Treatment and Recovery Pathways

There is no “right” way to recover. Treatment and recovery don’t look the same for everyone. People with opioid use disorder (OUD) must be able to get accurate and unbiased information about the effectiveness of different treatment pathways. Accurate information allows you to choose what’s right for you, which might change over time – and that’s okay. Your route to recovery might be made up of different services and supports from clinical and non-clinical pathways. 

Clinical Pathways or Clinical Treatment for Opioid use Disorder (OUD) 

Clinical pathways are treatments that involve the services of a trained clinician. The American Society for Addiction Medicine has developed levels of clinical care that, based on their intensity, range from 1 to 4. These levels create a universal standard and are also used by insurance companies. Some clinical pathways are:

Medication for Opioid Use Disorder (MOUD) 

Medication is an effective treatment for opioid use disorder. MOUD, sometimes called medication-assisted treatment or medication for addiction treatment (MAT), is the use of the FDA-approved medications to treat OUD. These medications include methadone, buprenorphine, and naltrexone. Naltrexone can also be used to treat alcohol use disorder. All of them help reduce cravings and withdrawal symptoms. People take them differently and in different settings, so which medication you take is a decision you should make with your provider. MOUD is most often used with outpatient counseling or other recovery support services, but medication alone can be effective for some people. MOUD can be a short-term treatment option or a long-term one (known as maintenance). 

Where to access Medication for Opioid Use Disorders (MOUD) services 

Opioid Treatment Programs (OTPs), Office-Based Opioid Treatment Programs (OBOTs), and bridge programs provide MOUD and offer other counseling and support services. You can find treatment locations in Massachusetts that offer MOUD through the Massachusetts Substance Use Helpline.  

Medication for Opioid Use Disorder (MOUD) Rights and Advocacy Tips: 
  • It is illegal to discriminate against people because they are receiving MOUD. Federal laws that prohibit discrimination against people with disabilities protect people receiving MOUD.  
  • Know what to look for when it comes to discrimination in health care settings. It can be subtle and difficult to name. Examples may include: 
    • Doctors minimizing your pain or need for treatment. 
    • Being turned away from medical treatments, care settings (like nursing homes), or addiction treatment services including residential care or sober living because you are treated with MOUD. 
    • Having probation, parole, child welfare, or drug court require one type of treatment or not allow you to stay on MOUD. 
    • Recommending treatment that you can’t access, and not referring you to other options when you ask.  
    • Treatment providers not considering the treatment you prefer and prescribing you something you don’t want.  
    • Treatment providers discharging you (releasing you from a program) before you say you are ready.  
    • Providers denying you your right to see your medical records. 
    • Providers not respecting your pronouns, name, and gender identity in treatment settings, or not working with you to find gender-affirming substance use disorder (SUD) treatment. Fenway Health in Boston has many LGBTQ+ affirming support groups, treatment programs, and resources. Sunshine Behavioral Health provides an overview of SUD treatment best practices for trans patients.  
    • Any comment or action that discriminates against you because of your race, sex, sexual orientation, class, or age. These can be subtle, but remember: if it feels wrong, trust that and report it to the Bureau of Substance Addiction Services complaint line, or to the Massachusetts Attorney General’s Civil Rights Division. 
  • You have a right to privacy. Personally identifiable health information relating to SUD and alcohol treatment needs to be treated more confidentially than other medical information. 
  • If you have MassHealth, there is no copay for SUD treatment, including MOUD.  
  • Treatment centers must provide interpreter services when asked, so that people who speak any language can get services. If the service or program can’t provide an interpreter, the Bureau of Substance Addiction Services (BSAS) at the MA Department of Public Health must work with you to find a treatment center that can. If they do not, you can report it to the Bureau of Substance Addiction Services complaint line
  • The Americans with Disabilities Act (ADA) and state public accommodations laws protect your right to request “reasonable accommodations” for a disability that impacts your ability to access a treatment center. If your treatment center is not wheelchair accessible or can’t accommodate your needs, BSAS must work with you to find another treatment facility that can. If they fail to do so, you can report it to the Bureau of Substance Addiction Services complaint line
Medication for Opioid Use Disorder (MOUD) Resources 
Resources for families, loved ones, and providers supporting people seeking treatment 
  • Shatterproof’s “How to Support a Loved One in Recovery” provides many simple tools to keep in mind as you help your loved one navigate treatment and recovery.  
  • You can learn more about how to talk with a loved one, and the types of treatment options you can share with them, with Health Care Resource Center’s Helping a Family Member with Opioid Addiction
  • The Massachusetts Organization for Addiction Recovery (MOAR) provides a detailed list of the types of treatment options available in Massachusetts in their mini guide

Walk-In Services (Opioid Urgent Care Centers)

Opioid Urgent Care Centers (OUCC) are walk-in programs that assess a person’s medical, behavioral health, and substance use treatment needs. Other services include medication, opioid overdose education, naloxone kits, community-based support services, program referrals, and follow-up care. Program staff include doctors, nurses, addiction counselors, recovery coaches, case managers, and social workers. 

  • OUCC Resources: 
    • You can find an OUCC by calling the Massachusetts Substance Use Helpline at 800-327-5050 or on the Helpline website

Inpatient and Residential Withdrawal Management (Detox) Treatment Options 
People who also use alcohol or sedatives or people who need to be in a structured inpatient setting may get medical management for withdrawal (sometimes called “detox”) in a residential setting. Withdrawal management is also known as Acute Treatment Services (ATS). It can be a first step toward stabilization and starting longer-term treatment options for some people. Withdrawal management services provide 3 to 5 days of 24-hour care and monitoring for withdrawal. This time frame is based on the patient’s individual needs. Medical management might be needed because the symptoms of withdrawal from alcohol or benzodiazepines can be dangerous and even deadly. Inpatient settings can also be a structured space to initiate (start) medication for opioid use disorder (MOUD) and allows a person to be closely monitored and given medication to manage withdrawal. For people who also have mental health disorders, Enhanced Acute Treatment Services (E-ATS) are available. 

