United States District Court, D. Massachusetts
MEMORANDUM AND ORDER
J. CASPER, UNITED STATES DISTRICT JUDGE
Geoffrey Pesce (“Pesce”) is a resident of
Ipswich, Massachusetts who has been in active recovery from
opioid addiction for two years with the help of a methadone
treatment program prescribed by his doctor. D. 15. Pesce
brings this lawsuit against Defendant Kevin F. Coppinger
(“Coppinger”), in his official capacity as
Sherriff of Essex County, and Aaron Eastman
(“Eastman”), in his official capacity as
Superintendent of the Essex County House of Corrections at
Middleton, Massachusetts (“Middleton”),
(collectively, “Defendants”), alleging that
Defendants' policy of denying inmates access to methadone
for the treatment of opioid use disorder violates the
Americans with Disabilities Act (“ADA”) and the
Eighth Amendment pursuant to 42 U.S.C. § 1983. D. 1. Due
to imminent probation and criminal matters pending against
him in Essex County, including a statutory mandatory minimum
sentence of sixty days, Pesce will be incarcerated at
Middleton as early as December 3, 2018. Pesce seeks
injunctive relief requiring that Defendants provide Pesce
with access to his physician-prescribed methadone treatment.
D. 12. For the reasons discussed below, Pesce's motion
for preliminary injunction is ALLOWED.
Standard of Review
Court recognizes that preliminary injunctive relief “is
an ‘extraordinary and drastic remedy.'”
Voice of the Arab World, Inc. v. MDTV Med. News Now,
Inc., 645 F.3d 26, 32 (1st Cir. 2011) (quoting Munaf
v. Geren, 553 U.S. 674, 689-90 (2008)). To obtain such
relief, the Court must consider: (1) the movant's
likelihood of success on the merits; (2) the likelihood of
the movant suffering irreparable harm; (3) the balance of
equities; and (4) whether granting the injunction is in the
public interest. Corp. Techs., Inc. v. Harnett, 731
F.3d 6, 9 (1st Cir. 2013). Likelihood of success on the
merits is the “main bearing wall of this
framework.” W Holding Co. v. AIG Ins.
Co-Puerto Rico, 748 F.3d 377, 383 (1st Cir. 2014) (quoting
Ross-Simons of Warwick, Inc. v. Baccarat Inc., 102
F.3d 12, 16 (1st Cir. 1996)) (internal quotation marks
omitted). Irreparable harm, on the other hand, is measured
“on a sliding scale, working in conjunction with a
moving party's likelihood of success on the merits, such
that the strength of the showing necessary on irreparable
harm depends in part on the degree of likelihood of success
shown.” Gedeon v. City of Springfield, No.
16-CV-30054-MGM, 2017 WL 4212334, at *8 (D. Mass. Feb. 24,
2017) (quoting Braintree Labs., Inc. v. Citigroup Global
Mkts., Inc., 622 F.3d 36, 42-43 (1st Cir. 2010)). The
plaintiff “bears the burden of establishing that these
four factors weigh in [his] favor.” Esso Standard
Oil Co. (P.R.) v. Monroig-Zayas, 445 F.3d 13, 18 (1st
otherwise noted, the following facts are drawn from the
complaint, D. 1, Pesce's motion for injunctive relief, D.
12, Defendants' opposition, D. 41, and the parties'
Diagnosis and Treatment of Pesce's Opioid Use
is a thirty-two year old man who has struggled with addiction
for several years. D. 13 at 10-11; D. 15 ¶¶ 1, 7,
9. Specifically, he suffers from a chronic disease known as
opioid use disorder. D. 1 ¶ 3; D. 18 ¶¶ 11,
20. This disease claims the lives of over one hundred
Americans every day. See Centers for Disease Control
and Prevention, Opioid Overdose: Understanding the Epidemic,
visited Nov. 20, 2018) (explaining that “[o]n average,
115 Americans die every day from an opioid overdose”).
More than half a million people in the United States have
died from opioid overdose in the last twenty years and the
death toll has rapidly increased in the last five years. D. 1
¶ 22. Here in Massachusetts, opioid-related deaths have
surpassed the national average and increased exponentially in
the last two years. See id (citing Massachusetts Department
of Public Health, The Massachusetts Opioid Epidemic, A Data
Visualization of Findings from the Chapter 55 Report,
http://www.mass.gov/chapter55(last visited Nov. 20,
2018)). Essex County, where Pesce resides, has had the second
highest number of opioid-related deaths of any county in
Massachusetts since 2013. D. 13 at 9; D. 14-1. In addition,
the opioid-related death rate in Massachusetts is 120 times
higher for people released from jails and prisons as compared
to the rest of the adult population. D. 17-8 at 51.
