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 City , 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 New York 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. Legal Action Center
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.
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. California
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
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. Albany County
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.
Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System (Published by the
) Legal Action Center
(Herman Joseph, Ph.D., Sharon Stancliff, M.D., and John Langrod, Ph.D.)
 Herman Joseph, Ph.D. et al: Methadone Maintenance Treatment (MMT): A Review of Historical and Clinical Issues.