It is important to know that withdrawal management alone without additional supports can be difficult and may not work for everyone. If a person uses opioids or other substances after withdrawal management, the risk of an overdose is high. A person’s tolerance is lower after going to detox, so ongoing treatment and support is important to help prevent overdose.  

Inpatient Treatment Resources: 

You can find inpatient treatment options by calling the Massachusetts Substance Use Helpline at 800-327-5050 or on the Helpline website. You can search for inpatient treatment options for yourself or someone else at the Helpline website.  

Residential Treatment Options

Residential treatment can provide short-term intensive care (less than 30 days) or longer-term support. Some residential treatment options are: 

  • Clinical Stabilization Services (CSS): These “step down” services offer 24-hour treatment for people who need a safe and structured setting to support their recovery after detoxification. Services include nursing support, case management, education and counseling, and aftercare planning. These programs help to bridge services between detoxification and rehabilitation programs, such as sober homes. 
  • Transitional Support Services (TSS): Like clinical stabilization services, transitional support services provide up to 30 days of residential services for people who need a safe and structured setting to support their recovery after withdrawal management. The provider will work with the patient to decide the length of the stay based on the person’s needs. Services include nursing support, case management, education, and aftercare planning. Programs also provide intensive case management to prepare people for longer term residential care, such as sober homes. 
  • Residential Treatment Over 30 Days: Residential Treatment Over 30 Days are programs for people who have recently stopped using drugs or alcohol, are medically stable, and can be in a structured residential recovery program. Options include recovery homes, social model homes, therapeutic communities, specialized residential services for women, specialized residential services for families, co-occurring enhanced residential rehabilitation services (RRS), and youth residential treatment programs. You can read more about these different types of residential recovery programs on the Bureau of Substance Addiction Services (BSAS) website.  
  • Sober Homes accredited through Massachusetts Alliance for Sober Housing offer sober living environments where people pay rent. In Suffolk County, people leaving in-patient treatment can use Housing First programs that link people in treatment to housing. You can call the Helpline 800-327-5050 or search for services here
  • All of these residential settings can be combined with MOUD. 
Residential Treatment Options Rights and Advocacy Tips 
  • Residential programs and Sober Homes cannot deny you because you are treated with medication for opioid use disorder (MOUD). 
  • Not all residential programs are equal, and sometimes programs “target” people. It’s important to make sure you are getting quality treatment. Some programs offer very little or poor care but try to get as many people as possible to come to their treatment centers. They are often outside of Massachusetts and will use predatory practices to recruit new patients. Here are some ways to recognize when a program may not be legitimate: 
    • They use “patient brokers” to recruit people to their program. A patient broker (sometimes called a patient marketer) is someone who is paid a fee to get people into a program. They might approach you in person or they might contact you by phone, text, or social media. 
      • Paying someone to refer people to a program is illegal in Massachusetts. 
    • The program offers to pay for your travel. 
    • The program offers to pay your health insurance costs. 
    • They focus on luxury services or accommodations, instead of treatment. 
You can protect yourself from addiction treatment scams: 
  • Be careful of giving anyone your personal information, including your social security number or health insurance information.   
  • Ask up front about billing and how treatment “add-ons” will be billed. Often, predatory treatment centers will provide additional services that are billed separately and at very high costs.  
  • Be aware of how often drug tests are given. Some treatment centers drug test very often, which can be expensive. Ask how often testing is done and how much each test costs so you don’t incur surprise costs.   
  • Every treatment center should have a grievance procedure, which is a way of making a formal complaint to the provider. Ask the facility if they have a grievance procedure, how to file one, and the timeframe for a resolution.   
  • Be sure to ask about whether family can be involved in your treatment. Often, treatment scams will discourage and prevent the support of loved ones. 
  • If someone offers to pay your travel costs, call the treatment program or your insurance company to make sure they’re an employee. If you accept a program’s offer to pay for your travel, make sure you have a plan and money to get back home.   
  • Be very careful about a program that offers to pay your insurance costs. They may stop paying at any time, and your insurance can be cancelled.   
  • It is not legal to advertise statistics for marketing purposes. For example, a treatment center cannot make statements such as:  
    • “We accepted 100 clients into our CSS program in 2020. 89% completed treatment and 75% remain drug- free according to a survey sent to those completing treatment in 2020.”  
    • “Our program guarantees lifetime sobriety.”  
  • These statements are probably false and might mean that the center should not be trusted.  
  • If you think you are the victim of an addiction treatment scam, file a health care complaint with the Massachusetts Attorney General’s office or call the Massachusetts Attorney General’s Health Care Helpline at 1-888-830-6277 or 617-727-4765 (TTY).  
  • Programs that provide any type of residential service cannot discharge (release) you to a homeless shelter or the street as part of your treatment plan.  
  • The law protects your privacy in residential treatment programs. Providers cannot disclose (share with others) your substance use disorder without your consent.  
Other Outpatient Treatment Options 

Outpatient programs provide assessment and counseling services while you live at home. Services are in a community-based setting, like a medical office. Depending on your needs and the level of services you get, you might participate in counseling weekly or many times per week. Counseling can be for individuals, families, couples, or groups. The most basic level of care for outpatient counseling is Individual Outpatient Counseling Level 1. At Level 2, Day Treatment/Intensive Outpatient Treatment/Partial Hospitalization is available. 

