Until now, the conversation on treatment options for opioid addiction has been going around in circles. Doctors support the use of medication-assisted therapy and advocate for their patients who want to access it. The judges stand firm that people with opioid addictions who come into their courtrooms had better get clean or else. Getting clean or else, according to the judges, means time spent in abstinence-based therapy such as a residential treatment center where 12-step work can fix you if you try hard enough—or so they say. The courts refuse to recognize that abstinence-based therapy fails approximately 80 percent of the time if the addiction involves an opiate such as pain pills or heroin.
Judge Karen Thomas, who adjudicates felony drug cases in Campbell County, Kentucky, tells a journalist from The Huffington Post that the addicts she has seen in her court report a history of 10 to 15 episodes of withdrawal and detox before they “get it right.” She insists that the withdrawal experience is so unpleasant that it should serve as a deterrent so that the addict will not use again. Anyone who doesn’t stay clean can go to jail.
What she doesn’t realize, what she can’t possibly understand because opioid addiction hasn’t touched her personally, is that opioid addiction is one of the strongest, most overwhelming addictions on the face of the Earth. It’s a longer, harder struggle for the opiate addict than it is for any other single demographic group that seeks help to overcome an addiction. There’s also the important fact that addiction has been recognized as a medical disorder, and a person with addictions is no more to blame than a diabetic.
She believes that therapy with methadone and buprenorphine, which is available in pill or film form through prescriptions given at Suboxone treatment centers, is nothing more than a substitution of one opioid drug for another. Like many judges, she turns a blind eye to the fact that Suboxone is a partial opiate agonist that does not provide any euphoric effect for the people who take it. It acts by blocking the effects of opiates, by quieting the person’s cravings and calming withdrawal symptoms, and by remaining active in the system throughout the day so that the person can lead a normal, active life.
Thomas refuses to heed the pleas for medication-assisted recovery from countless people throughout the state who cannot resist the compulsions that come with opiate addiction. It doesn’t seem to matter to her that most of the opiate addicts who die from an overdose will do so within hours of being released from jail.
“I understand [advocates of Suboxone treatment centers] are talking about harm reduction,” says the Judge. But: “Those things don’t work in the criminal justice system.” Later, she clarifies her position: “I don’t give them a choice. This is the structure that I’m comfortable with.”
With addiction researchers and treatment professionals everywhere hailing methadone and Suboxone as more successful than any other therapy, the federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) decided to use a little coercion on courtrooms across the country. Early in 2015 SAMHSA threatened to withhold federal grant money from courts that refused to approve methadone and Suboxone treatment centers as options for drug court clients. But SAMHSA left a loophole for drug courts: If Suboxone remained unavailable in the county, then the drug court could exercise its options without interference.
Adding to the problem, Suboxone has remained scant in many places, with the government limiting doctors to the total numbers of patients whom they could treat. Waiting lists have sprung up in Suboxone treatment centers all over the country. It might be weeks or months before a person’s name rises to the top of the waiting list. And what is the addicted person supposed to do during that waiting period? One anonymous case manager shrugged and admitted, “We can’t tell them what to do in the absence of treatment. We know that they’re going to keep using while they wait. We just have to hope they won’t die.”
The stigma against medication-assisted therapy spreads to families through judges like Karen Thomas and other advocates of abstinence-based therapy. Families remain ignorant of the fact that people do not get high from taking Suboxone. They don’t realize that Suboxone therapy is combined with substance abuse treatment counseling so that the person can work on the underlying problems that led to their addiction in the first place. Stigma and shame prevent many people who suffer from addictions from reaching out for the one form of therapy that might actually help them.
So, with the stigma against medication-assisted therapy, the refusal of drug courts to consider it as an option, the waiting list to get into treatment, and the cost of treatment with insurance companies refusing to pay, too many people have died not long after completing abstinence-based therapy. But now those concerns have risen to the attention of the White House itself:
- In November 2015, President Obama set a 90-day deadline for federal agencies to identify and remove barriers to treatment at methadone or Suboxone treatment centers.
- The order states that all agencies that either directly provide services or contract to provide them, pay reimbursement of health care services, or facilitate access to health benefits shall identify “strategies in order to identify any barriers individuals with opioid use disorders would encounter in accessing MAT.”
- The ceiling will be raised on the number of patients each doctor can treat, so that 60,000 patients or twice the previous amount can be treated with Suboxone or buprenorphine.
- Obama states that treatment providers, law enforcement officials, and families must work together in order to “wrap our arms around this problem.”
His words, according to Dr. Carl Sullivan, a professor and director of addiction programs at West Virginia University’s School of Medicine, will bestow legitimacy upon medication-assisted treatment as a therapeutic option. That will make a huge difference for the many people who fail to seek help at Suboxone treatment centers simply because of the stigma.
Even so, the President’s mandate may have no effect on stubborn judges like the so-called Honorable Karen Thomas. But it’s a start.