How to Make Drug Courts Work

May 13, 2013 by Leave a Comment

Pg8_law“Drug courts have made a surprisingly small contribution to the crime reduction that has occurred over the past twenty years. They process only a small fraction of drug-involved offenders within the criminal justice system, and an even smaller fraction of offenders who commit serious crimes. Most chronic cocaine, heroin and methamphetamine users who reach court will end up in jail or prison, often for minor crimes.

Drug courts could be more helpful in reducing crime and incarceration, but only if they become more ambitious and less risk-averse by taking in populations likely to serve real time.”

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/26/how-to-make-drug-courts-work/

Source: WashingtonPost.com – April 26, 2013

Filed Under: 2013-05-14, Addiction, Drug Courts & Criminal Justice, News Updates Tagged With: , , , ,

Forced Methadone Withdrawal in Jails Creates Barrier to Treatment in Community

April 4, 2013 by 1 Comment

jail croppedMethadone treatment for opioid dependence remains widely unavailable behind bars in the United States, and many inmates are forced to discontinue this evidence-based therapy, which lessens painful withdrawal symptoms. Now a new study by researchers from the Center for Prisoner Health and Human Rights, a collaboration of The Miriam Hospital and Brown University, offers some insight on the consequences of these mandatory withdrawal policies.

According to their research, published online by the Journal of Substance Abuse Treatment and appearing in the May/June issue, nearly half of the opioid-dependent individuals who participated in the study say concerns with forced methadone withdrawal discouraged them from seeking methadone therapy in the community after their release.

“Inmates are aware of these correctional methadone withdrawal policies and know they’ll be forced to undergo this painful process again if they are re-arrested. It’s not surprising that many reported that if they were incarcerated and forced into withdrawal, they would rather withdraw from heroin than from methadone, because it is over in days rather than weeks or longer,” said senior author Josiah D. Rich, M.D., M.P.H., director of the Center for Prisoner Health and Human Rights, which is based at The Miriam Hospital.

He points out that methadone is one of the only medications that is routinely stopped upon incarceration. “This research highlights that what happens behind bars with methadone termination impacts our ability to give methadone, a proven treatment, to people in the community,” he added. “Given that opioid dependence causes major health and social issues, these correctional policies have serious implications.”

For the past four decades, methadone has been the treatment of choice for opioid dependence, including heroin, and is on the World Health Organization’s list of “Essential Medicines” that should be made available at all times by health systems to patients. This “anti-addictive” medication prevents withdrawal symptoms and drug cravings and blocks the euphoric effects of illicit opioids. Additionally, methadone therapy has been shown to reduce the risk of criminal activity, relapse, infectious disease transmission (including HIV and hepatitis) and overdose death.

However, in the United States, a significant proportion of people who are opioid dependent are not engaged in methadone replacement therapy. Rich says the majority of patients terminate treatment prematurely, often within the first year.

In their study, Rich and colleagues surveyed 205 people in drug treatment in two states – Rhode Island and Massachusetts – that routinely enforce methadone withdrawal in correctional facilities. They found nearly half of all participants reported concern regarding forced methadone withdrawal during incarceration. Individuals in Massachusetts, which has more severe methadone withdrawal procedures, were more likely to cite concern.

“If other evidence-based medicines like insulin therapy were routinely terminated or withdrawn from those who were incarcerated, we would hear about these serious lapses in care. They would likely garner some attention. But routine termination of methadone maintenance therapy has been occurring in the criminal justice system for decades and remains a little discussed and highly neglected issue,” says lead author Jeannia J. Fu, Sc.B., a former researcher with The Miriam Hospital who is now affiliated with the Yale University School of Medicine.

Rich adds, “We should examine the impact of incarceration itself, and what happens behind bars, on public health and public safety outcomes, and tailor our policies appropriately. We have methadone, which has been shown to improve public health and public safety, yet we have policies that reduce access to this treatment. The correctional policies on methadone should be re-evaluated in terms of the impact they have on the individual and the community.”

http://www.eurekalert.org/pub_releases/2013-03/l-fmw032713.php

Information on the American Association for the Treatment of Opioid Dependence (AATOD) initiatives to increase access to methadone treatment in the Criminal Justice System is available at: http://www.aatod.org/projectseducational-training/methadone-treatment-in-the-criminal-justice/

Source: Eurekalert.org – March 27, 2013

Filed Under: 2013-04-08, Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), Methadone, News Updates Tagged With: , , ,

A Day at the Drug Court

March 9, 2013 by Leave a Comment

“Developed locally, their operations vary significantly. Defendants are diverted to drug court programs at various stages in the judicial process. And while many people arrested for non-violent offenses are eligible, prosecutors ultimately determine who gets offered the option of treatment. Participants must usually plead guilty as a prerequisite, and they’re drug tested throughout treatment. Judges can reward or punish their behavior: Incentives include certificates, cards and applause from the courtroom. Sanctions include admonishments, assigned essays, increased drug testing and court appearances, and, sometimes, a few days or weeks in jail.”

