The scene plays out every day in Massachusetts, thousands of times a year.

A loved one is addicted to opioids. Their life is spinning out of control as they use more and more. Their family panics. Rehab can be unaffordable – and it may require waiting for a spot. But they need to get their loved one somewhere they can’t use before it’s too late.

It’s about now that they might consider section 35, a process in Massachusetts by which persons abusing drugs or alcohol can be involuntarily committed to treatment for up to 90 days after a family member, guardian, law enforcement officer or doctor petitions a judge. Many states have similar laws in place and have turned to them in battling the opioid crisis gripping the nation.

But in Massachusetts, involuntarily committed men can end up in jail or prison even though no charges have been levied against them.

That’s how Jim, a 29-year-old student, arrived at the Hampden county jail in the western Massachusetts town of Ludlow in March after overdosing on opioids. Despite being forced into jail with no charges, he told the Guardian he was glad to be there.

“I’ve never been in trouble with the law, but it was absolutely necessary for a cop to come to the house, put me in handcuffs and take me here,” he said.

To proponents, the section 35 process is seen as lifesaving, putting people in a place where they cannot get drugs and where they cannot walk out

Eight days into his stay, he said jail was “the best thing that’s probably ever happened to me”.

As Massachusetts struggles against an opioid crisis that kills five times as many people than automobile accidents every year in the state, the placement of civilly committed men in correctional facilities has emerged as one of the most controversial tactics to confront addiction in the state – and one not seen anywhere else in the nation.

To proponents, the section 35 process is seen as lifesaving, putting people in a place where they absolutely cannot get drugs and where they cannot simply walk out. But its detractors say that forced rehabilitation does not work, that putting men in correctional facilities is unconstitutional and that putting patients in prison settings is detrimental to recovery and increases the risk of relapse once patients are released.

Women were once held in correctional facilities in Massachusetts for addiction, but after an ACLU lawsuit, the state ended the practice in 2016.

But the state has ramped up its incarceration of civilly committed men. According to Prisoners’ Legal Services, a not-for-profit that has been a key opponent of the practice, Massachusetts places more than 2,000 men involuntarily committed for substance abuse in correctional facilities per year.

The Hampden county jail wing looks like a jail, but the people here are patients, not inmates, and have been charged with no crime. Photograph: Josh Wood/The Guardian

‘Shamed and stigmatised’

In March, PLS filed a lawsuit against the department of correction and department of public health on behalf of 10 unnamed patients being held at the Massachusetts Alcohol and Substance Abuse Center (Masac), a facility operated by the DoC in the town of Plymouth.

The lawsuit charges that holding the men in correctional facilities is unconstitutional, constitutes unlawful discrimination on the basis of gender and disability and is overall detrimental to recovery. They also describe an abusive environment where patients are “routinely” humiliated by correctional officers (COs) and where patients lack access to opioid substitution medications such as Suboxone.

“These people are being shamed and stigmatised on the basis of a disease that’s acknowledged as a disability,” said Bonnie Tenneriello, PLS staff attorney.

One of the unnamed plaintiffs said officers called patients pussies, bitches, junkies and crackheads while telling him that his “mother is a whore”.

Another plaintiff described how during detox, his roommate urinated and defecated on himself, but that nobody cleaned it up.

Others described being too afraid to call their employers or loved ones as all phone calls coming from the facility inform the person being called that they are receiving a call from a correctional facility.

PLS says patients have been sent to solitary confinement for seemingly minor offences like smoking a cigarette, not answering questions or taking extra milk with their meals.

“All of that is counter-therapeutic, all of that is traumatising, all of that is telling people you are not a full citizen, you are not to be trusted, you are a bad person,” said Tenneriello of placing patients in correctional facilities.

A cell – or bedroom – in the wing for civilly committed men at the Hampden county jail. While the facility is locked, cells remain unlocked. Photograph: Josh Wood/The Guardian

‘It’s a jail mentality’

Joel Kergaravat, 36, was hooked on heroin and crystal meth when his mother petitioned him to be sectioned last summer. They both thought that sectioning him would mean rehab, but instead he was put in restraints and loaded into a hot van for a long drive to Masac.

His experience at Masac appeared to mirror allegations laid out in the lawsuit.

Once he got to Masac, he did not have access to detox medications. “It’s barbaric not to give people that medication, because you’re basically vomiting and shitting yourself for six days,” he said. “That’s what happens. It’s not pretty.”

Inside, he said guards were abusive. He felt the place was unsanitary and unclean and worried about getting sick. Patients would get into fistfights.

“It’s a jail mentality,” he said. “They have you in a prison setting so people act accordingly.”

When he got out, he was traumatized. He got back on drugs and at one point tried to kill himself by overdosing – a result, he says, of his experience at Masac.

