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methadone maintenance Therapy & Drug Courts: Round Two

The Jury is still debating methadone maintenance therapy for opiate drug addiction
The Jury is still debating methadone maintenance therapy for opiate drug addiction

There are many people who participate in methadone maintenance therapyfor opiate drug addiction that would love to opt for drug court rather than jail. However, they are turned away by the judges who run those courts if they wish to opt for or are currently enrolled in a methadone maintenance treatment program. There is just too much resistance to the idea that methadone maintenance therapy can mean the difference between success or failure, even with the Substance Abuse and Mental Health Services Administration (SAMHSA) urging courts to recognize the benefits of this therapy. Lack of understanding and stigma play a large role in this problem.

Facts About Drug Court

According to The California Drug Court website take a look at these fascinating facts:

  • The arrest rate drops 85 percent for people who participate in drug court, looking at the two years following their completion of drug court.
  • Drug court costs represent an average of 68 percent savings over prison and jail costs. In the year quoted in this report, $14 million was spent on the Drug Court Partnership Program resulting in a savings of $43 million in jail and prison costs.
  • On admission to drug court, 38 percent of participants are employed; by the time of drug court completion, this skyrockets to 70 percent.

We wrote on these pages in March 2015 that SAMHSA wants to award grants only to those courts that consider methadone maintenance therapy as an option for people with opiate drug addiction. At that time, with its grant application deadline looming in April, their words had little effect on drug courts. Now for the upcoming 2016-2017 fiscal year, the wording is revised—but the frustrating truth is that it still lacks the teeth it needs to bring about effective changes.

SAMHSA Waffles Over methadone maintenance Therapy

For example, in its publication entitled Grants to Expand Substance Abuse Treatment Capacity in Adult and Family Drug Courts, RFA number TI-15-002, SAMHSA says that in recognition of the benefits of medication-assisted treatment (MAT), which includes buprenorphine and naltrexone in addition to methadone maintenance therapy, the agencies that receive grants are encouraged to use up to 20 percent of grant funds to pay for medications if the person served has no money to pay for treatment.

But the weakness comes in the words that follow, when SAMHSA also recognizes that not all communities have access to buprenorphine or methadone maintenance therapy, and so agencies that do not set aside that 20 percent are still welcome to apply.

Then, SAMHSA goes on to say that the agency receiving funds must not prevent someone from buprenorphine or methadone maintenance therapy, and that the rights of the person served extend to participation in a drug court program. Only the physician serving the medication-assisted treatment (MAT) program can determine if a buprenorphine or methadone treatment program is appropriate for the person served. But SAMHSA backs off once again, with: “A judge…retains the judicial discretion to mitigate [or] reduce the risk of abuse, misuse, or diversion of these medications.”

So therein lays the escape hatch for the judges who run drug court programs. All they have to do is confess their abiding fear that the medication received at a licensed, certified methadone treatment program is at high risk of being diverted from the persons served at the clinic and passed out like free milkshakes at drug court.

Drug Courts Continue to Ignore the Benefits of MAT

If you note that “person served” is a phrased used repeatedly, it’s because the Commission on Accreditation of Rehabilitation Facilities has targeted “the needs of persons served” for scrutiny in its 2015 Standards. Yet drug courts continue to get away with dismissing the benefits of methadone maintenance therapy. Just what do state drug court guidelines say about methadone maintenance therapy?

  • You can check out Georgia Drug Court Standards, issued by a state with 81 drug courts. The document issued says nothing about the subject.
  • You can read through the report on Building a Problem-Solving Judiciary published by California’s Collaborative Justice Courts (226 drug courts), and you’ll find nothing about methadone maintenance therapy.
  • You can peruse Overview of Drug Courts in Texas (137 drug courts), and you’ll find zip, zero, zilch about methadone, buprenorphine, and naltrexone.

You have to travel all the way to New York to find anything about methadone maintenance therapy, which is addressed on page 19 of New York State Adult Drug Treatment Courts. This document quotes the Pricniples of Drug Abuse Treatment for Criminal Populations that “medications are an important part of treatment for many drug-abusing offenders and notes that both methadone and buprenorphine are helpful in normalizing brain function.” Yet in the same paragraph it cautions court officers that “methadone clinics have become associated with illegal sales of methadone near the clinics, loitering, and other behavior that draws complaints from neighborhood residents.”

Ultimately, and thankfully, the New York recommendation is for drug court officials to become educated about buprenorphine and methadone maintenance therapy and to consult closely with substance use treatment professionals. That brings up a completely different can of worms.

Opiate Drug Addiction, Drug Courts and MAT Counselors

There have been ongoing disputes between drug court judges, probation officers, and the counselors who diagnose and treat persons who suffer from opiate drug addiction. The judges insist on dictating treatment to the counselors, who in turn bridle at the interference. They are trained to recognize the symptoms of addiction and create effective treatment plans, they say, while judges are trained to administer the law. The two are mutually exclusive of one another.

Another area of concern for counselors includes the increasing protections of confidentiality of persons served. There is a federal statute known as “42 CFR Part 2” which refers to the protection of confidentiality for someone with a substance use disorder, including opiate drug addiction. Authorizations to exchange information contain carefully worded language to identify and protect those rights. Most people are familiar with HIPAA, and it does in fact permit disclosure for purposes of securing payment, providing treatment, or for “healthcare operations.” The patient involved is never entirely certain what that includes.

So what happens when someone in drug court is participating in methadone maintenance therapy and also is receiving counseling and he decides he wants to revoke his consent? The person served cannot realistically revoke his consent between his counselor and the drug court, because the drug court will issue sanctions without delay. However, if there are multiple treatment agencies involved—say a TASC program and a methadone program, or a methadone program and a mental health counselor—the person served can revoke the release that permits either counselor to talk to the TASC case manager.

The solution devised by some agencies offering integrated care is a requirement that the authorization can only be revoked at the place where it was issued. Requiring the authorization to be issued with the TASC or drug court counselor means the patient will get nowhere trying to revoke it.

At the End of the Day

The best hope for the counselors who work with people in methadone maintenance therapy is to continue to advocate and work with drug court personnel to have this treatment viewed as an acceptableoption to mitigate crimes associated with addiction rather than to have the blinders on thinking that abstinence is the only answer. It will eliminate expensive trials and incarceration of people who have not committed violent crimes but who have perhaps stolen in order to pay for their drugs or presented negative behaviors in public because they were high. Jail cells and the money it costs to maintain them will be reserved for the real criminals.

With the Centers for Disease Control reporting that deaths from heroin abuse have quadrupled between 2002 and 2013, we have to start putting pressure on the drug courts to approve methadone maintenance therapy. If you’re facing drug-related charges for a non-violent crime, ask the court for help with opiate drug addiction. If you’re already in treatment, talk to the counselor at your buprenorphine or methadone maintenance program about the help and services that are available for you.

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