“Drug courts are one of the most important pieces of evidenced-based drug policy reform we have seen in generations,” US drug czar Gil Kerlikowske says in an email to The Fix. “By providing non-violent drug offenders with a chance to reclaim their lives through treatment rather than wasting away in prison, we save lives, save taxpayer dollars, reunite families, and reduce rates of incarceration. Decades of research and experience reveal that addiction—the underlying cause of too much crime in our communities—is a disease that can be successfully treated. Drug courts are what today’s discussion about drug policy should be about.”

http://www.thefix.com/content/drug-courts91363

Source: The Fix.com – March 5, 2013

Filed Under: 2013-03-11, Addiction, Drug Courts & Criminal Justice, News Updates, Opioid Abuse/Addiction Tagged With: , ,

Outside Box, Federal Judges Offer Addicts a Free Path

March 9, 2013 by Leave a Comment

“Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive. The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.”

http://www.nytimes.com/2013/03/02/nyregion/us-judges-offer-addicts-a-way-to-avoid-prison.html?_r=1&

Source: NYTimes.com – March 2, 2013

Filed Under: 2013-03-11, Addiction, Drug Courts & Criminal Justice, News Updates Tagged With: , ,

Drug Abuse Treatment Could Save Billions in Criminal Justice Costs

February 1, 2013 by Leave a Comment

Sending drug abusers to community-based treatment programs rather than prison could help reduce crime and save the criminal justice system billions of dollars, according to a new study by researchers at RTI International and Temple University.

Nearly half of all state prisoners are drug abusers or drug dependent, but only 10 percent receive medically based drug treatment during incarceration. Untreated or inadequately treated inmates are more likely to resume using drugs when released from prison, and commit crimes at a higher rate than non-abusers.

The study, published online in November in Crime & Delinquency, found that diverting substance-abusing state prisoners to community-based treatment programs rather than prison could reduce crime rates and save the criminal justice system billions of dollars relative to current levels. The savings are driven by immediate reductions in the cost of incarceration and by subsequent reductions in the number of crimes committed by successfully-treated diverted offenders, which leads to fewer re-arrests and re-incarcerations. The criminal justice costs savings account for the extra cost of treating diverted offenders in the community.

The findings were based on a lifetime simulation model of a cohort of 1.14 million state prisoners representing the 2004 U.S. state prison population. The model accounts for substance abuse as a chronic disease, estimates the benefits of treatment over individuals’ lifetimes, and calculates the crime and criminal justice costs related to policing, trial and sentencing, and incarceration.

The researchers used the model to track the individuals’ substance abuse, criminal activity, employment and health care use until death or up to and including age 60, whichever came first. They also estimated the benefits and costs of sending 10 percent or 40 percent of drug abusers to community-based substance abuse treatment as an alternative to prison.

According to the model, if just 10 percent of eligible offenders were sent to community-based treatment programs rather than prison, the criminal justice system would save $4.8 billion when compared to current practices. Diverting 40 percent of eligible offenders would save $12.9 billion.

The authors also address a concern common with diversion programs, which is that instead of being incarcerated, offenders are released into the community where they may commit additional crimes. Their analysis showed an immediate, short-lived increase in crimes, however, by the end of the first year, fewer crimes were committed, generating cost savings.

The study builds on previous research led by RTI indicating that increased investment in treatment for substance-abusing prisoners can reduce crime rates and cut criminal justice spending. In a study released earlier this year, Zarkin and colleagues found that increasing and improving prison-based drug treatment programs could save up to $17 billion in criminal justice system costs.

http://www.newswise.com/articles/study-replacing-prison-terms-with-drug-abuse-treatment-could-save-billions-in-criminal-justice-costs

Source: RTI International – January 9, 2013

Filed Under: 2013-02-01, Addiction, Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), News Updates, Opioid Abuse/Addiction, Other Drugs of Abuse, Prescription Drugs Tagged With: , , ,

Plan to End Methadone Use at Albuquerque Jail Prompts Alarm

January 14, 2013 by Leave a Comment

For the last six years, the Metropolitan Detention Center, New Mexico’s largest jail, has been administering methadone to inmates with drug addictions, one of a small number of jails and prisons around the country that do so.

In November, however, the jail’s warden, Ramon Rustin, said he wanted to stop treating inmates with methadone. Mr. Rustin said the program, which had been costing Bernalillo County about $10,000 a month, was too expensive.

