Since Proposition 47 was passed last year, both drug courts and treatment professionals have been waiting to see how opportunities for methadone treatment in California will play out. It’s best if someone who’s arrested and addicted to opiates goes from lock-up directly into treatment, followed by dismissal of the charges that put them there and a reintegration into society. But it’s not always that easy.
Recognizing the efficacy of California methadone treatment goes back to 1997. At that time the National Institutes of Health (NIH) published its NIH Consensus Statement on Effective Medical Treatment of Opiate Addiction. The NIH identified opiate dependence as a “brain-related medical disorder” and stated that “society must make a commitment to offer effective treatment for opiate dependence to all who need it.” But drug courts have never offered a real opportunity for people to get methadone treatment in California.
Methadone treatment has been supported by the California Society of Addiction Medicine (CSAM) based on research that dates back to the 1960s. Of 600 people who participated in a study some 40 years ago, at least half of them now are dead. Only 10 percent of them succeeded at stabilizing their lives. Very few of them received the opportunity to try methadone treatment in California.
The CSAM refers to methadone treatment as the gold standard therapy for opiate dependence. Yet there are fewer people in drug courts today than a year or so ago, because of Proposition 47. The history of mandated drug treatment goes back to the year 2000, when Proposition 36 was passed. It sent those sentenced for nonviolent felony drug possession charges to probation, and the sentence mandated participation in drug court including treatment instead of jail time.
Treatment professionals hoped that mandatory methadone treatment in California—and everywhere—would really take off. Methadone and buprenorphine therapy carry a high level of effectiveness even for those forced into treatment. People become engaged in therapy and learn how to change their lives, even if they go into it unwillingly. So Proposition 36 seemed like a good thing.
The big problem then became that judges throughout the country were not willing to allow people addicted to opiates to participate in drug court programs. The judges wanted their people to be clean, goshdarnit, and they stubbornly refused to recognize it as that “gold standard” of treatment.
If they did permit them into drug court, they required them to detox without managed help. Ask a judge or a court officer, and they’ll tell you that it’s justified. Well, they’ll say, Just in case Jimmy Joe gets arrested and we have to send him to jail, we can’t give him methadone in jail. Considering that most people graduate successfully from their drug court programs, why not anticipate the best? Even if they did have their probations violated with a return to jail, they could be switched to Suboxone, which could be managed as a daily medication.
But many drug court judges, just like many of the families that have a loved one needing methadone treatment in California, refuse to recognize it as a legitimate therapeutic option. They insist that people in methadone treatment actually continue to enjoy their daily high, only it’s coming from methadone instead of pain pills or heroin. They don’t believe that medically managed methadone brings no euphoria, and they refuse to recognize opiate addiction as a bona fide medical diagnosis. It’s just voluntary bad behavior, they say, and shame on those people. Put them in jail. In 2000, a judge court drug in California ordered methadone treatment to stop for one man, who died two months later. That’s when Golden State voters passed the law permitting methadone treatment in California.
But acceptance of methadone treatment by California drug court judges has never really taken off. In a national study, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that two-thirds of judge courts offered detox as an option, while only 18 percent permitted methadone as a treatment choice. In 2014 it issued a statement that it would no longer provide grant funds to drug courts that nixed methadone treatment. But drug courts don’t care, or they find loopholes and still rake in those funds.
Prop. 47 Threatens Methadone Treatment in California
Something else happened in 2014. A woman rejoiced when her heroin-addicted son was arrested and sentenced to drug court. Finally, she thought, he would get the help he needed. But when he was released from jail, he was not immediately mandated into treatment. So, still in the throes of withdrawal, he went out and got high. He was sent to jail for a punitive 10-day period and then released, again without treatment. He relapsed again and again went back to jail for another 10 days. When he was released again, he overdosed and died.
Treatment professionals and other critics of this case question how the judge could recognize that a young man’s arrest stemmed from the medical diagnosis of addiction and then take it upon himself to determine what form of treatment should be available. Had the young man been ordered directly from the jail to report to a methadone program, he would be alive today.
With voters passing Proposition 47 in late 2014, they have taken the teeth out of mandated treatment. People with opiate addictions who are arrested will be charged with misdemeanors and they will not face the choice between jail or methadone treatment in California. Even if offered treatment, they will take the short-term jail sentence over a long-term drug court program, because the nature of addiction prevents them from making the wiser choice. But the proposition passed, despite opposition by the National Association of Drug Court Professionals.
So where do we go from here? SAMHSA wants drug courts and treatment professionals to collaborate on a review of the barriers to methadone treatment in California. There are higher numbers of opiate addicts arrested in the suburbs or rural areas than in urban communities, yet most methadone treatment programs are located in the cities. The drug court personnel including probation officers need to become better educated about the medical diagnosis of addiction and treatment options including buprenorphine and naltrexone as well as methadone treatment in California.
Drug court judges also lack knowledge in treatment options for people who have co-occurring diagnoses. With almost half of all people incarcerated affected by both addiction and mental health diagnoses, the time is ripe to act. The dialogue has to begin, but it will only be effective if the judges participate willingly.
In the meantime, don’t wait until you are ordered into court—or until you overdose like the young man above. Don’t wait for an under-educated judge to make a decision that affects you. Call your local methadone treatment program and take back control of your future into your own hands.