Two skilled nursing facilities in North Carolina reached a settlement this month that bars them from discriminating against people with a history of substance use — potentially setting a precedent for how long-term care facilities nationwide treat people with addiction. 

Under the settlement, the facilities are to adopt new antidiscrimination admission policies and apply reasonable judgment to individual applicants, instead of automatically denying them based on past substance use. 

The policies apply to people taking addiction medications like methadone and buprenorphine, as well as those who currently use illegal drugs; facilities are not required to bend their own rules regarding admitted patients’ substance use. It is believed to be the first case in the U.S. to successfully challenge long-term care facilities’ systemic denials of admission to people with substance use disorders. 

“The Americans with Disabilities Act prohibits the denial of health services to people on the basis of current drug use,” said Rebekah Joab, an attorney with the New York-based Legal Action Center. “So somebody with the disability of substance use disorder has to be treated the same as anyone else.” 

The lawsuit was brought jointly by the Legal Action Center, which advocates on behalf of people with addiction or who are incarcerated, and another nonprofit, Disability Rights North Carolina. 

It was filed on behalf of an anonymous “John Doe” client who was denied admission to two facilities in Raleigh and Durham, N.C., respectively: Sunnybrook Rehabilitation Center and Treyburn Rehabilitation Center. 

In an interview, Sara Harrington, an attorney with Disability Rights North Carolina, stressed that the settlement doesn’t require facilities to admit potentially disruptive patients. Instead, she said, it requires them to treat all applicants equally and not automatically reject those with a history of substance use. 

“We’re not saying that they need to condone [drug use] or let people break their rules,” Harrington said. “We’re just saying that people need a chance. If our client had been interviewed, if he had been assessed using nondiscrimination policies, he would have been admitted, most likely. He’s in a facility now, and has been there for over a year, and any concerns the other facilities had came to nothing, because he’s a great resident.” 

The rehabilitation facilities did not immediately return STAT’s request for comment. 

The settlement is the latest in a string of legal developments that, in recent years, have expanded applications of the Americans with Disabilities Act, or ADA, to apply more broadly to people in recovery, people taking medications for opioid use disorder, and increasingly, people who currently use illicit drugs. 

While the ADA views addiction as a disability, it does not protect Americans from repercussions for their drug use — for instance, being dismissed from a job. Increasingly, however, attorneys have used the landmark 1990 law to protect people with opioid addiction from discrimination in various health care and carceral settings. 

Under former President Biden, the Department of Justice issued a string of guidance warning that the denial of medications like methadone or buprenorphine to people with opioid use disorder would violate the ADA. Recently, a federal judge certified a class-action lawsuit against a branch of the Salvation Army for denying admission to people taking either medication based on its religious views. 

Under Biden, the DOJ reached similar settlements with a trial court in Massachusetts, the Indiana Board of Nursing, a Colorado-based social services program, and Pennsylvania’s court system, all for discriminating against people with opioid use disorder, either broadly or specifically with regard to their use of addiction medications. 

While the North Carolina settlement doesn’t create new doctrine for skilled nursing facilities elsewhere across the state or country, it does lay groundwork for similar lawsuits in the future. It is unclear, however, whether the Department of Justice under President Trump will continue efforts from the previous administration to roll back discrimination against people with addiction. 

“The implication should be understood by nursing homes in every state and territory that they have to have antidiscrimination policies and they cannot exclude individuals who have substance use disorder or who are in active use,” said Holly Stiles, the assistant legal director for litigation at Disability Rights North Carolina. “That’s what federal law requires, is that it be interpreted uniformly across the country, so we would encourage other facilities to understand that this is their obligation, too.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.