Moreover, Mr. Rustin, a former warden of the Allegheny County Jail in Pennsylvania and a 32-year veteran of corrections work, said he did not believe that the program truly worked.

http://www.nytimes.com/2013/01/07/us/alarm-in-albuquerque-over-plan-to-end-methadone-for-inmates.html?smid=fb-share&_r=2&

Source: NYTimes.com – January 13, 2013

Filed Under: 2013-01-14, Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), Methadone, News Updates Tagged With:

Habit OPCO Helps Educate the Criminal Justice System about Medication-Assisted Treatment

October 11, 2012 by 1 Comment

Although it’s well known that many people wind up in the criminal justice system because they are addicted to opioids, there is still work to be done in educating the system about the value of medication-assisted treatment (MAT). Jonathon Wasp, MS, director of Pennsylvania operations for Habit OPCO opioid treatment programs (OTPs), has a background in management of addiction treatment in the correctional system, and is helping to do just that.

Mr. Wasp, formerly associated with MinSec, a private community correctional services provider focusing on behavioral health care, said that the criminal justice system—especially corrections—has made strides in recent years in recognizing the importance of addiction treatment.

“By reaching out to drug-treatment courts and probation and parole officers, and requesting an opportunity to speak with them about criminal justice and addiction, we are opening the doors,” he said. But there are still barriers. As much as criminal justice officials are aware of the fact that they have people who are addicted in probation, parole, and prisons and jails, many “don’t understand the neurobiology of addiction. The way they see it, these people could just stop. They are missing the science. If you don’t understand the basic concepts, you won’t understand how methadone is important in providing addiction treatment.”

Re-entry and Drug Courts

One focus of the Habit OPCO criminal justice initiative is re-entry—treating people who are about to be released from prison and were addicted to opioids prior to their incarceration. Under the federal guidelines, a patient who met the criteria for admission to an OTP immediately before incarceration can be admitted to a program, because incarceration is “forced remission,” he said. Forced abstinence is not the same as treatment, and federal studies have shown the value of admitting inmates into OTPs prior to their release, and continuing with treatment after release. So Habit OPCO is working with prison officials on getting inmates who were addicted to opioids into treatment before their release.

Another focus of Habit OPCO is preventing people from going to prison or jail by providing them treatment up front in collaboration with a drug court or probation. But focusing on this population also means that addiction treatment providers must educate themselves about “criminogenic” thinking and risks, he said, citing the work of Edward Latessa, PhD, who developed a correctional program checklist assessment—and this can be used in community corrections as well. (Community corrections are those that take place outside of prison or jail, such as with probation and parole.)

Addiction–Crime Overlap and Dichotomy

The overlap between addiction and criminal justice involvement is so big—as many as 80 percent of inmates are incarcerated because of a drug or alcohol problem—that the treatment and criminal justice systems should understand they are dealing with the same people, he said, adding that all addiction treatment providers should do a “risk-need-responsivity” assessment for criminal behavior. Substance abuse is one of the seven risks for criminal behavior under this model, first developed in the 1980s. Others include social isolation, poor education, and distrust of or lack of adherence to authority, he said. Interestingly, these risks are also relapse triggers.

“At the end of the day, not only are we serving the same people, but we’re supposed to be serving them in the same way—and we’re not. We never got away from the dichotomy that addiction treatment is for public health and criminal justice is for public safety.” The biggest danger of this dichotomy is that the criminal justice system “looks at treatment agencies as completely separate, and we don’t advance at all. So our purpose at Habit OPCO is to show that not only are we serving the same people, but we have the same vested interest.” Public safety is improved by people getting MAT, and that’s the message that he is taking to corrections, probation, and parole officials.

There is no reason to separate patients who are referred from drug courts or pretrial diversion—not convicted—from other patients in an OTP, he said. “They’re not incarcerated, they’re supervised by a probation officer.”

But it’s important to understand the different mindset of someone who is coming into an OTP after months of incarceration, he said. Even if they had been unfairly incarcerated, they were in the prison system, and that inevitably had an effect on them.

The ‘Substitution’ Question

Many criminal justice practitioners view methadone as a substitute for heroin, and while there is some truth in that, when we look at the neurobiology of opiate dependence, the substitution “debate” is overly simplistic. It ignores a substantial body of evidence that suggests that this treatment modality, which also provides extensive individual and group interventions, addresses the stressors and causes of addiction. At the same time, it ensures that the opiate dependent person is physiologically stabilized with a substance that does not provide the euphoric effects of heroin.

