I write in response to the Letter to Editor written by Ms. Marie Irving
An OPINION by Ginger D. Schroder, Esq. Vice Chairman, Cattaraugus County Legislature
Ms. Irving: respectfully, your letter misses the point Cattaraugus County’s Sheriff Butler was making. The issue is not whether MAT can help people struggling with addiction. The issue is the enormous cost of a New York State-mandated program and the way that mandate actually operates in our county jail.
Unlike in the community, medical costs for incarcerated individuals cannot be billed to health insurance or Medicaid, they are paid for with County tax dollars. Last year, our jail MAT program cost Cattaraugus County taxpayers nearly $500,000 for medications alone. We have gone from roughly 10–15% of our jail population participating in MAT to well over 50%. We also have had to incur substantial additional costs to acquire and staff the medical personnel required to administer the program and correction officers needed to accompany inmates to and from treatment.
The MAT program is not limited simply to people who enter the jail already receiving addiction treatment. We are required to assess any incarcerated individual who requests inclusion in the program, including individuals who were not receiving MAT previously, and those who actually had no substance abuse issues when they entered the jail.
This is another uncomfortable reality that should not be ignored. Buprenorphine—the active opioid medication in Suboxone—is itself an opioid and can produce pleasurable or euphoric effects in someone who is not opioid-dependent. That creates an obvious incentive for some inmates who entered the jail sober and without an opioid dependency to seek participation in MAT: the medication can provide psychoactive effects, while participation also gets them out of their cells for treatment. With repeated use, it can also produce physical dependence, meaning that abruptly discontinuing it can cause withdrawal. The troubling result is that a program intended to treat opioid addiction can, if provided to individuals who were not opioid-dependent in the first place, create physical dependence that did not exist when they entered the jail. That is not an argument against MAT for people who genuinely suffer from opioid use disorder. It is an argument for the appropriate diagnosis, medical safeguards, and accountability we have in place before taxpayers are required to fund opioid medication for someone who did not enter the jail with an opioid use disorder. The state’s mandates do none of this.
I serve as Vice Chairman of the Cattaraugus County Legislature’s Finance Committee, so I see these costs firsthand. They are not abstractions. Every dollar Albany requires us to spend is a dollar that cannot be spent elsewhere—or must be raised from local taxpayers.
Approximately 91 cents of every dollar of County revenue is already committed to State-mandated programs and expenses, leaving us roughly nine cents on the dollar for the discretionary or not fully funded services our residents also expect: roads, refuse disposal, our nursing homes, Meals on Wheels, and numerous other local and necessary priorities.
That was Sheriff Butler’s point. It was not an attack on people suffering from addiction, and it was not an argument that MAT has no value. It was an objection to Albany continually imposing programs, determining how counties must administer them, setting pretty extraordinary and sometimes even non-sensical requirements, and then sending the bill to local taxpayers.
You acknowledge in your letter that local governments should not be expected to shoulder significant costs without adequate State support. On that point, you and Sheriff Butler actually agree.
I would sincerely invite you to spend some time with us or any county legislature during the budget process in November. Committee meetings and legislative sessions are open to the public. Come see how much of any New York State county’s budget is already dictated by Albany and how difficult the choices become when only a small fraction of local revenue remains available for local priorities that are just as important as meeting those with substance use disorders “where they are,” and assisting with recovery options.
The human side of addiction absolutely matters. But so does the human side of taxation and local government—the seniors relying on Meals on Wheels, families depending upon our nursing homes to care for elderly and/or medically frail persons, motorists traveling our roads, and taxpayers who ultimately have to pay the bills.
Local elected officials have an obligation to consider all of them.
Read Irving’s original Op-Ed here