Outpatient Treatment Resources: You can find outpatient counseling services by calling the Massachusetts Substance Use Helpline at 800-327-5050 or on the Helpline website

Non-Clinical Pathways or Peer-Based Recovery Support

Non-clinical pathways to recovery focus on community and peer-based supports, and some people find other activities like acupuncture, exercise, and meditative practices helpful, too. Peer-based recovery is about people with similar experiences offering support to one another. Some examples of peer-based recovery support options are: 

Mutual/Self-Help Options:

Mutual and self-help groups either have a religious or spiritual lens (like 12-step groups) or are secular (non-religious).  

Mutual/Self-Help Resources: Find self-help/12-step groups: MA Substance Use Helpline12step.orgFaces and Voices of Recovery Mutual Aid Resources 

Peer Recovery Support Center/Multi-Service Recovery Centers: 

These centers focus on recovery and offer drop-in services, peer- and 12-step-based support, and other recovery services. 

Recovery Coaches 

Recovery Coach Resources: Find recovery coaching and Peer Recovery Support Centers: MA Substance Use Helpline 

Recovery Support Navigators (RSNs) are people who can provide care management and support people as they navigate the treatment system. You are eligible for RSNs if you have a diagnosed SUD. The RSN can help you develop a wellness plan for your recovery. This is a covered benefit that does not need prior authorization from MassHealth, and other health insurance may cover RSNs. Ask your provider or call your health insurance to find out. 

Recovery High Schools:

Recovery high schools are public high schools for youth ages 14-21 that provide educational environments to support youth recovering from SUD. They serve 30 to 50 students per school and are supported by the state, local school districts, and educational collaboratives. Students receive support for their recovery within an academic setting consistent with Massachusetts State Standards. Students with a diagnosed SUD can choose to attend a recovery high school. A referral from a student’s sending district is not needed. 

Community Recovery Programs: There are many programs across the state that focus on running, CrossFit, yoga, and other wellness activities run by people in recovery for people in recovery. You can find a list of these programs at the Massachusetts Substance Use Helpline.  

Harm Reduction Services

Harm reduction is a person-centered approach and a set of practical strategies to reduce the negative consequences of drug use. Harm reduction recognizes the dignity and autonomy (ability to make one’s own choices) of people who use drugs. Harm reduction supports and embraces any positive changes that people want to make in their drug use and health. Harm reduction recognizes that there are safer and less-safe ways to use drugs and provides nonjudgmental services that meet people who use alcohol or drugs where they’re at. These services help people stay safe, improve the quality of their life and health, prevent and manage disease, and prevent fatal overdoses. Some harm reduction services are: 

  • Overdose Prevention Training/Naloxone Distribution 
    • Narcan® (also known by its generic name naloxone) is a medication called an “opioid antagonist” used to reverse an opioid overdose. Narcan works quickly and reverses an opioid overdose in 3 to 5 minutes. Rescue breathing and another dose of naloxone are sometimes needed. The one-step nasal spray is the most common form of Narcan in Massachusetts. People at risk of an overdose can get Narcan and training on how to use it at Overdose Education and Naloxone Distribution (OEND) sites. You can also get Narcan at most pharmacies without a prescription, and the pharmacist can show you how to use it. MassHealth and many other health insurers cover Narcan. 
  • Syringe Services Programs/Needle Exchanges 
    • These programs provide new needles (syringes) and can take back used ones, too. Syringe/needle exchange programs often offer other services such as HIV counseling and testing, referrals to substance use treatment, Hepatitis C education, harm reduction strategies, and bleach kits. 
  • Supervised setting for observation and drug use 
    • Overdose prevention sites are used in many countries and offer supervised settings for people who use drugs to be monitored and to prevent overdose. While these are not available now in Massachusetts, SPOT (see below) can help to keep people who are over-sedated from substance use stay safe. 
  • Drug checking 
    • The drug supply changes without warning and dealers often mix in synthetic fentanyl and other adulterants that can cause overdose and other harm. Drug checking allows people who use drugs to test what they are using so they can know what’s in the drug and stay safe from overdose or other accidental harm. Drug checking can be done with fentanyl test strips or with special devices like handheld testing devices that tell people exactly what is in a drug. 
  • Safer smoking services 
    • These programs offer supplies for safer smoking of drugs, which reduces the risk of infections that can happen with injection drug use and also reduces the risk of overdose. 
Harm Reduction Rights and Advocacy Tips: 
  • If someone is overdosing, don’t be afraid to call 911 for help. The Good Samaritan law in Massachusetts protects a person having an overdose and the people who call for help. The laws protect you from arrest when you’re trying to help in an emergency, but they don’t cover everything. You can be arrested for the W’s: weapons, warrants, or weight. If you have an unregistered weapon, an open warrant out from your arrest, or enough drugs on you that it is clear you are trafficking drugs instead of just using them, the laws do not protect you. 
  • You can get Narcan® (naloxone) at many pharmacies in Massachusetts without a prescription. At the pharmacy, tell the pharmacist you would like Narcan. MassHealth covers the whole cost, and many other health insurers cover Narcan. If you don’t have MassHealth, there may be a copay depending on your insurance. Be sure to ask the pharmacist. 
Harm Reduction Resources: 
  • Learn more about how to respond to an overdose and how to get Narcan
  • Find an Opioid Overdose Education and Naloxone Distribution (OEND) site on the Helpline website or call 800-327-5050. You can find a Syringe Services Program/Needle Exchange through the Helpline too. 

Treatment and Recovery General Resources 

  • The Massachusetts Department of Public Health’s Bureau of Substance Addiction Services (BSAS) provides a complete description of each service type on their website
  • You can learn more about the levels of care created by the American Society of Addiction Medicine on the Recovery Research Institute’s website
  • You can learn more about Harm Reduction as a set of practical strategies and a social justice movement on the national Harm Reduction Coalition website
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Treatment and Health Care

As you navigate treatment and recovery, you have rights and protections with your health care and health insurance. Health insurance can be hard to navigate, but state and private health insurance policies cover a variety of services for people with opioid use disorder (OUD). The Mental Health Parity and Addiction Equity Act, for example, requires health insurers provide the same level of benefits for OUD treatment and services than they do for physical health care. And for those without health insurance, Overdose Education and Naloxone Distribution (OEND) sites offer many clinical services for people in recovery for free, and they won’t take any insurance information. 