Mr. Wasp related a particularly poignant example of the need for education. A medical provider of correctional treatment services in Pennsylvania was looking for a provider for pregnant opioid-dependent women. So the prison physician toured an OTP. “I could tell he had something on his mind; I could tell from his body language,” said Mr. Wasp. “I said that methadone is a tool, part of the recovery process. But clearly my agenda and his were not in sync.

“So I asked him, ‘What did you expect to get from coming here today?’” The physician—whom Wasp declined to identify—responded, “How would you answer the question, which I will be asked by my superiors, ‘Why should we substitute these people’s heroin addiction on the taxpayer’s dollar?’” Mr. Wasp answered, “With all due respect, you’re going to pay one way or another.” He noted that treatment with MAT is much less expensive than being incarcerated.

Other ways Habit OPCO reaches out to the criminal justice system, in addition to providing tours for county correctional administrators and health care administrators, include:

1)    providing information to corrections, probation, and parole staff members by purchasing and staffing a booth at the Pennsylvania Probation Parole and Corrections annual state-wide conference;

2)    attending and presenting information to the Lackawanna County Criminal Justice Advisory Board (a board comprised of sentencing judges, county probation, county corrections, county investigators, the District Attorney’s office, and Pennsylvania state police);

3)    inviting our local state parole office to host their monthly staff meeting at our facility (encouraging parole agents to tour the facility while on site); and

4)    creating and presenting a four-hour training to county probation staff on the benefits of medication-assisted treatment with the criminal justice population.

“In many cases, we have handed out the AT Forum White Paper on medication-assisted treatment and criminal justice,” said Mr. Wasp. “In this day and age, with evidence-based practices being the buzz in criminal justice, it’s nice to be able to hand them the evidence in a well-done, prepackaged document.”

Because of his experience with the criminal justice system, Mr. Wasp sympathized with the physician who questioned the value of MAT. “There is not a single institution anywhere in this country where there’s not some level of a rub between the security professionals in a jail and the medical people,” he said. “Corrections officers believe that it’s their job to do custody and control. And there’s the treatment people, who say it’s their job to help people be more productive.”

Filed Under: Addiction, Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Summer 2012 Tagged With: , , ,

Infographic: Why Drug Treatment is More Effective Than Incarceration

August 10, 2012 by Leave a Comment

Infographics are graphic visual representations of information, data or knowledge that present complex information quickly and clearly.

http://www.rehabinfo.net/why-drug-treatment-is-more-effective-than-incarceration/

Source: www.RehabInfo.net

Filed Under: 2012-08-10, Drug Courts & Criminal Justice, News Updates, Opioid Treatment Programs (OTPs) Tagged With: ,

Prescription Drug Abuse Driven by Availability, Barriers to Treatment

June 22, 2012 by Leave a Comment

prescription drugsExperts say prescription drug abuse continues to be a big problem in Maine and across the country because of the availability of the drug and continuing barriers to treatment.

Michael Torch of the Addiction Technology Transfer Center of New England at Brown University said it’s a problem nationwide. “We’re kind of stuck in one of those awkward cycles where we’ve dismantled the treatment system, so one of the only places where people have access to treatment is in the criminal justice system.”

Brenda Westberry, the former Chief Probation Officer for the state of Connecticut also says that people leaving prison often don’t get matched with the kind of treatment they need. Probation officers have large case loads. She says more resources for treatment are important but, “not just resources, appropriate and effective resources.”

http://www.wcsh6.com/news/article/204467/2/Prescripton-drug-abuse-driven-by-availability-barriers-to-treatment

Source: WCSH6.com – June 20, 2012

Filed Under: 2012-06-25, Drug Courts & Criminal Justice, News Updates, Opioid Abuse/Addiction Tagged With:

Local Judge Works to Fight Prescription Drug Abuse in Northeast Ohio

June 22, 2012 by Leave a Comment

Scales of JusticeCuyahoga County Judge David Matia has overseen the county’s drug court for years. In his time working with folks struggling from addiction, he has noticed a disturbing trend.

“Sixty percent of the people in drug court are opiate dependent and of that sixty percent, half got their start by being treated for a medical condition,” said Matia.

According to Matia, research shows that in 1997, the average dosage for opiates was 7 pills. In 2010 that dosage sky rocketed to 67 pills.

http://www.newsnet5.com/dpp/news/local_news/oh_cuyahoga/local-judge-works-to-fight-prescription-drug-abuse-in-northeast-ohio

Source:  NewsNet5.com – June 11, 2012

Filed Under: 2012-06-25, Drug Courts & Criminal Justice, Legal, News Updates, Opioid Abuse/Addiction, Prescription Drugs Tagged With: ,

Data Suggests Drug Treatment Can Lower U.S. Crime

June 6, 2012 by Leave a Comment

U.S. crime statistics show illegal drugs play a central role in criminal acts, providing new evidence that tackling drugs as a public health issue could offer a powerful tool for lowering national crime rates, officials said on Thursday.

