use disorder and his long-term use of physician-prescribed Suboxone as part of his medication-assisted treatment (MAT) program.”
In that case, federal officials said, West Virginia’s Bureau of Children and Families Programs “declined to provide the aunt and uncle the opportunity to serve as a kinship placement option for these children, even though the aunt would have been the primary caregiver, and even though the uncle had not tested positive for illegal use of drugs during the course of his treatment (and eventually ceased using Suboxone altogether).”