By Alison Knopf
Drug courts, corrections, and in fact the entire criminal justice system is undergoing a sea of change relative to medication-assisted treatment (MAT) for opioid addiction. Not long ago, judges dismissed out of hand any recommendation to divert an offender from prison or jail to outpatient treatment with methadone. Inside prison and jail, methadone treatment was increasingly rare.
That’s starting to change, especially when offenders are lucky enough to get into a drug court with an educated judge. These offenders may well be recommended for methadone treatment. And if they are already in methadone treatment, drug courts are increasingly allowing them to stay in treatment.
That said, “MAT” is a broad term. It applies to the antagonist naltrexone (Vivitrol in extended release form), as well as to methadone and buprenorphine. And drug courts have a clear bias towards naltrexone. Even if the medical expert recommends methadone, for example, the drug court may prefer naltrexone, reflecting a bias against any drug that produces dependence. That’s why so many people view drug courts as barriers to, not supporters of, treatment in an opioid treatment program (OTP).
For offenders who are incarcerated, the availability of treatment is still very limited, however. It’s very difficult for a patient who is in an OTP and is sentenced to a prison term. Given current federal regulations, there are limits on what the OTP can do, said John Peloquin, PhD, president of the CTC (Comprehensive Treatment Center) division of Acadia Healthcare (Acadia bought CRC, where Dr. Peloquin also ran the methadone treatment division, referred to as CTC).
State corrections systems are not set up to provide methadone maintenance; only recently did Connecticut announce that it would be the first state to do so, and then only with the OTPs volunteering to bring in medication for their patients.
However, OTPs can help offenders get treatment by making themselves available as information sources to local criminal justice officials, said Dr. Peloquin. Even if the prison or jail doesn’t provide methadone, the inmate can enroll in an OTP upon release. The main job of the OTP is to educate the criminal justice system about methadone maintenance, explaining what treatment is and trying to eradicate stigma.
“An OTP can engage the local criminal justice system to collaborate with parole officers and other agencies to get individuals into treatment as they are being released,” Dr. Peloquin said. “This requires education and awareness to eliminate any individual prejudices and biases that would interrupt an individual’s treatment opportunity.”
Indeed, the National Association of Drug Court Professionals (NADCP) has long recommended that drug courts be involved with getting treatment to patients—and the organization has come a long way in accepting MAT.
Instead of the wholesale rejection of methadone that courts typically espoused years ago, wanting only residential inpatient treatment, there is now a sense that drug courts are not doing their jobs if they have blanket prohibitions against methadone. And the federal Substance Abuse and Mental Health Services Administration (SAMHSA) has said it will not fund drug courts that have such bans (about 20 percent of drug courts received SAMHSA funding).
In 2013, the NADCP’s Adult Drug Court Best Practice Standards stated: “Numerous controlled studies have reported significantly better outcomes when addicted offenders receive medically assisted treatments including opioid agonist medications such as naltrexone, opioid antagonists such as methadone, and partial agonist medications such as buprenorphine. Therefore, a valid prescription for such medications should not serve as the basis for a blanket exclusion from a drug court.”
Nevertheless, the fact is that many people with opioid use disorders who get in trouble with the criminal justice system have committed crimes in order to pay for drugs; and, of course, being found buying or selling drugs can itself end up with a criminal charge.
Stigma of Methadone
For people who are in the criminal justice system and need treatment, the stigma against methadone is problematic. “Education and awareness designed to eliminate the many fallacies of an OTP is the best form of proactivity,” said Dr. Peloquin. “Many times the prosecutor’s office is not aware of the benefit and need of medication-assisted treatment to an offender.”
With support from federal Bureau of Justice Assistance and the Office of National Drug Control Policy, NADCP has developed fact sheets and training curricula to teach drug courts about the benefits and uses of various forms of MAT, including methadone and buprenorphine, said Douglas Marlowe, PhD, NADCP’s chief of science, law, and policy. “We are training drug courts to follow scientific evidence, not personal or political beliefs.”
Dr. Marlowe recommends that OTP personnel develop productive working relationships with drug court teams, including providing in-service trainings and participating in clinical case reviews. “In this way, drug courts can begin to dispel their myths about how OTPs operate, and OTPs, in turn, can dispel their own myths about drug courts and the criminal justice system,” he told AT Forum.
When an OTP patient is on probation, Dr. Peloquin advises that the OTP work collaboratively with the criminal justice agency. “It is not up to the OTP to supervise individuals, but both the OTP and the probation department can establish a partnership of communication that can help the individual stay in treatment while meeting their probation requirements,” he said.
For Volume I of the NADCP Adult Drug Court Best Practice Standards, go to http://www.allrise.org/sites/default/files/nadcp/AdultDrugCourtBestPracticeStandards.pdf.
For NADCP’s policy on the importance of MAT in drug courts (approved in 2011), in a board resolution on the availability of MAT for addiction in drug courts, go to http://www.nadcp.org/sites/default/files/nadcp/NADCP%20Board%20Statement%20on%20MAT.pdf.
Also see the Legal Action Center Report on Effective Strategies for Use of MAT in Drug Courts, at: http://lac.org/lacs-groundbreaking-report-shares-effective-strategies-for-use-of-medication-assisted-treatment-in-drug-courts/.