Summary of Argument At the heart of this case is Cameron Douglas, who has misused drugs since at least age 13, began using heroin at age 20 and who by age 25 was opioid dependent. Mr. Douglas ingested heroin five to six times a day in the five years prior to his arrest and was under the influence of heroin at the time of his arrest, at age 30, for drug distribution. Mr. Douglas continued to use heroin while under pre-trial release, causing the revocation of his bail, his incarceration, and the filing of a second federal criminal charge for heroin possession.

For the crimes of drug distribution and heroin possession Mr. Douglas was sentenced to 60-months imprisonment – a sentence with which Amici do not take issue. While imprisoned, however, Mr. Douglas was again caught with opioids, this time with small amounts of Suboxone and heroin, two drugs that share similar chemical properties and produce similar effects in the brain. He subsequently tested positive for ingested opioids. At no point during his incarceration has Mr. Douglas been provided substance abuse treatment.

For this new offense – illicit drug possession in a correctional facility – Mr. Douglas was sentenced by the federal district court to an additional prison term of 54 months, to be served consecutively to his 60-month sentence. Mr. Douglas was also sanctioned administratively by the Bureau of Prisons which, inter alia, ordered him confined to his cell for 23 hours a day for 11 months, denied him contact with the outside world (aside from legal counsel) In explaining this sentence, the district court acknowledged Mr. Douglas’ “co-occurring addictions” and “mental health issues,” but focused on Mr. Douglas’ serial failure to follow – or seeming choice to continually flout – the rules, regulations and laws prohibiting illicit drug use as grounds for extending Mr. Douglas’ prison term by an additional four and one-half years.

But substance abuse treatment professionals and researchers, as well as persons who have experienced opioid dependence directly or through loved ones, view Cameron Douglas’ conduct, and the appropriate response to that conduct, in a substantially different light. They recognize Mr. Douglas’ actions for what they are – the classic, textbook behaviors of someone suffering from untreated opioid dependence, a chronic medical condition often caused by permanent changes to the brain, defined by repeated drug use and, after periods of drug use remission, drug relapse – behaviors that can persist for decades, or a lifetime, in the absence of proper treatment.

Like other chronic medical conditions, opioid dependence can be effectively managed through appropriate treatment. Opioid dependent persons are encouraged to complete a continuum of care that typically involves counseling (of which there are various forms) and the acquisition of decision-making and life management skills to constructively deal with life’s difficulties. Several medications also are available to help address the neurobiological effects of chronic opioid use including buprenorphine and methadone maintenance treatment, the latter of which has been shown over several decades to be one of the most efficacious and cost effective interventions in modern medicine.

These medication-assisted therapies are administered, with much success, in corrections institutions in many other countries and have been shown to reduce illicit drug use and criminal behavior while improving health and well-being. Such treatments, however, are almost entirely absent from American correctional facilities despite the over-representation of opioid-dependent persons in U.S. jails and prisons, the documented prevalence of drug use therein, and the unique opportunity that incarceration provides for initiation into (or continuation of) critical medical and counseling services. Notably, no form of professional treatment has been given Mr. Douglas since his incarceration.

Amici do not contend that reversing Mr. Douglas’ 54-month sentence – and offering Mr. Douglas and those like him appropriate treatment behind bars and access to community treatment upon release – would result in a “miracle cure.” But experience shows that these important steps would be an “intercession of [one of] a thousand smaller sanities,” Adam Gopnik, The Caging of America, The New Yorker (Jan. 30, 2012), that would help reduce the crime, disease, suffering and death that afflict the thousands of opioid-dependent persons enmeshed in our criminal justice system and be a fitting and humane response to Mr. Douglas’ conduct.

Summary

Cameron Douglas has a documented history of substance misuse, beginning at age 13, progressing to heroin use by age 20, and developing opioid dependence by age 25. For five years prior to his arrest at age 30, Mr. Douglas ingested heroin multiple times daily, and was under its influence when apprehended for drug distribution. His continued heroin use during pretrial release led to bail revocation, incarceration, and a second federal charge for heroin possession. For these initial offenses, Mr. Douglas received a 60-month prison sentence. While incarcerated, he was found with small quantities of Suboxone and heroin, and subsequently tested positive for opioid ingestion. Throughout his imprisonment, Mr. Douglas has not been provided with substance use treatment.

For the offense of illicit drug possession within a correctional facility, Mr. Douglas was sentenced by the federal district court to an additional 54-month prison term, to be served consecutively to his initial sentence. Concurrently, the Bureau of Prisons imposed administrative sanctions, including 23-hour cell confinement for 11 months and restricted external contact. In rendering this sentence, the court acknowledged Mr. Douglas’ "co-occurring addictions" and "mental health issues" but emphasized his repeated disregard for regulations and laws prohibiting illicit drug use as justification for the extended incarceration.