“If you’re going to force people into treatment, that’s fine, put them into treatment,” he said. “You can’t just rename a prison or a section of a prison and call it treatment.”

A sheriff champions section 35

The Hampden county sheriff, Nick Cocchi, might be the biggest proponent of section 35 in the state.

Cocchi views his mission as a rehabilitative one. His COs don’t carry weapons of any kind and those on the section 35 wing don uniforms consisting of polo shirts – an attempt to look less guard-like. He keeps a folded, ageing piece of paper in his pocket that lists the names of those that have died at the jail in the 26 years he has been working there. When western Massachusetts residents call him and send him Facebook messages pleading for advice about loved ones who have been trapped by addiction, he invites them to his office, even if it is a weekend. Men who have previously been sectioned call him up when they are relapsing.

Cocchi says that when done right, forced rehab works.

His enthusiasm about section 35 was born out of a desire to provide treatment closer to home for residents of western Massachusetts.

“You serve no purpose taking somebody two and a half hours from home, detoxing them and then saying ‘here’s a bus ticket to get back to where you’re going.’ Where’s the support?” he said. “There’s no support. And when there’s no support, there’s relapse.”

Sheriff Nick Cocchi says that done right, forced rehab works. If Massachusetts stops allowing correctional facilities to hold men civilly committed for drug and alcohol abuse, he says it will ‘devastate’ the state. Photograph: Josh Wood/The Guardian

He said the kind of abusive treatment outlined against Masac in the lawsuit brought by PLS doesn’t happen at his jail. He said that there need to be reforms to the section 35 process, but that his facility is “second to none” in the state.

Recently the gregarious sheriff brought the Guardian into the section 35 wing, walking in with a five-month-old bull mastiff puppy named Brooklyn.

“What’s up guys?” he beamed at the patients – or “clients” as they are referred to in the jail administration’s parlance. “I don’t want anyone to panic – this is not a drug sniffing dog!”

Opponents of jailing section 35 patients say that even if abuses are not present at a correctional facility, keeping civilly committed men there is wrong and dangerous

The wing appeared clean and orderly. The patients wore a uniform of brown pants and yellow or blue T-shirts with inspiring mottos like “recovery works” and “one day at a time” on them. They appeared friendly with the sheriff and the COs, stopping them to share their thoughts and concerns about their time on the unit.

Several patients eagerly lined up to speak to the Guardian about their experience at the jail, all saying positive things. Many were optimistic that being closer to home, having counseling about their discharge plan and having access to advice after they were out would mean it would be easier to stay off drugs or alcohol once released.

Some had spent time at Masac in Plymouth and said their current surroundings were much better.

Jim, the 29-year-old student who was sectioned after an overdose, said: “The COs don’t treat you like inmates, they treat you like a patient essentially.”

The wing has only been receiving section 35 patients since May, but Cocchi says he is confident that statistics will eventually show that his program has a higher success rate than any other treatment facilities.

“There’s also a group out there that says forced treatment doesn’t work – when you force someone to go into treatment, it doesn’t work,” he said. “That is absolutely false.”

If people trying to put an end to correctional facilities holding civilly committed men are successful, Cocchi says “they will devastate the commonwealth of Massachusetts, specifically western Massachusetts right now … And I will not lay down on that.”

‘Setting them up to die’

But opponents of jailing section 35 patients say that even if the abuses laid out against Masac are not present at a correctional facility, keeping civilly committed men there is wrong and dangerous.

“No matter how well run any prison might be, we’re saying that it’s a disease,” said Tenneriello, the PLS attorney. “Putting people in prison because they have a disease is fundamentally wrong”

Leo Beletsky, an associate professor of law and health sciences at Boston’s Northeastern University is an expert on the opioid epidemic and sits on the state’s section 35 commission.

He points to studies, like one by the Massachusetts department of public health, that show that persons recently released from incarceration are 120 times more likely to die of an opioid overdose than members of the general public.

“By putting people in correctional settings, we’re essentially setting them up to die,” he said.

Physician Sarah Wakeman, an addiction medicine specialist and medical director of the Substance Use Disorders Initiative at Boston’s Massachusetts general hospital, said those leaving forced rehab are at particular risk for overdosing given they did not want to be there in the first place and have lowered their tolerance.

To Wakeman, more focus needs to be placed on making sure that voluntary treatment for substance abuse is more readily accessible.

“The reality is that tough love is not a useful intervention to help a person suffering from addiction,” she said.

Beletsky said the section 35 system remains popular as it is much easier to access than voluntary treatment programs.

“Section 35 in many ways is the path of least resistance for getting into treatment,” he said. “It’s immediate, it’s free, it requires no navigation.”

It “illustrates how broken our systems of care are,” he said. “In many ways it’s easier to put somebody away than have them access normal healthcare.”