  • If you are working, you may be offered health insurance as a benefit through your employer. If your employer doesn’t offer a health insurance benefit, you can find a health insurance plan through the Massachusetts Health Connector. The plans offered through the Health Connector by different carriers meet state and national coverage standards, and you can compare plans and see costs to find the plan that will work best for you. 
  • Types of plans: The most common types of health insurance plans in Massachusetts are Health Maintenance Organization plans (HMOs), Preferred Provider Plans (PPPs), and Indemnity Plans. 
    • HMOs cover hospital, medical, and preventive care within a network of providers. Care that you get from a provider outside of the provider network is not covered. You usually pay a portion of the cost of each service (called a co-pay) and the HMO pays the rest of the cost. 
    • Like HMOs, PPPs usually cover hospital, medical, and preventive care within a network of providers. In a PPP, you can also get care from providers outside of the network and the PPP will still pay a portion of the cost, but it may be a smaller amount. 
    • Indemnity Plans cover hospital and medical expenses for an accident or illness. Some also cover preventive care. These plans will pay a part of the cost and you are responsible for the rest. 
    • MassHealth: If you meet certain income requirements, you may be eligible for MassHealth. MassHealth is a Medicaid program paid for by state and federal taxes. There are different types of coverage available through MassHealth based on your age, living and family situation, disability status, and certain health information. 
    • Copays: There is no copay for substance use disorder (SUD) treatment covered by MassHealth   
    • MedicareMedicare is the federal health insurance plan for people age 65 or older and people with certain disabilities or health conditions. Both original Medicare and Medicare Advantage provide coverage for SUD, ranging from screening to inpatient and outpatient treatment by a Medicare-approved provider. However, a person who receives treatment must still pay deductibles, copayments, and coinsurance. 
    • Other subsidized plans (ConnectorCare): You may be able to get a ConnectorCare plan if you: have a household income at 300% of the Federal Poverty Level or lower; you don’t qualify for MassHealth, Medicare, or other public health insurance programs; and you meet other eligibility requirements. ConnectorCare plans offer comprehensive coverage and have low monthly premiums, low out-of-pocket costs, and no deductibles. 
    • No insurance: If you do not have health insurance, you can still receive treatment in Massachusetts. There are some programs funded by the state that offer free treatment to people without insurance. You can learn more about state-funded services and how to find them by calling the Helpline at 800-327-5050 or on the Helpline website. When you search for services on the Helpline website, you can choose “Only show BSAS-funded programs” to see free treatment options. 

Rights, Protections, and Tips for Advocacy 

  • The Massachusetts Mental Health Parity Law makes it illegal for insurers to put smaller annual or lifetime limits on coverage of care for mental health and substance use disorders than on physical disorders.  
    • Under this act, patients are allowed 14 days of inpatient care and $500 worth of outpatient benefits. When a person gets treatment for mental health and substance use disorders, the patient has the right to more coverage.  
  • Your right to fill your prescription for medication for opioid use disorder (MOUD) at a pharmacy is protected, but people may still experience discrimination in pharmacy settings. A pharmacist can refuse to fill your prescription because it is against their religion or the pharmacist believes the prescription is not appropriate. If that happens, you have a right to ask for a pharmacist who will fill your subscription. You cannot be denied your medication if the pharmacist serving you will not fill it.  
  • Know what else to look for when it comes to discrimination in pharmacy settings. Here are some examples:  
    • A pharmacy worker refusing to fill your prescription and refusing to refer you to someone who will. A pharmacist may have the right to refuse to fill your prescription if it is against their religion, or they believe the prescription is not appropriate, but they must find another pharmacist or technician who will fill your prescription.  
    • Pharmacists asking you who the medication is for or asking why you were prescribed MOUD. The pharmacist may ask if you have any questions about your prescription, but not any personal probing questions.  
    • Receiving a lower dose or fewer pills than what your doctor prescribed. If you believe the pharmacist gave you less than you were prescribed, you can ask to see what your doctor prescribed you.  
    • Saying anything negative about the medication you are prescribed and telling you a different form of MOUD is better. You know what treatment works best for you.  
    • If you are a loved one picking up a prescription for someone on MOUD, and the pharmacist refuses to give it to you. The pharmacist does not need written or oral notice by the patient before picking up and does not need any additional documentation or identification.  
  • You have a right to health care and certain protections even if you are undocumented. 
    • You have the right to health care regardless of your immigration or health insurance status. Healthcare providers, including emergency rooms, can give you care without asking for your immigration, citizenship, or insurance status. 
    • Applying for government subsidized health insurance will not affect your immigration status. But you will be asked to disclose your immigration status to apply for health insurance. 
    • Immigration and Customs Enforcement (ICE) usually cannot detain (take) you at hospitals or at other places that provide care, and your health information is protected information no matter what your immigration status is.  

Resources for Health Care 

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Recovery and Family Resources

Seeking treatment while balancing family, especially a new or growing family, can feel hard but there are resources available to help you. If you are pregnant and are looking for treatment options, the MA Substance Use Helpline can point you in the right direction. Medication for opioid use disorder (MOUD) is effective and safe during pregnancy. Treatment with MOUD during pregnancy improves both the health and safety of the birthing person and of the fetus. 

