Drug Courts Choose Medical Science Over Profits and Ideology

The Huffington Post pointed out today what happens when an individual Drug Court fails to follow proven best practices for Drug Courts (Federal Government Set To Crack Down On Drug Courts That Fail Addicts). But, it fell well short of explaining how addiction medications are used by the majority of more than 2,900 life-saving Drug Courts; leaving readers to conclude that Drug Courts are not adequately addressing the opioid addiction and overdose epidemic in this country. Nothing could be further from the truth.

Drug Courts treat over 145,000 addicted individuals per year, referring more people to medication assisted treatment (MAT) than any other program in the U.S. An individual in Drug Court is 10 times more likely to receive medication than one on probation or parole, and 5 times more likely than the typical patient in substance abuse treatment.

For years, the National Association of Drug Court Professionals has been an outspoken proponent of the responsible, safe, and effective use of MAT to accompany long-term behavioral health services in Drug Courts (see, for example, Adult Drug Court Best Practice Standards Vol. I and NADCP Board Resolution on the Availability of Medication Assisted Treatment for Addiction in Drug Court). But these decisions are not all-or-nothing, as some zealots would have us believe. Science tells us that some patients need MAT for a period of time, a small group may need it indefinitely, and some will not need it at all. For those who do need MAT, some will need medications like buprenorphine (suboxone) or methadone, which are themselves highly addictive. Other patients, however, can be treated effectively with medications, like naltrexone (vivitrol), which are not addictive, intoxicating or medically hazardous.

We train our Drug Courts to make these complicated and critical decisions guided by competent physicians with expertise in addiction psychiatry or addiction medicine. It is irresponsible to allow general practitioners or family physicians to prescribe potentially dangerous medications to seriously addicted criminal offenders after receiving the minimal eight hours of training required to dispense buprenorphine. Lest we forget, the largest upsurge in drug addiction in our country is inappropriately prescribed narcotics by poorly trained or ethically compromised physicians.

Our courts cannot and will not be pressured by the financial interests of Big Pharma and its out-sized influence on government. With nothing less than public health and public safety at stake, our guiding principles must be science and justice, not profit or ideology.