Were You Ordered to Stop Taking
Methadone, Buprenorphine (Suboxone) or
Naltrexone (Vivitrol) by a Court?
Did Probation or Parole Order You to Stop?
It may be illegal discrimination for a court, probation or parole agency to forbid all people under their supervision from using medications—like methadone, buprenorphine (Suboxone), or naltrexone (Vivitrol)—to treat opioid addiction. Yet many criminal justice and child welfare agencies have policies that do just that.
If you were required to stop taking addiction medication because of such a policy (or know of someone who was), please fill out this form. All information will be kept confidential. The Legal Action Center (LAC) is investigating bringing a lawsuit to overturn a criminal justice or child welfare agency’s policy denying access to addiction medication in the following states: Arizona, California, Connecticut, Delaware, Idaho, Nevada, Oregon, Washington, Montana, New Jersey, New York, Pennsylvania, or Vermont. This will be a cutting edge lawsuit, as no court has yet decided this issue.
If you live in one of these states, we may contact you for more information and to discuss your possible participation in a lawsuit. Filling out the form does not commit you to anything! Unfortunately, due to limited resources, we will not be able to represent most people who complete the form. However, we will try to give you helpful information. If you do not hear back from us, it may be due to our limited resources and not because your case is not strong.
If you do not live in one of the states listed above, LAC may not be able to offer additional assistance or get back to you. But LAC will use information you provide to inform our education and advocacy work. To learn how you, your treatment provider, or your lawyer can advocate for you to stay on your medication, please read Advocating for Your Recovery: What to Do When Ordered Off Medication, available at http://lac.org/resources/substance-use-resources/medication-assisted-treatment-resources/.
Please do not fill out this form for denials of these medications in jails or prisons.
Please email this form to the Legal Action Center at and write “MAT denial” in the subject, or fax the form to (212) 675-0286.General Information /
Name of patient
If someone other than patient is completing form / Name:
Relationship to patient:
Organization/title (if applicable):
Phone
Date completing form
Denial of Medication Details
Where Did Denial of Medication Occur? / City/town:
County:
State:
Denial of Medication was Ordered By…. / ☐Probation
☐Parole
☐Drug Court
☐Other Court
☐Other______
How Were You Denied? / ☐Ordered to get off medication
☐Ineligible for program or plea unless stopped medication
☐Ineligible for child custody unless stopped medication
☐Other ______
Type of Medication / ☐Methadone
☐Buprenorphine/Suboxone
☐Naltrexone/Vivitrol
☐Other ______
Name(s)/Title(s) of Person Ordering You (or others) to Get Off These Medications
Was Order in Writing?
[if so, please attach documents including any written policy.]
Reason Given for Denial
Reason Documented Anywhere?
[if so, please attach document, including any written policies.]
If No Written Denial, How Was Order Expressed?
[e.g., policy of drug court, stated in court]
Deadline for getting off medication
Treatment Information /
Name of Treatment Program or Prescribing Doctor
Location of Program or Prescribing Doctor
Phone # and Contact Name for Program or Doctor
Date Began Most Recent Treatment with Addiction Medication
Are You (or patient, if other person is filling out this form) Still Taking the Medication? / ☐Yes, still taking the addiction medication.
☐No, not taking the medication any more.
☐Other ______
Legal Counsel /
Are You/ (or person denied medication) Now Represented by a lawyer?
Name/Organization of Attorney
Phone and/or Email for Attorney
Criminal Justice Information /
Date(s) of arrest(s)
Charge(s)
Current Status of the Case? / ☐Not yet convicted of charge(s).
☐Has been convicted.
☐Sentence has been issued. What is it? ______
When Is Next Court Date or Meeting with Probation or Parole? What Is Expected to Happen on that Date?
Form revised 6.16.15
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