Overcoming poverty and addiction, he passed the bar exam. Then his prescription got in the way.

This article was produced as a project for the USC Annenberg Center for Health Journalism’s 2023 National Fellowship.

NASHVILLE, Tenn. — After he graduated, Derek Scott proudly hung his degree from the University of Tennessee College of Law on his wall at home. By most measures, he’d been an unlikely candidate for law school — he was the first in his immediate family to go to high school and struggled for years with opioid addiction before enrolling in college at age 32. The degree served not just as a reminder of all he had overcome, but also as proof that he belonged.

When he passed the bar exam in 2021, his dream felt almost in reach. All he had left to do was pass the “character and fitness” portion of his application — a step all prospective lawyers have to take.

“I knew there were going to be questions asked,” Scott, now 44, said. “But I didn’t think my medication would be the biggest hurdle.”

On his bar application, Scott disclosed that he had been convicted of three misdemeanors nearly two decades earlier, as well as accused of other criminal charges that would ultimately be expunged from his record. To his surprise, those disclosures would thrust him into a nearly three-year battle over his right to use buprenorphine, a Food and Drug Administration-approved medication that addiction medicine experts and top federal health officials call the “gold standard” of treatment for opioid use disorder.

Buprenorphine had changed Scott’s life — it gave him a sense of normalcy, he said, and set him on the path to law school. His future, however, would come to hinge on a choice that didn’t feel like much of a choice at all: get off the medication that protected him from relapse and attend abstinence-only treatment, or lose