Based on thousands of arrestee interviews and drug tests, the study showed that on average 71 percent of men arrested in 10 U.S. metropolitan areas last year tested positive for an illegal substance at the time they were taken into custody.

According to Dr. Redonna Chandler of the National Institute on Drug Abuse, 5 million of an estimated 7 million Americans who live under criminal justice supervision would benefit from drug treatment intervention. But only 7.6 percent actually receive treatment.

The 2011 Adam II Annual Report can be accessed at: http://www.whitehouse.gov//sites/default/files/email-files/adam_ii_2011_annual_rpt_web_version_corrected.pdf

http://www.reuters.com/article/2012/05/17/us-usa-drugs-idUSBRE84G06G20120517

Source:  Reuters.com – May 17, 2012

Filed Under: 2012-05-31, 2012-06-06, Drug Courts & Criminal Justice, News Updates, Research/Surveys Tagged With: ,

Prisoners Taking Effective Methadone Doses Report to Methadone Treatment Programs After Release

May 29, 2012 by 1 Comment

“To be effective, [opioid addiction] treatment must begin in prison and be sustained after release through participation in community treatment programs.”—Nora D. Volkow, MD, Director, National Institute on Drug Abuse (NIDA)a

A simple goal, but rarely achieved. So it’s refreshing to hear of a detention system that actually views incarceration as “an opportunity for prevention and treatment, including initiating methadone treatment prior to release”—a system where inmates’ doses are titrated to effective levels, and inmates report to methadone treatment programs (MTPs) after release.

That system is the Rikers Island Key Extended Entry Program (KEEP), offering methadone treatment to opioid-dependent inmates of New York City’s jails. The KEEP program began in 1986; today its goal remains to relieve or prevent opioid-dependent inmates’ withdrawal symptoms, and to engage inmates in long-term, effective methadone maintenance treatment (MMT).

The Effective-Dose Effort

In July 2007, in response to a trend toward low-dose methadone prescribing, KEEP initiated an evidence-based, dose-adjustment, quality-improvement (QI) protocol to maximize the therapeutic effects of methadone, and to improve inmates’ reporting rate to MTPs after release. They trained counselors, physicians, and pharmacists in the QI guidelines, which call for gradual titration to methadone doses of 70 mg per day or higher, as necessary, at increases of 5 to 10 mg per day.

About 650 opioid-dependent prisoners were enrolled in the QI study. Roughly half were in MTPs at the time of arrest. The group was fairly representative of the Rikers’ population—average age, 40 years, 72 percent men, 40 percent African American, 41 percent Hispanic, and 19 percent Caucasian/other.  Data were collected in July and November, 2007.

Results

The methadone dose at the time of discharge ranged from 15 to an exceptionally high 1,140 mg/day, with a median of 50 mg/day. The proportion of patients reaching effective doses increased significantly among those incarcerated at least 21 days, allowing time for titration. At discharge, significantly fewer patients (34 percent vs. 72 percent) were within the lowest methadone dosage range—15 to 30 mg/day—than those discharged before the QI program began.

In addition to providing the best results, effective doses yielded the best rates of reporting to MTPs upon reentry. In fact, all prisoners who reached 55 mg/day or higher—even those not in the QI study—reported to an MTP post-release.
The authors note some shortcomings in their study, published January 2012 in Substance Abuse. Gradually increasing a prisoner’s methadone dose requires several weeks, so the short length of stay of many jail prisoners made it difficult to reach an optimum dose before their release. The authors also said it would be helpful to add more data to the study, especially on dosage, and to follow up with prisoners after reentry, to see if they remained in treatment.

Here’s some evidence from follow-up data from NIDA: a graph showing that prisoners started on methadone one month before release are more likely to be in treatment and heroin-free six months later than those who receive counseling alone. Dr. Volkow, who presented this slide at a Blending Conference in April 2010, called for implementation of this evidence-based treatment nationwide, calling it a “win-win scenario.”

 

Dr. Volkow’s initial premise doesn’t seem so difficult to carry out. So why aren’t other jails and prisons doing what KEEP has done?  We look forward to hearing your comments on your experiences with medication-assisted treatment in your probation, parole, jail, or prison system.

References

aNational Institute on Drug Abuse. Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-based Guide. National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD. NIH Publication No. 06-5316. Published September 2006, Revised January 2012.
http://www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations

bHarris A, Selling D, Luther C, et al. Rate of community methadone treatment reporting at jail reentry following a methadone increased dose quality improvement. Subst Abus 2012;33(1):70-75.