Treatment Options for Pregnant People 

  • People who are pregnant can access the same services as the general population. This includes clinical and non-clinical treatment options, including MOUD. 
  • Pregnant and post-partum people (people who have recently given birth) are federally identified priority populations. If you need residential treatment and can’t receive it right away because a bed is not available, you have the right to interim supportive services until a bed becomes available.  
  • You have options and people to turn to as you seek treatment and stay connected with your family. The Institute of Health and Recovery offers family residential treatment services to help support your recovery and your family.  

Rights, Protections, and Tips for Advocacy 

  • You cannot be denied medication for opioid use disorder in the child welfare system or if you are pregnant and breastfeeding – this a violation of your rights under the Americans with Disabilities Act (ADA).  
  • If you are on MOUD, you will not automatically be involved with the Massachusetts Department of Children and Families (DCF).  
  • Know what to look for when it comes to facing discrimination. It can be subtle and difficult to name. A few examples are: 
    • Being denied visitation rights to your child because you are on MOUD like methadone or buprenorphine (Suboxone or Subutex). Unless you are using non-prescribed substances, you cannot be denied visitation rights while on MOUD.  
    • Having your infant taken from your custody after the hospital where you gave birth reported you for having legally prescribed MOUD in your system. Social services cannot take your child if the only reason is that you are on legally prescribed MOUD.  
    • Having your child taken away because your recovery status is automatically seen as making you unfit to care for your child. You can be on MOUD and stay with your child if you are otherwise providing your child with the care that they need.  
    • Your caseworker, lawyer, or advocate making any negative statement to you about your ability to be a good parent because of your recovery status, race, ethnicity, class, marriage status, age, sex, or sexual orientation.  
  • You have a right to access your recovery plan, often called a Plan of Safe Care (POSC). The document is made between a pregnant or parenting woman and her provider. This document helps women to think about what services or supports they might find useful, to record their plans for being a parent, and to organize the care and services they are receiving.  

Supporting Recovery While Working with DCF 

  • The reunification process can be difficult and painful. You have a right to access mental health and social support services throughout every step of the process.   
  • You have a right to see your child. You may ask DCF to see your child as soon as possible after your 72-hour hearing, and DCF must set up a visit within 5 business days, so long as the visits will not be harmful to the child. 
  • You have a right to an interpreter during your court hearing. Your lawyer will ask the judge for this. 
  • Document your case at every step of the process. Keep a notebook with you at all times and record communications with DCF, questions, and notes from child visits.  
  • If you feel your lawyer doesn’t listen to you, you can ask the judge for a different lawyer. You can also file a complaint with the Committee for Public Counsel Services at 617-482-6212. 
  • You have a right to see your Service Plan, which is the list of services and action items written by DCF that you must complete to be reunified with your child. This could include counseling, substance use treatment, or parent education classes. The Service Plan needs to explain what the services are, and why you are asked to comply with them.  
  • You can ask a judge for a Court Appointed Special Advocate or a Guardian ad Litum (GAL). 

Resources for Families

  • Learn to Cope is a non-profit support network that offers education, resources, peer support and hope for parents and family members coping with a loved one addicted to opiates or other drugs.
  • Parents Helping Parents is a resource made by parents working with DCF for other parents working with DCF.  
  • The Massachusetts Organization for Addiction Recovery (MOAR) provides a list of resources for parents and families in their mini guide
  • The Journey Recovery Project provides advice, information, and resources for parents at all stages in their recovery and family journey.  
  • The Children and Family Law Division provides attorneys to work with parents navigating family court.  
  • The Parental Stress Line (1-800-632-8188) is a 24-hour helpline staffed by trained volunteer counselors who are available to help you.  
  • The Family Engagement Project is an in-home treatment and case management program for mothers with SUD who also have an open case with DCF.  
  • Moms Do Care is a peer-based recovery support program in ten communities across Massachusetts for mothers with substance use disorder (SUD).  
  • IHR has an interactive resource map that spans housing, employment, and treatment services for pregnant people and parents.  
  • National Advocates for Pregnant Women (NAPW) is a legal and advocacy organization which works to advance the equal rights of all pregnant people.  
  • If you are a grandparent caring for a child involved with DCF, you can connect with Grandparents Raising Grandchildren, a support group for grandparents in Massachusetts.  
  • Pregnancy and substance use: A harm reduction toolkit  
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Recovery and Housing

Everyone in recovery has the right to safe and livable housing in Massachusetts, whether you are looking to rent or own, or to live in certified sober housing. In any phase of recovery, housing is important in making a person feel safe and connected to their community. You have rights and protections through all stages of getting and keeping your housing. 

  • Sober Homes, also known as alcohol- and drug-free housing, can offer people in recovery a safe and positive environment where they pay rent. These group living homes ensure that people in recovery are not alone, and they can share their success and support with others reaching for the same goal. See the list of accredited Sober Homes here.  
  • The Massachusetts Fair Housing law prohibits discrimination in housing because of race, religion, nationality, age, ancestry, military background or service, gender, gender identity, sexuality, marital status, familial status (for example, if you have children), source of income (for example, a Section 8 voucher or RAFT), or disability. Under this law, a person in treatment and on medication for opioid use disorder (MOUD), for example, cannot be denied housing. 