other chronic diseases, opioid use disorder involves cycles
of relapse and remission. D. 1 ¶ 21. Without treatment
or other recovery, opioid use disorder may result in
disability or premature death. Id Before entering
active recovery, Pesce's battle with opioid use disorder
caused him to lose his job, forced him to surrender custody
of his son and rendered him effectively homeless. D. 15
¶¶ 7-10. Pesce overdosed on opioids at least six
times, and, on multiple occasions, paramedics administered
Narcan to save his life. Id ¶ 11. Pesce made
numerous attempts to overcome his opioid addiction, including
by enrolling in at least four detoxification programs and by
taking medications such as buprenorphine (commonly known by
the brand name Suboxone®) and naltrexone (commonly known
by the brand name Vivitrol®). Id. ¶ 12; D.
19 ¶ 6. None of these efforts were successful at helping
Pesce maintain long-term recovery. D. 15 ¶ 12.
was admitted into a treatment program for substance abuse at
the Lahey Behavioral Services facility (“Lahey”)
in Danvers, Massachusetts in December 2016. D. 19 ¶ 10.
Pesce's physician there, Dr. Shorta Yuasa (“Dr.
Yuasa”),  prescribed medication-assisted treatment
(“MAT”) with methadone to treat Pesce's
disorder. Id ¶¶ 6, 10. According to Dr.
Yuasa, MAT is the “standard of care for treatment of
opioid use disorders.” Id ¶ 7. MAT
involves the use of FDA-approved pharmaceutical medications,
including methadone, buprenorphine and naltrexone, in
combination with counseling, behavioral therapy and other
interventions for the treatment of substance use disorders.
Id. As part of his decision to prescribe methadone,
Dr. Yuasa considered, among other things, the length and
severity of Pesce's addiction to opioids and his
previously unsuccessful attempts to achieve long-term
recovery using buprenorphine and naltrexone. Id.
¶ 10. In Dr. Yuasa's experience, “there are
some people for whom buprenorphine and naltrexone simply do
not work, and [Pesce's] history suggests that he is one
of those people.” Id.
late 2016, Pesce has received a daily dosage of methadone in
liquid form at Lahey. D. 19 ¶¶ 13, 15-16;
see D. 44 ¶ 8 (explaining that methadone is a
liquid that is administered orally). With this methadone
treatment, Pesce has been in active recovery from opioid use
disorder for almost two years. D. 19 ¶¶ 13-14; D.
15 ¶¶ 14-22. During this time, Pesce has not had a
positive drug screening and he has not intentionally missed a
day of treatment. D. 19 ¶ 13. He is working again as a
machinist, contributes financially to his family and is able
to spend time with his son. D. 15 ¶¶ 18-19. Pesce
is now able to take home and self-administer a three-day
dosage of methadone. D. 19 ¶ 14. Nevertheless, Dr. Yuasa
opines that Pesce must continue to use methadone as part of
his ongoing recovery as he is not ready to be tapered off his
medication. Id. ¶ 17. According to Dr. Yuasa,
without methadone treatment, Pesce will no longer be in
remission from active addiction and his tolerance for opioids
will diminish significantly. Id. ¶ 24. Dr.
Yuasa has treated numerous patients who have relapsed,
overdosed and died after being denied access to MAT during
Pesce's Current Criminal Matters
has two criminal matters pending in Essex County. In March
2016, prior to his recovery, Pesce was charged with operating
a motor vehicle under the influence of drugs. D. 26; D. 26-2
¶ 3. Pesce entered a guilty plea in September 2017 and
received a sixty-day sentence that was suspended under the
condition that he successfully complete probation, set to
expire in September 2019. D. 26-2 ¶ 3; D. 26-1 ¶ 2.
In July 2018, while still on probation, Pesce was pulled over
on the way to Lahey and charged with driving with a revoked
or suspended license. D. 26-1 ¶¶ 3 -4. The criminal
charge for driving with a revoked or suspended license
constituted a violation of the terms of Pesce's
probation. D. 26-2 ¶ 5.
must now appear in Lynn District Court for a probation
violation hearing on December 3, 2018. D. 31. At that
hearing, as a sanction for violation of the terms of his
probation, the court could impose the sentence of sixty days
previously imposed, but suspended. D. 26-2 ¶ 5. On
January 14, 2019, Pesce must appear in Ipswich District Court
for entry of a guilty plea and sentencing for driving with a
revoked or suspended license in July 2018. D. 31 at 1. That
charge carries a mandatory minimum sentence of sixty days
pursuant to Mass. Gen. L. c. 90, § 23. See ...