Substance use treatment professionals, researchers, and individuals with direct experience of opioid dependence or through loved ones interpret Mr. Douglas’ actions and the appropriate response differently. They recognize his conduct as characteristic of untreated opioid dependence, a chronic medical condition often involving enduring neurobiological changes. This condition is defined by repetitive drug use and subsequent relapses after periods of remission, behaviors that can persist indefinitely without effective intervention.

Opioid dependence, akin to other chronic medical conditions, is amenable to effective management through appropriate treatment. Individuals with opioid dependence are typically encouraged to engage in a comprehensive continuum of care, which encompasses various forms of counseling and the development of decision-making and life management skills to address personal challenges constructively. Several medications, including buprenorphine and methadone maintenance treatment, are available to mitigate the neurobiological effects of chronic opioid use. Methadone, in particular, has been empirically demonstrated over decades to be among the most efficacious and cost-effective interventions in contemporary medicine. Despite the significant prevalence of opioid-dependent individuals in U.S. correctional facilities and documented drug use within these environments, such medication-assisted therapies are largely absent. This represents a missed opportunity for initiating or continuing vital medical and counseling services during incarceration; notably, Mr. Douglas has received no professional treatment since his imprisonment.

Advocates for treatment do not assert that reversing Mr. Douglas’ 54-month sentence and providing appropriate treatment during incarceration and community-based care upon release would constitute a "miracle cure." However, empirical evidence suggests that these crucial steps would facilitate a series of smaller, yet significant, improvements. Such interventions would contribute to reducing the crime, disease, suffering, and mortality rates prevalent among the thousands of opioid-dependent individuals entangled in the criminal justice system, representing a more fitting and humane response to Mr. Douglas’ conduct.

Summary of Argument

Cameron Douglas has a long history of drug misuse, beginning at age 13. By age 20, he started using heroin, becoming opioid dependent by age 25. For five years before his arrest at age 30, Mr. Douglas consumed heroin multiple times daily and was under its influence when arrested for drug distribution. His continued heroin use during pre-trial release led to his bail being revoked, his incarceration, and an additional federal charge for heroin possession. Mr. Douglas received a 60-month prison sentence for these offenses. While incarcerated, he was again found with opioids, specifically Suboxone and heroin, and tested positive for their use. Throughout his imprisonment, Mr. Douglas has not received any substance use treatment.

For possessing illicit drugs within the correctional facility, a federal district court sentenced Mr. Douglas to an additional 54-month prison term. This sentence was to be served after his initial 60-month term. The Bureau of Prisons also imposed administrative penalties, including confining him to his cell for 23 hours a day for 11 months and limiting his contact with the outside world to legal counsel. The court acknowledged Mr. Douglas’ "co-occurring addictions" and "mental health issues" when explaining this extended sentence. However, the court primarily focused on his repeated failure to follow rules and laws against illicit drug use as the reason for adding four and a half years to his prison time.

Substance use professionals, researchers, and individuals with direct experience of opioid dependence view Mr. Douglas's actions differently. They identify his conduct as typical behavior for someone with untreated opioid dependence, which is recognized as a chronic medical condition. This condition often involves lasting changes in the brain, characterized by repeated drug use and relapses even after periods of sobriety. Such behaviors can continue for decades or a lifetime without proper treatment. Like other chronic conditions, opioid dependence can be effectively managed. Treatment typically involves a range of care, including various forms of counseling and developing skills for decision-making and life management. Medications like buprenorphine and methadone are also available to address the brain's neurobiological response to chronic opioid use. Methadone maintenance treatment, in particular, has proven to be highly effective and cost-efficient for decades.

Medication-assisted therapies have been successfully used in correctional facilities in many other countries. These treatments effectively reduce illicit drug use and criminal behavior while improving the health and well-being of individuals. However, such treatments are largely absent from American correctional facilities. This is despite the high number of opioid-dependent individuals in U.S. jails and prisons, the documented presence of drug use within these facilities, and the significant opportunity that incarceration offers to start or continue crucial medical and counseling services. It is important to note that Mr. Douglas has not received any professional treatment since he was incarcerated.

Advocates do not suggest that reversing Mr. Douglas’s 54-month sentence or offering treatment would be a "miracle cure." However, experience indicates that providing appropriate treatment during incarceration and access to community treatment upon release would be a significant step. These measures could help reduce crime, disease, suffering, and death among the many opioid-dependent individuals within the criminal justice system. Such an approach would also represent a more appropriate and humane response to Mr. Douglas's circumstances.

Summary of Argument

The case centers on Cameron Douglas, who began misusing drugs by age 13. By age 20, he started using heroin, and by 25, he was dependent on opioids. For five years before his arrest, Mr. Douglas used heroin five or six times daily. At age 30, he was arrested for distributing drugs while under the influence of heroin. He continued using heroin during his release before trial, which led to his bail being canceled, his imprisonment, and a second federal charge for possessing heroin.