Filed Under: Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Spring 2012 Tagged With: ,

New Study: Methadone Clinics Don’t Bring Crime to Neighborhoods

April 6, 2012 by Leave a Comment


The NIMBY (“not in my backyard”) people are at it again. But a new study refutes their claims and shows that methadone clinics don’t attract crime.

The Good News

Crime Rates Aren’t Higher Around Methadone Clinics

In a well-designed study published online in Addiction, March 2, 2012 ahead of print, investigators compared data from a computer listing of all FBI reports of serious crimes, such as robbery, homicide, and sexual assault, in specific areas of Baltimore. The areas included 13 methadone treatment centers and three types of control locations: 13 convenience stores, 13 residential points, and 10 general medical hospitals.  The study team found no significant increase in crime around methadone treatment centers (MTCs) or general hospitals. (The study period was January 1, 1999 through December 31, 2001.  After collecting the data, the team spent several years developing the technology and analyzing the data before publishing the article.)

And—here’s something very interesting—investigators did find significantly higher crime counts close to convenience stores. Bottom line: Methadone clinic neighborhoods, unlike those of convenience stores, are not associated with a higher crime rate.

The authors note, ”Our finding that MTCs are not associated with increases in neighborhood crime addresses a major impediment to the establishment of new clinics, and should lead to greater availability of methadone maintenance treatment for the many persons who need it.”

Let’s hope the NIMBYs are paying attention.

Reference: Boyd SJ, Fang LJ, Medoff DR, Dixon LB, Gorelick DA. Use of a “microecologic technique” to study crime incidents around methadone maintenance treatment centers [published online ahead of print March 2, 2012].  Addiction.  doi: 10.1111/j.1360-0443.2012.03872.x. 

But Emotional Protests Persist

From Orange County, Florida: a methadone clinic that opened last month is the latest in a string of establishments “bringing crime to the neighborhood,” some residents complain. Locals told WFTV’s Drew Petrimoulx that pain clinics and pharmacies moving into the area are “attracting the wrong kind of people.” “There’s a lot more vagrancy.” A resident gave WFTV a photo of two people passed out at a bus stop; she said the pair had just left the new methadone clinic.

It’s not as if this was an elite section of Orange County to begin with. In fact, one resident asked why the neighborhood was picked for a new methadone clinic when the area already had so many problems. 

Readers responding on the WFTV website echoed that opinion:

“Don’t make me laugh. That area has been horrible for a decade or more.”

“That area has been called heroin run for many years.”

“ . . . one is a fool to go near there.”

(http://www.wftv.com/news/news/neighbors-say-methadone-clinic-bringing-crime/nLPyN/).

Another From Somers Point, New Jersey: Fear gripped residents when an 89-year-old woman was attacked and sexually assaulted in her home. A suspect was arrested, and the incident apparently is totally unrelated to the local methadone clinic that has been operating for 10 years. But that hasn’t calmed people. They’re upset and angry about the clinic. Staff writer Christopher Ramirez said residents are “fed up with problems in their neighborhood and are placing blame for recurring issues on a methadone clinic directly across from their homes.”

The City Council got creative and found a novel way to spur the methadone clinic to move: it introduced an ordinance to prohibit parking on the street bordering the clinic.

(http://www.pressofatlanticcity.com/news/top_three/article_68980e70-bee0-11df-be4a-001cc4c03286.html.)

And lastly from Salem, Florida: the Zoning Board of Appeals last month unanimously rejected a permit request for a methadone clinic. SalemPatch.com says Community Substance Abuse Centers (CSAC) plans to appeal, raising alarm among residents.

The ZBA’s stated reasons for rejection: traffic concerns and the residential character of the area, which includes Witchcraft Heights. [The Salem name is linked with a rumored ghost population; some say Salem is “bursting with struggling spirits just waiting to spook you.” Maybe that’s part of the problem. www.ghostsofamerica.com.]

Any evidence of a rise in crime around existing clinics? Not that Salem Police Chief Paul Tucker is aware of. He should know, and he supports having a methadone clinic in Salem.

http://salem.patch.com/articles/area-police-chiefs-meth-clinics-dont-up-crime

Sometimes Good Sense Prevails

As reported on the AT Forum website last November, a Warren, Maine methadone clinic won a NIMBY battle after a yearlong fight. Education, mediation, and lawsuit considerations triumphed over a classic NIMBY response based on emotions, and the community finally granted permits for an opioid treatment program.

http://atforum.com/news/2011/11/methadone-clinic-wins-nimby-battle/OTP Patients

(All sites accessed March 30, 2012.)

 Tell us about your OTP NIMBY experiences and how you overcame them. You
 can post your comments by clicking the comment link at the top of this page.

