JUDGES PLAY DOCTOR

A courtroom is not the best place to determine medical care. But because of
a gap in Vermont law on the treatment of drug addiction, the care of a
heroin addict imprisoned in Burlington has become the subject of a legal
struggle.

Last week a judge ruled that Vermont law does not allow the Department of
Corrections to administer methadone to heroin addicts inside Vermont prisons.

Corrections argued that state law allows methadone to be administered only
at clinics and universities, not in prisons. Shawn Gibson had been
receiving methadone from a clinic in Greenfield, Mass., but when he entered
prison because of a parole violation, he was forced against his will into
withdrawal from methadone.

Sometimes cold turkey withdrawal is the best treatment for a heroin addict.
Shawn Gibson, however, was using methadone as a heroin substitute, which is
often a useful method for staying free of heroin. When he found himself in
jail, his treatment had to be changed from methadone to cold turkey - not
from considered medical judgment, but because of the limits of Vermont law.

In an earlier case, Judge Alan Cheever ordered the Corrections Department
to administer methadone to a prisoner who had entered treatment in
Greenfield as part of a plea agreement. But the department refused,
releasing the prisoner early rather than initiate a program of methadone
treatment inside the prison.

The hard line taken by the department against methadone in jail is
supported by the law passed last year allowing for the establishment of
methadone clinics at hospitals. Gov. Howard Dean, an opponent of methadone
treatment, may be responsible for the department's rigid defense of that
provision of the law.

Gibson's lawyers argued that Gibson was receiving second-class medical
treatment because the Department of Corrections would not allow him to take
the methadone that had been prescribed for him. If drug addiction were
viewed from the medical perspective, it would make as much sense to
prohibit the administration of methadone in prison as it would to prohibit
the administration of insulin for diabetes.

Dean, however, may be of the view that cold turkey withdrawal is more
virtuous than methadone, which is itself addictive. On the other hand, it
is widely believed in the medical profession that methadone is frequently
the most effective treatment for heroin addicts. And judgments about
prescriptions should be made on medical rather than on moral grounds.

Given Judge Cheever's ruling in the Gibson case, it would seem that to
allow prisoners the same medical options as people on the outside, the law
governing methadone would have to be changed to allow its use inside of
prisons. For a patient on methadone who is imprisoned for a brief term
suddenly to disrupt his or her treatment merely because the law is written
in a particular way is to allow the law to interfere in an arbitrary and
potentially harmful way in medical decisions.

In the meantime, methadone users who have managed to put their lives back
together with the help of the drug ought to make sure they stay out of jail.

Otherwise, their painstaking process of recovery may fall victim to the
quirks of Vermont law.