Rights / Advocacy Tips 

  • A landlord cannot evict you, only a judge can. You may receive a “Notice to Quit,” but that does not mean you need to leave your housing. This also applies to certified sober housing units.   
  • Know what to look for when it comes to housing discrimination. It can be subtle and difficult to name. Some examples can include: 
    • You call and get an appointment to look at a house, but when you get there, you are told that the house was just sold or rented. 
    • You are told that the apartment you are looking at has been rented, but you see the posting still active on housing sites. 
    • You are told a higher selling price than what was advertised, or what you hear others being told. 
    • You are given different terms or conditions for signing a lease than other applicants. 
    • You are only shown homes in certain parts of town. 
    • You are not given the opportunity to negotiate. 
    • You are told that housing vouchers are not accepted by the landlord, or you see an advertisement that says, “people with vouchers cannot apply.” 
    • You face harassment, intimidation, or questions about your ability to pay rent on time.  
  • If you believe you are being discriminated against, you have the right to file a claim to the Massachusetts Commission Against Discrimination (MCAD), the U.S. Department of Housing and Urban Development (HUD), the  Massachusetts Attorney General’s Office Civil Rights Division, or your local Fair Housing Task Force. 
    • If you were convicted before on drug-related charges, you may be told you are not eligible for public, or federally assisted housing. This ineligibility usually lasts for 3 years after you leave incarceration. A public housing agency can lift or shorten that time period if you successfully complete a rehabilitation program. However, depending on the charge, some individuals may still not qualify for federally assisted housing unless they can present an argument for changed behavior. This includes: 
      • Individuals who have been convicted of drug-related criminal activity involving the manufacture or production of methamphetamine on the premises of federally assisted housing.   
      • Individuals charged with violence-related activity that may pose a risk to the safety or well-being of other tenants. 


  • City Life/ Vida Urbana has a hotline for people who are facing evictions and a list of resources for those looking for housing support.  
  • Find certified sober homes in Massachusetts. If you are in sober housing already and need to file a grievance (complaint), you can do so here.   
  • If you believe you have been discriminated against, Mass Access can help you file a claim, investigate the realtor, and link you to further resources.  
  • The Massachusetts Commission Against Discrimination also has resources for people who experience discrimination.  
  • The Attorney General’s Civil Rights Division has a Know Your Rights resource for income-based housing discrimination.  
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Recovery and Education

Navigating college and higher education can be hard for anyone but navigating while in recovery can bring new challenges. Many colleges now offer student support groups and resources to help people pursuing degrees while in recovery. Wherever you are in your recovery process, you have support and tools to be successful in your education.  

Rights, Protections, and Tips for Advocacy 

  • You are still eligible for federal financial aid. Your financial aid cannot be taken away if you are prescribed medication for opioid use disorder (MOUD).  
    • What if I have a drug possession charge on my record? If you are convicted as an adult for drug possession and your Free Application for Federal Student Aid (FAFSA) is suspended, you can become eligible again by 1) successfully completing an approved drug rehabilitation program, or 2) by passing two unannounced drug tests done by an approved drug rehabilitation program.  
  • Every college campus has its own policy regarding The Good Samaritan law, even if it’s different than the state Good Samaritan law. Students for Sensible Drug Policy created a spreadsheet outlining campus policies if a student overdoses on campus and calls 911. Check with your Dean of Students and ask what the policy is if an overdose occurs on campus.  
  • Many colleges provide peer-based recovery groups, but do not prescribe MOUD. If you are interested in exploring MOUD services, you have a right to ask your campus provider for a referral to a community-based prescriber.  
    • If you are on a University Health Plan, call your university’s health insurance office to ask about coverage for mental health and substance use services.  

Resources for Education

  • The Association of Recovery in Higher Education (ARHE) is the only association that represents collegiate recovery programs (CRPs) and collegiate recovery communities (CRCs). The website provides a list of universities with active recovery programs. 
    • The Association of Recovery in Higher Education provides education, resources, and community connections for students in recovery, and the faculty, staff, and peers who support them. 
  • For information around eligibility for financial aid, FAFSA has created this FAQ.  
  • Sober Living has compiled a list of undergraduate universities that offer sober, substance-free housing options on campus.  
  • The Massachusetts Organization for Addiction Recovery (MOAR) provides information on additional ways to fund your education or vocational training in their Mini Guide.  
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Recovery and Employment

All workers have a right to a fair wage, a safe workplace, respect, and dignity. For people in recovery, it’s especially important to feel supported and empowered at their place of work. All workers have a right to advocate for themselves for the treatment supports they need and any accommodations that can help them return to work safely.  

Rights, Protections, and Tips for Advocacy 

  • You cannot be discriminated against in the hiring process or on the job for having a history of opioid use disorder (OUD) or for receiving medication for OUD (MOUD). The Americans with Disabilities Act (ADA) and the Massachusetts Anti-Discrimination Act protect the rights of people with substance use disorder (SUD) in all stages of employment. This includes the application and interview, after a job offer, and on the job.  
  • Advocate for the workplace you need for a successful recovery. Federal law and state laws require that employers provide “reasonable accommodations” when needed to allow employees with a disability to perform their job duties. Reasonable accommodations can include:  
    • Job restructuring.  
    • Flextime for counseling, doctors’ appointments, and attending a treatment clinic.  
    • Permitting a leave of absence, such as for residential treatment programs.  
  • Know your privacy information. An employer or interviewer cannot ask questions about past illegal drug use, participation in a rehabilitation program, or extent and frequency of substance use. But employers can ask about current use of alcohol or illegal drugs.  
  • Keep your employment while getting treatment. Massachusetts recently updated the Paid Family and Medical Leave Act. As of January 1, 2021, most Massachusetts workers will be eligible to take up to 26 weeks of paid leave per year. Here are some of the qualifying reasons for leave:   
    • Up to 20 weeks for a worker’s own serious health condition, like a SUD.   
    • Up to 26 weeks for the worker to care for a family member who is a covered service member with a serious health condition. 
    • Beginning July 1, 2021, eligible workers may also take up to 12 weeks to care for a family member with a serious health condition. 
  • Know your workplace rights about drug testing. The National Labor Relations Act (NRLA) requires that drug-free workplaces must work with unions to negotiate how drug testing programs work, such as when tests are given and what the penalties would be.  
  • Know what to look for when it comes to discrimination in the workplace. It can be subtle and hard to name. Here are some examples: 
    • Being asked about substance use in your past during interviews.  
    • You are pressured to share medical information or previous substance use during the interview process or on the job.  
    • The person interviewing you pressures you to explain time gaps in your resume. If you have gaps in your resume due to time in treatment, the person interviewing you can ask questions about the gap, but you do not have to share that you were in treatment.  
    • Being asked by your employer or the person interviewing you about the frequency of past substance use. For example, they cannot ask, “How much alcohol or illegal drugs did you consume? How often do/did you drink alcohol or use illegal drugs?” 
    • Having a manager or supervisor change the work you do after you share information about a disability or your recovery if you did not ask for those changes.  

