Wednesday, January 4, 2012

Treatment Court Judges Should Embrace the Use of Medically Assisted Treatment (MAT) in their Courts

In New York City in 2010, nearly one-quarter, or 21.8% of defendants admitted to treatment court identified heroin (an opiate) as their drug of choice.  For the rest of New York, that number is only slightly lower at 17.9%.  The good news for these individuals is that there are medications that have been proven to be very effective at treating opioid addiction.  The bad news is that many treatment court judges refuse to utilize this proven means of treatment, and even go so far as to deny treatment court admission to  defendants who are currently being treated with one of these medications.  The Legal Action Center recently released an article titled, “Legality of Denying Access to Medication Assisted Treatmentin the Criminal Justice System.”  The article goes beyond failure to use medication assisted treatment (MAT) in treatment court, indicating that MAT should be available to individuals at all stages of the criminal justice system, including prison.  The Legal Action Center posits that to deny opiate-addicted individuals MAT violates their 8th Amendment rights (prohibiting cruel and unusual punishment) and their 14th Amendment rights (guaranteeing due process).  While these legal arguments may have to be utilized in the long-term to compel criminal justice actors to use MAT, our hope is that the failure to use it in treatment court can be reversed in the short-term by educating judges as to the efficacy of these medications, how they work, and how the benefits of MAT outweigh the risks. 

The two medications commonly administered to treat those suffering from an opioid addiction are methadone and buprenorphine (often sold under the trade names Subutex and Suboxone).  These medications normalize brain chemistry, block the euphoric effects of opioids, and relieve physiological cravings. The use of these medications has been studied extensively, and over 300 published studies confirm MAT is both safe and clinically effective for opioid dependence.  Using MAT to safely and effectively treat heroin addiction not only reduces drug arrests and crimes related to heroin abuse, but also reduces the spread of diseases and viruses such as HIV, which are often acquired through the use of shared needles. 

                Not surprisingly, given its proven effectiveness, the National Association of Drug Court Professionals has strongly recommended the use of MAT in drug courts.  California has gone as far as to pass a law prohibiting judges from banning opioid replacement therapy.  Notably, this law was passed after a drug court participant died of a heroin overdose because the judge ordered him to stop taking methadone.  This tragedy highlights how dangerous it can be to remove individuals from MAT.  Despite this danger, several judges routinely require defendants to detoxify from methadone or buprenorphine treatment as a condition of receiving an alternative to incarceration such as treatment court, even if doing so goes against the advice of a treating physician.  This course of action leaves defendants destined to fail: one study found that 82% of patients who had left methadone treatment relapsed to heroin addiction within 12 months.[1]
                Treatment court judges who are opposed to MAT commonly express the belief that this form of treatment merely substitutes one addiction with another.  Indeed, an Albany County drug court judge stated that he would not allow drug court participants to receive MAT because he “believes in recovery.”  Similarly, other judges believe that being addicted to methadone or buprenorphine is “like” being addicted to heroin and that any addiction is unacceptable.  Implicit in these beliefs is the notion that addiction is a “moral failing” rather than a medical problem amenable to medical treatment.  These beliefs also ignore the enormous difference between an active heroin addiction and the medical use of methadone or buprenorphine.  Heroin is remarkably different from both methadone and buprenorphine: while heroin induces intense euphoric effects, methadone and buprenorphine have only moderate effects that quickly disappear as the individual develops a tolerance.  MAT is not used to “get high,” but instead to treat withdrawal symptoms and relieve cravings. 

                To be sure, MAT does not “cure” an addiction to heroin.  Rather, it is a “corrective approach,” or a tool to help a person manage the incredibly intense symptoms and cravings associated with withdrawing from heroin. Using medication as a corrective approach has long been accepted in the treatment of other medical and mental health problems, and there is no legitimate reason that MAT should be considered differently.  In fact, long-term methadone maintenance is, “a medically safe, nontoxic treatment with minor, mostly transitory side effects, found mainly during the induction phase of treatment.”1  As such, it appears that the only potential downside of MAT is the fear that individuals prescribed methadone or buprenorphine will distribute them to others in the community, a practice the research calls “diversion.”  Judges however should be aware that primary addiction to these medications is rare since they do not produce the sharp euphoria that heroin does.  Thus, the “diverted” medication is not be used to “achieve a high,” but instead to treat the withdrawal symptoms of other individuals addicted to heroin.  In other words – even when diverted, the MAT medications are being taken for their originally prescribed purpose. Naturally, greater acceptance and availability of MAT treatment would diminish diversion, and allow those who need MAT to obtain it in a safe and controlled environment under the supervision of treatment professionals.   

                In sum, the use of methadone or buprenorphine in conjunction with traditional substance abuse treatment has proven to be the most effective method of treating opioid addicted individuals.  Treatment court judges interested in reducing crime, increasing public safety and promoting healthier communities should embrace MAT as a part their treatment programs.  For more information about MAT and the legality of denying MAT to individuals in the criminal justice system, I encourage you to read the two articles linked to below.

(Herman Joseph, Ph.D., Sharon Stancliff, M.D., and John Langrod, Ph.D.)

[1] Herman Joseph, Ph.D. et al: Methadone Maintenance Treatment (MMT): A Review of Historical and Clinical Issues.


  1. Steven Hawking1/5/12, 11:42 AM

    With high unemployment and a worldwide recession, I can understand why Britain and the rest of Europe is worried about the increase in drug use. Drug abuse is just bound to happen when people are going through a rough time, and when the economy is bad almost everyone is going through a rough patch. Last recession that Britain had, drug use increased to its all-time high. Many popular drugs are the ones that are illegal. There have been many new evolutionary drugs in the making and those are the ones becoming more recently abused. Drugs are a terrible way for a country to spend its money. It will make the economy even worse and harder to get out of the recession.
    Steven Hawking

  2. Hey, nice site you have here! Keep up the excellent work!

    Opiate Addiction

  3. Gee how I whilst my judge would read this. Right now I'm fighting in getting the kids back in my care , but because I am a methadone patient ,well c.p.s is making it difficult and having the judge on. Their side is a bit challenging, I've been on methadone for about six years and in throes three years I've tried coming off two times ,but every time I mange to get down at a good dose and feel good I got pregnant, so there I go back up again, now this last time I went all the way down to 1mg and got pregnant again, doc wouldn't allow to getting off cause of me having a miscarriage . So here I am again going down again this time no holding back ,cause I tied my tubes. :-) .so now cause this was my third baby on methadone ,they took my kids away c.p.s saying and the judge ,that I need to come off my methadone ,that there is no ex cues why I should stay on it any longer, well since they have my kids I'm going to do it, I was on 107mg when I
    had my son,now six months later I'm at 85mg going slowly ,but
    Its not "fast enough". That there has been other girls that get off in six months, three months, but no withdrawals or relapse . I say if that is true awesome,but of how many, if cases load have been by the thousands.....then who's to say they didn't come up with a back up plan..... and have they followed up with these cases.? Where are they now,what are they doing? So with this being said I'm having a hard time, because of me being s patient
    at a methadone clinic, the judges says at the end "Get Off"!!!!