 

Filed Under: Blog, Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), Methadone Tagged With: , , ,

Retention in Opioid Agonist Treatment after Prison Release Reduces Re-incarceration

March 23, 2012 by Leave a Comment

Opioid agonist treatment (OAT) in prison and after release might influence the risk of re-incarceration. This prospective cohort study linked data on OAT and incarceration among 375 men with heroin use originally recruited in 1996–1997 for a randomized controlled trial of OAT in prison in New South Wales, Australia. Participants were followed through 2006.

  • During 9+ years of observation, 331 participants engaged in OAT 1081 times, with a median of 2 episodes per participant (mean length of engagement, 156 days); 58% started OAT in prison.
  • Ninety percent of participants were re-incarcerated after the first incarceration.
  • Engagement in OAT at the time of release had no effect on re-incarceration.
  • Post-release retention in OAT was associated with a one-fifth reduction in the number of re-incarcerations.

Comments: This study affirms that retention in OAT following release is associated with reduced re-incarceration among former prisoners with opioid dependence. Although other investigations have shown that initiating OAT prior to release maximizes post-release treatment retention, the current study suggests active linkage to ongoing treatment is an essential component. Continuing or initiating OAT during incarceration is necessary but not sufficient to optimize post-release outcomes among opioid-dependent inmates; correctional systems and treatment providers must also provide transitional assistance to ensure that former inmates reach OAT programs after release.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue January/February 2012. Access checked 3/12/12. Peter D. Friedmann, MD, MPH

Original Source: Larney S, Toson B, Burns L, et al. Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of reincarceration. Addiction. 2012;107 (2):372–380.

Filed Under: 2012-03-23, Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), News Updates, Research/Surveys Tagged With: ,

Denying Medication-Assisted Treatment (MAT) in the Criminal Justice System—Is It Legal?

March 8, 2012 by Leave a Comment

Denying access to medication-assisted treatment (MAT) for opioid addiction has been a long-standing practice throughout the criminal justice system, with devastating consequences—unnecessary incarceration, increased spread of HIV, hepatitis, and other infectious diseases; drug overdose, sometimes fatal; and recidivism rather than recovery.

Many arrestees and inmates in U.S. facilities are addicted to opioids, yet a December 2011 report from the Legal Action Center says that the vast majority of jails and prisons fail to offer MAT as ongoing maintenance treatment, even when it’s recommended or prescribed by a treating physician. At an estimated cost of about $4,000 per year, MAT successfully reduces addiction and related criminal activity, allowing people to lead productive lives, support families, and pay taxes—rather than costing taxpayers as much as $40,000 annually for imprisonment.

But some probation and parole agencies prohibit MAT, and courts often require detoxification from methadone or buprenorphine before defendants can complete drug court requirements as an alternative to jail or prison.

The Legal Action Center report, Legality of Denying Access to Medication Assisted Treatment in the  Criminal Justice System, (see link) explains why withholding access to MAT at any level of the criminal justice system—correctional facilities, courts, and parole and probation boards—makes no sense, and can violate federal antidiscrimination laws and the United States Constitution.

For example, the Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973 prohibit discrimination on the basis of disability, and require that each individual’s ability to take part in specific activities be evaluated objectively. Denying access to MAT at any level of the criminal justice system violates these Acts, whether denial is based on a blanket policy or carried out on a case-by-case basis, but without the required objective, individualized evaluation.

Moreover, jails and prisons that force those receiving MAT to detoxify without proper medical supervision and treatment risk violating the Constitution’s EighthAmendment prohibition on cruel and unusual punishment, or the Fourteenth Amendment Due Process clause. Thus, medical best practices continue to elude the vast majority of those who have an opioid use disorder and are unfortunate enough to come up against the criminal justice system. They’re being forced to taper or go to jail.

Access Denied!

Despite advocates’ attempts to work with judges and probation and parole boards, denied access continues. Some examples:

  • Drug court judges who believe in MAT, but rarely refer people for treatment because they feel pressure from district attorneys.
  • District attorneys concerned with what they view as public safety risks in granting outpatient versus residential treatment, and who regard MAT as having the risk of abuse or diversion.
  • Defense attorneys who have little information about what’s appropriate or needed for their clients, or an understanding of best practices in treating opioid addiction, and aren’t prepared to advocate for medication-assisted treatment.
  • Judges and drug court staff who “have a rule: we just don’t let people stay on methadone and graduate from drug court.”
  • The Federal Bureau of Prisons guidelines for treating opioid addiction that call for medically supervised detoxification (including with methadone), cognitive behavioral therapy, and drug abuse education—but do not recommend methadone maintenance treatment, and prohibit treatment with buprenorphine as maintenance therapy.