Mr. Douglas received a 60-month prison sentence for drug distribution and heroin possession, a sentence the Amici do not dispute. While in prison, he was caught with opioids again, specifically small amounts of Suboxone and heroin, and later tested positive for using opioids. It is important to note that Mr. Douglas has not received any substance use treatment during his time in prison. For this new offense of possessing drugs in a correctional facility, the federal court gave Mr. Douglas an additional 54-month prison sentence, to be served after his first 60-month sentence. The Bureau of Prisons also disciplined him, confining him to his cell for 23 hours a day for 11 months and limiting his contact with the outside world. The court acknowledged Mr. Douglas’ "co-occurring addictions" and "mental health issues" when explaining this extended sentence. However, the court mainly focused on his repeated failure to follow rules and laws against illicit drug use as the reason for adding four and a half years to his prison term.

However, experts in substance use treatment, researchers, and people who have experienced opioid dependence themselves or through family members see Mr. Douglas’ actions differently. They view his behavior as classic signs of untreated opioid dependence. This is a chronic medical condition, often caused by lasting changes in the brain, marked by repeated drug use and relapses even after periods of stopping. These behaviors can last for decades or a lifetime if not properly treated.

Like other long-term medical conditions, opioid dependence can be successfully managed with the right treatment. Individuals with opioid dependence are typically encouraged to receive a range of care. This often includes various forms of counseling and learning skills to make better decisions and manage life's challenges. Several medications are also available to help with the brain effects of chronic opioid use. These include buprenorphine and methadone maintenance treatment, which have been proven over many decades to be among the most effective and affordable medical interventions. Many other countries successfully use these medication-assisted therapies in their prisons. They have been shown to reduce illegal drug use and criminal behavior while improving health. However, these treatments are almost entirely missing from American prisons and jails. This is true even though a large number of people in U.S. jails and prisons are opioid-dependent, and drug use is known to occur within these facilities. Imprisonment actually offers a unique chance to start or continue important medical and counseling services. It is important to remember that Mr. Douglas has received no professional treatment since he was imprisoned.

The Amici do not claim that reversing Mr. Douglas’ 54-month sentence and providing him and others like him with proper treatment in prison, along with access to community treatment after release, would be a "miracle cure." However, experience shows that these important steps would contribute to "a thousand smaller sanities," helping to reduce crime, illness, suffering, and deaths that affect thousands of opioid-dependent people caught in the criminal justice system. Such actions would also be a suitable and humane response to Mr. Douglas’ behavior.

Summary

Cameron Douglas started using drugs at age 13 and began using heroin at age 20. By age 25, his body needed opioids. For five years before his arrest, he used heroin five or six times a day. At age 30, he was arrested for selling drugs and was high on heroin at the time. Mr. Douglas kept using heroin while out on bail, which caused him to lose his bail and go to jail. He also faced a second charge for having heroin. For these crimes, Mr. Douglas was sentenced to 60 months in prison. This first sentence is not being argued against. However, while in prison, Mr. Douglas was again caught with small amounts of Suboxone and heroin, which are similar drugs. He then tested positive for using opioids. He has not received any drug treatment during his time in prison.

For having drugs in prison, Mr. Douglas was given another 54 months in prison. This extra time will be added to his first 60-month sentence. The prison also punished him by making him stay in his cell for 23 hours a day for 11 months. He could not talk to people outside of prison, except his lawyer. The judge said Mr. Douglas had "addictions" and "mental health problems." But the judge mostly said the extra prison time was because Mr. Douglas kept breaking the rules about drug use.

Experts who treat drug problems, researchers, and people who have dealt with opioid dependence see Mr. Douglas’s actions differently. They understand his actions as what often happens with someone who has untreated opioid dependence. This is a long-lasting health problem, much like other illnesses. It can change the brain and leads to repeated drug use and falling back into old habits, even after trying to stop. These behaviors can last for many years or a lifetime without the right care. Just like other long-term health problems, opioid dependence can be managed well with proper treatment. People with this problem need ongoing help, including talking with counselors and learning skills to handle life's challenges. There are also medicines that help, such as buprenorphine and methadone. Methadone treatment has been shown for many years to be a very good and low-cost way to help.

These kinds of medicine-based treatments work well in prisons in many other countries. They help lower illegal drug use and crime, and they make people healthier. However, these treatments are almost completely missing from American prisons. This is true even though many people in U.S. jails and prisons struggle with opioid dependence, and drug use is known to happen inside prisons. Being in prison could be a good chance to start or continue important medical and counseling services. It is important to know that Mr. Douglas has not received any professional treatment since he was put in prison.

Those who support Mr. Douglas do not say that changing his 54-month sentence and giving him proper treatment in prison and after he gets out would solve everything. But experience shows that these important steps would help reduce crime, illness, pain, and deaths for thousands of people with opioid dependence caught in our justice system. They would also be a kind and fitting way to respond to Mr. Douglas’s actions.