Resources for Employment

  • The Grayken Center has an Employer Resource Library for employers to help understand and support people in recovery from SUD.  
  • The U.S. Department of Health and Human Services offers the Know Your Rights toolkit for people on medication for opioid use disorder.  
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Legal and Justice System Resources

The legal system can be difficult to navigate, whether you are waiting for a trial, held in corrections, on probation, or in the process of re-entering the community. You have rights in every entry or exit point in the system, and people to help you navigate. Maintaining your recovery after being justice-involved is key, and there are resources to help.  

Navigating the Legal and Court System

What to know if you: 

  • Have a case in a civil court: If you have a case in a civil court, you can’t be detained (held). Civil court includes Housing Court, Juvenile Court (child welfare cases), Probate and Family Court, and Appeals Court. To see if free legal representation for your civil legal problem is available visit Mass Legal Services
  • Receive a criminal citation (either in the mail or from a police officer): If you receive a criminal citation you will be assigned a court date for a Clerk Magistrate Hearing, also referred to as a “show cause” hearing. This is a preliminary (early) hearing where a clerk decides if a criminal charge should be issued and if you will be formally charged with a crime. You are not entitled to have representation from a defense attorney at this point, but you may bring your own lawyer.   
  • Are arrested or have a criminal complaint issued after a Clerk Magistrate Hearing: If you are arrested you will be brought to the police station or a regional lock-up facility to be “booked.” You may be released by the bail clerk or you may be held until the court is open and you are brought to court. If you are released by the bail clerk, they will tell you when you need to be in court.  
    • Your case will be heard in a District Court. The first court process is called “arraignment” and at this point you have the right to representation by a defense attorney. An attorney will be appointed to you if you meet the eligibility requirements (called “indigency criteria” by the court) and will work closely with you. For more information about public defenders in Massachusetts go to the Committee for Public Counsel Services.  

Rights, Protections, and Advocacy Tips for Appearing in Court 

  • When someone charged with a drug offense comes to court, the judge must tell the person that they are allowed to request an evaluation of whether or not they have a substance use disorder (SUD) and would benefit from treatment instead of incarceration. If you wish to exercise this right, you must make a request in writing within five days of your hearing.  
  • A judge can divert (direct) eligible people into treatment instead of incarceration. If you successfully complete a treatment program, the charges can be dismissed. Probation officers are required to screen each person charged with a drug offense for eligibility for a diversion program and to tell the judge. There are some charges that may make a person ineligible for this, such as a previous sex offense or arson charge. The District Attorney in the county where you are may have a diversion-to-treatment program that you may be eligible for.  
  • At arraignment, you have the right to ask to be placed in a treatment program while on probation. You can also request to be diverted through a drug court, which would require you to complete a treatment program instead of a two-year sentence. There are certain eligibility requirements for participating in a drug court session. You will want to work closely with your attorney to determine the best path for you.  
  • If you are released after your hearing, there may be conditions from the court you need to meet when you’re released. If you do have conditions, you will be assigned a probation officer who will communicate with you about what you need to do during the period of time before the next stage of your case.  

Navigating the Correctional and Justice System

If you are pre-trial for a criminal case, you will most likely be held in a House of Correction, however you may be held in a Department of Correction facility.  

Houses of Correction (HOCs) facilities are under the jurisdiction (rule) of the county Sheriff. These HOCs provide treatment options for people with opioid use disorder (OUD): Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, and Suffolk. 

Department of Correction (DOC) facilities are under the jurisdiction (rule) of the state. These DOCs provide treatment for people with OUD: MCI Cedar Junction, MCI Framingham, South Middlesex Correctional Center, and Massachusetts Alcohol and Substance Abuse Center (MASAC). 

Treatment programs “behind the wall” (in corrections facilities) can be continued into re-entry services.  

What to know if you are sentenced: 

When your case is closed, you may be released with 1) no conditions, 2) sentenced to probation supervision, 3) sentenced to a correctional facility, or 4) you may have what is called a “split sentence.” A split sentence is when you serve a period of time in corrections and have a term of probation when you are released. If your sentence includes probation supervision, you will work closely with your probation officer to meet the conditions of your sentence.  

  • You have a right to choose your treatment if you are imprisoned and in a minimum or medium security facility. 
  • You have the right to talk with your probation/parole officer or court-appointed advocate and appointed judge about what kind of treatment you want to get, whether it’s clinical or non-clinical treatment. Your probation/parole officer must communicate this to the judge. 
  • There are multiple treatment options available in some corrections units.  