AT Forum spoke with Sally Friedman, legal director of the Legal Action Center and author of the Center’s report. Written at the request of the American Association for the Treatment of Opioid Dependence (AATOD), the report is being distributed to government and criminal justice agencies, and to consumer groups and advocacy organizations.

Litigation

“The report has focused significant attention on these discriminatory policies, but litigation is another key strategy to bring about the necessary change,” said Ms. Friedman. “Even a few federal court decisions holding criminal justice agencies liable for denying access to MAT could make a big impact.”

“The Legal Action Center is prepared to bring litigation when we find the right case,” said Ms. Friedman—“someone who’s willing to challenge a criminal justice agency and willing to fight to the end of the litigation. We’d welcome hearing from people who’ve been forced off their addiction medications in order to take part in drug courts or other alternative sentencing programs, or by any other part of the criminal justice system.”

Potential cases may be a successful patient in an opioid treatment program (OTP) with a job and family who is picked up on an old warrant and told to taper or face jail; or one where a physician recommends MAT and the judge demurs. “MAT as a treatment option shouldn’t be off the table because of a judge’s misconception that it’s substituting one addiction for another, or because of overblown concerns about diversion,” Ms. Friedman said. “The point of the ADA and the Rehab Act is that the government should make decisions on the basis of objective medical evidence that applies to that individual, and not on the basis of stereotypes or broad generalizations. ADA case law is quite clear that people must be evaluated individually.”

Criminal justice agencies and courts who deny access to MAT despite a physician’s recommendation generally haven’t faced legal consequences. “Many courts have found that the ADA prohibits employment and zoning discrimination against people who need or receive MAT,” Ms. Friedman pointed out. “But courts have not yet addressed the question of whether the criminal justice system’s failure to provide or permit MAT violates the ADA or Rehabilitation Act. We think now is the time.”

Suggestions for OTPs

Helpful publications and audiovisual presentations from the Legal Action Center include Educating Courts, Other Government Agencies and Employers About Methadone (2009), a PDF explaining how people in MAT can advocate for their rights so they can get in or stay in treatment, without discrimination; and Know Your Rights: Are You in Recovery from Alcohol or Drug Problems? Rights for Individuals on Medication-Assisted Treatment (see link).

If an OTP patient is forced off of methadone or prohibited from enrolling despite the recommendations of a physician, an OTP Director can contact the Legal Action Center (phone: 212-243-1313 or 1-800-223-4044; fax: 212-675-0286; email: lacinfo@lac.org).

About the Legal Action Center

The only nonprofit law and policy organization in the U.S. whose sole mission is to fight discrimination against people with histories of addiction, HIV/AIDS, or criminal records, the Legal Action Center has for nearly four decades worked to combat stigma and prejudice and to help people reclaim their lives.

Legal Action Center Resources

Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System.
http://www.lac.org/doc_library/lac/publications/MAT_Report_FINAL_12-1-2011.pdf.
Accessed February 20, 2012.

Know Your Rights: Are You in Recovery from Alcohol or Drug Problems? Rights for Individuals on Medication-Assisted Treatment.
http://www.lac.org/doc_library/lac/publications/Know_Your_Rts_-_MAT_final,_9.28.10.pdf.
Accessed February 20, 2012.

Webinar: Medication-Assisted Treatment: Special Anti-Discrimination Issues.
http://lac.org/index.php/lac/webinar_archive. Accessed February 20, 2012.

Memo on Driving and Psychomotor Studies.
http://www.lac.org/doc_library/lac/publications/mmt-memo_on_driving_and_psychomotor_studies.pdf. Accessed February 20, 2012.

National Association of Criminal Defense Lawyers. http://www.nacdl.org/. Accessed February 20, 2012.

Additional Resources

National Institutes of Health, U.S. Department of Health and Human Services. Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide. Bethesda, MD: National Institute on Drug Abuse. Revised January 2012. NIH Publication No. 06-5316.
http://www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations. Accessed February 20, 2012.

Whitten L. Prison use of medications for opioid addiction remains low. NIDA Notes, Research Findings. 2011 (July);23(5). http://www.drugabuse.gov/NIDA_notes/NNvol23N5/Prison.html.
Accessed February 20, 2012.

Krantz MJ, Mehler PS. Treating opioid dependence: Growing implications for primary care. Arch Intern Med. 2004;164:277-288. http://archinte.ama-assn.org/cgi/content/abstract/164/3/277.
Accessed February 20, 2012.

Filed Under: Drug Courts & Criminal Justice, Legal, Medication-Assisted Treatment (MAT), Newsletter, Opioid Treatment Programs (OTPs), Winter 2012 Tagged With: , , , ,
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