Malpractice and Injustice Continues in Drug Treatment Court

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There are 3,100 drug treatment courts in the United States alone. Since 1989 they have continued to expand into every state across the US without medical over site by physicians or psychiatrists trained in addiction medicine. Although these courts claim that they offer treatment, the court in and of itself is not a medical entity and is allowed to function without doctors. Furthermore, before acceptance into drug treatment court, participants must sign court waivers that give up statutory and/or constitutional rights and agree to exempt the court, police, court officials and participating programs from liability.

Drug treatment court operates with little regulation or standard operating procedures. Judges without medical degrees chose rehabilitation practices that match their own understanding of addiction medicine and chose rehab centers that tailor their programs to meet the guidelines of their local drug court system. These cozy partnerships can flourish unsupervised as drug treatment courts operate under no medical guidelines and have no liability for the damage that may be caused by under educated counselors, ineffective addiction practices or unsuitable addiction rehab centers. Although, this could be grounds for malpractice lawsuits as well as wrongful death claims in the medical field, participants, families, as well as lawyers hesitate to question drug court missteps.

Those not familiar with the drug court system find it hard to believe that participants have no recourse when damaged from mandated treatment but suing judges and court officials for forcing ineffective addiction care that may cause harm or death is not a case that lawyers want to pursue. Few cases have gone forward. Instead, participants and families are encouraged to go on with their lives and leave the drug court experience behind. Families are left with unanswered questions and a waiver contract that they feel they had no choice but to sign.

A new report released June 2017 by the Physicians for Human Rights tilted Neither Justice Nor Treatment –Drug Courts in the United States paints a troubling picture and validates what critics of drug courts have professed all along. The report investigated the drug court practices in New York, Florida and New Hampshire as a sample of the drug court model. The report finds that drug courts in these states failed to provide adequate treatment to those that needed it and mandated that treatment be provided to those that did not meet addiction criteria. Furthermore in all cases, the functioning of the courts posed significant human rights concerns.

One key concern motivating this research was whether drug courts were able to appropriately diagnose and facilitate treatment for people with substance use disorders who are in conflict with the law. We found that, in many cases, they are not. Diagnosis and initial treatment plans for drug court participants were often developed by people with no medical training or oversight, at times resulting in mandated treatment that was directly at odds with medical knowledge and recommendations. The most egregious example of this was the refusal, delay, or curbing of medication-assisted treatment (MAT) (also known as substitution or replacement therapy) to people with opioid use disorders, despite evidence that treatment for such disorders

in many cases requires long-term – sometimes permanent – medication. Some drug courts also prevented participants from accessing or staying on medically prescribed treatment for anxiety, Attention Deficit Hyperactivity Disorder, and other chronic health problems. Ironically, the form of MAT that appeared to have the most support in many of the drug courts visited – an injectable form of naltrexone, Vivitrol – has the weakest evidence base of all Food and Drug Administration- approved treatments for opioid dependence. (from Executive Summary, Neither Justice Nor Treatment)

Proponents of the drug court system continue to refuse to provide data to refute critics concerns and use the National Association of Drug Court Professionals (NADCP) to advance the drug court agenda. The NADCP hold yearly conferences heavily sponsored by the drug company Alkermes, (maker of Vivitrol, sited in the report) and market the drug court model to their growing membership.

The NADCP mission is to “not rest until there are drug treatment courts within reach of every American in need”. In doing so, they rely on their public relations team to use celebrities and personal stories that reflect success to the public and expand their powerful hold over drug court policy within the US. They will state that drug courts are the most researched criminal justice reform in the US but the research is not data driven, consistently monitored or reviewed for their medical practices or human rights violations.

The media is beginning to take notice that not all is so sunny within drug courts. Jason Cherkis’s HuffPo investigation, Dying to be Free as well as other investigations are beginning to bring to light a criminal court system that has been operating unchecked and unregulated for years. These investigations are beginning to make a difference. Federal drug courts are changing their policies and withholding grants to drug courts that do not use medication-assisted-treament when needed, stories are being shared about the harm that participants must endure and lawsuits are being filed when participants are forced off of standard medications. But much, much more needs to change.

It is my hope that investigative reporters as well as others will seriously read the Noble Peace Prize Co-Laureate PHR report and continue to investigate the drug treatment court system. These courts continue to expand unchecked, rubber stamped by policy makers while bringing grave harm to drug court participants and families.

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