Re-entering the Community After Incarceration:

  • You will want to work closely with the healthcare and treatment team, as well as your correctional and re-entry caseworkers, to develop a re-entry plan that will help you transition back to the community. Your plan may include help with:  
    • Health insurance enrollment 
    • Refills for prescription medications 
    • Appointments with health care, substance use disorder, and/or mental health treatment services 
    • Connections to housing 
    • Military and/or social security benefits 
    • Support for reconnecting with children and family 
    • Workforce opportunities 
    • Relapse and overdose prevention planning 
    • Recovery support 
    • Referrals get to Narcan (naloxone) 
    • Anything else you may need to help you succeed after your release.  
  • You may be released on parole and/or probation supervision: Probation and parole are two different programs that both provide supervision in the community. You will work closely with your probation and/or parole officer to understand and meet the conditions of your supervision. They are trained to help connect you to resources that include treatment, housing, employment supports, and other re-entry programs. 
  • You may be released from incarceration without probation and/or parole supervision. Not all individuals re-entering the community are assigned a parole officer, so there are re-entry programs people can use. Ask the re-entry team at the correctional facility if there are any post-release re-entry services that you can use after you leave the facility.  
  • Know your rights around privacy and disclosure. You can request a copy of your Criminal Offender Record Information (CORI), and you have the right to “seal” your CORI if you meet the eligibility criteria so that no one else can look at it.   
    • A judge in the court that handled your case has the power to seal a first-time drug possession conviction where you did not violate (break) any court orders connected to being on probation or a “CWOF” (continuance without a finding). The court orders might include going to drug treatment or doing community service. 
      • Under state law, you have to show “good cause” to seal a record. To show there is “good cause” to seal records, you need only show there is a present or possible future disadvantage that stems from your criminal record.  
        • Things a judge can consider are:  
          • A lot of time has passed since the case was filed against you 
          • You are sober and have made efforts to rehabilitate yourself  
          • You successfully completed probation in your case(s) 
          • You have other evidence of rehabilitation from the date of the offense or dismissal
    • Your privacy is protected by state and federal laws in areas like housing and employment to protect you from discrimination.  
      • Under the “Ban the Box” law, employers cannot ask about a criminal record at any point in the application process. Employers are generally permitted to ask about felony convictions and some misdemeanor convictions during the hiring stage (after the initial job application), but most employers are not permitted to ask about any of the following during any point in the hiring process:  
        • criminal cases that did not end in conviction  
        • an arrest or detention 
        • first convictions for drunkenness 
        • simple assault  
        • speeding 
        • minor traffic violations 
        • affray, or disturbance of the peace  
        • misdemeanor convictions where the date of conviction or release from incarceration was 3 or more years ago (unless there were subsequent convictions) 
        • juvenile court records 
        • sealed or expunged records 
  • Know what to look for when it comes to discrimination for being justice-involved. It can be subtle and hard to name. Here are some examples: 
    • Being denied housing because of your CORI or recovery status.  Landlords have limited access to your CORI, and may deny you housing because you have a criminal record, but housing providers that automatically reject all applicants with criminal records might be violating state and federal civil rights laws because using criminal records in this way can have a disproportionate effect on protected groups, including racial minority groups and people with disabilities. For more information about CORI protections in the housing process, please see the Attorney General’s Guide to Criminal Records in Employment and Housing
    • Not being referred by your attorney or judge to drug courts if you are being tried for drug-related charges or have a substance use disorder. Drug courts that divert people from criminal courts still serve many more white people than Black, Indigenous, or other people of color. Be sure to ask about “diversion options” for court, including drug courts. 

Resources for Justice-Involved Individuals 

  • The Sequential Intercept Model created by Policy Research Associates, which identifies resources and gaps for justice-involved people. 
  • Request your CORI online at the Massachusetts Department of Criminal Justice Information Services.  
  • Each facility uses a certified Housing Search Specialist to access residential programs, shelters, and sober houses as options to consider while working on re-entry plans. They can use a database of housing options for releasing inmates at risk for homelessness in MA. 
  • Department of Corrections also partners with MassHealth to provide health care to people who are previously incarcerated.
  • There are options available for people living in incarceration who are looking for tailored recovery programs. See the list here.  
  • Coming Home has a list of re-entry programs for people in Greater Boston. 
  • Mass Legal Help has a “Know Your CORI Rights” toolkit that offers guidance on sealing a CORI. 
  • Massachusetts Commission Against Discrimination has a fact sheet on CORI issues and employment discrimination.  
  • The Boston Bar Association offers a clinic where free attorneys will assist individuals in the Boston area in sealing their criminal record.  

Navigating Section 35 and Involuntary Commitment

Section 35 

If all other treatment and recovery options have been tried, Section 35 is a Massachusetts law that allows a qualified person to request a court order for someone to be civilly committed and treated involuntarily (against their will) for an alcohol or substance use disorder. Under section 35, a person can be held up to 90 days. This should only be used as a last resort, if used at all.  

Who can “section” someone (use Section 35 to have a person committed to treatment)? 

  • Only a “qualified petitioner” can ask the court to commit someone to treatment under Section 35. This includes: a police officer, physician, spouse, blood relative, guardian, or court official. 

What happens when a person is sectioned? 

  • Summonsing: The court will review the petition and decide whether to issue a summons or a “warrant of apprehension.” If summonsed, a person will receive an order to appear in court. If the court believes the person is an immediate physical danger or will not voluntarily come to the court, a police officer will be sent to find the person, take them into custody, and deliver the person to court. Law enforcement often uses handcuffs and shackles when transporting the person to court and when they are in court.  
  • Representation and Evaluation: Once the person is brought to court, they will be appointed an attorney who will represent them in court. Then the court clinician will evaluate them. The clinician will also interview the petitioner.  
  • Hearing and Decision: After hearing testimony and argument, the judge will decide if there is “clear and convincing evidence” that the person has a substance use disorder (SUD) and is at risk of harming themselves or others as a result of their SUD. If the judge decides the person will be committed, they will be taken directly to treatment from the courthouse. If the judge decides the person does not meet the standard for commitment, they will be released.  
  • Detaining: Once committed, an individual will be sent to wherever there are beds available. The person submitting the petition cannot choose and has no control over which facility the person will go to, which may include a house of correction. You can find a list of all treatment locations here.  
  • If you are being sectioned (committed under Section 35), you still hold these rights:  
    • The right to be represented by an attorney 
    • The right to refuse the medical examination the judge requests  
    • The right to choose your own witnesses for testimony on your behalf 

Resources for Section 35

Committee for Public Counsel Services provides legal representation to people who can’t afford an attorney. 

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