27 February 2015

Feds to Drug Courts: You Will Feed Their Addiction

In a stunningly senseless act of non-understanding, the federal government is going to try to force drug courts to give drugs to participants.

A while back, a member of our local drug court asked me to look at the requirements for a federal grant.  I was more than a little shocked when I came across a requirement that any drug court receiving the grant would have to spend a certain percentage of its grant on drugs for the participant (as I recall 20%, but I don't have the papers anymore). What the purpose seemed to be was to have participants use buprenorphine (subutex / suboxone) and possibly even methadone.  Needless to say, our drug court chose not to apply because this requirement is contrary to the purpose of the program: to help people become productive, drug-free members of society.  Shortly thereafter, I forgot all about that grant - believing it to be some sort of specialized grant with a specific type of court in mind that must exist somewhere else.

But, no, it turns out the federal government has decided to gut drug courts by requiring drug use to be allowed during the program.

"A spokesman for the Office of National Drug Control Policy . . . said that applicants for drug court grants will be required to affirm that they will allow access to medications such as Suboxone (buprenorphine) and will not force defendants to ween off the medication as a condition of participating in court programs."

The reason?

"Suboxone (buprenorphine) is a semi-synthetic opioid that eliminates an addict’s cravings, largely prevents overdoses and, if used properly, does it without causing intoxication. Its use to combat heroin and other opioid addiction is widely endorsed by the medical establishment."

Guess what?  It's not "used properly." A few years back, a doctor came to our county and gave all us attorneys and judges a lecture about the new wonderdrug that was non-addicting, couldn't be used to get high, and would stop all cravings for opiods: buprenorphine.  It was so wonderful that it solved all the problems that methadone treatment has and would supplant it. Unlike methadone (highly addictive, abused in its own right, and basically a legalized high substituted for an illegal high), buprenorphine's inability to make someone high meant it could be prescribed by doctors and taken home by patients without any danger of abuse or resale.  Of course, about 15 minutes after this drug started being prescribed by doctors the people who got it from them figured out what they could mix it with to get high and it has become a fixture as one of the top drugs sold illegally in our community.

Beyond the fact that buprenorphine is a readily and commonly abused drug, there are other problems with it being allowed for participants in a drug court. First, it is an opioid. That means that in drug tests it will trigger the opioid indicator - just like oxycodone, hydrocodone, and heroin.  I don't think most ready use drug tests differentiate (a hand-held test is only so sophisticated) and therefore samples would have to be sent off to the lab and one of the key premises of drug court is defeated (quick punishment for choosing to use).

On the other hand, let's assume I'm wrong about the ability of a hand-held test to determine the differences between different types of opioids (or that one could be easily developed or that there are already more expensive tests which could be used).  The next problem you run into is that since buprenorphine is an abused drug, you would have to test for quantity in a participant's system to see if the participant has more than should be there for mere inhibition.  Again, that means sending the sample to a lab to be tested and defeats the quick punishment for choosing to use (study after study after study claims that it is the rapidity of the punishment which is the most effective element in changing behavior). 

The Office of National Drug Control Policy needs to stop schlepping for whatever companies are selling this drug and whichever doctors are fronting for them (either out of a misguided belief that it can't and won't be abused or pure, simple greed). The reality is that if used properly this drug can be used to switch people off whatever drug their drug of choice is (just like methadone). Thereafter, the patient is supposed to be slowly weened off the substitute drug by getting lower and lower doses (just like methadone). However, no one ever seems to get actually weened off the drug (just like methadone).  As long as everybody keeps using the drug people keep making money. If you actually ween them off . . .

If the ONDCP really put some thought into this and wanted to incorporate buprenorphine usefully it would not demand that people be allowed to use it throughout the entirety of drug court.  Instead, it could mandate a pre-program. This program could be six months long and during that period doctors approved by the drug court could switch the participant from her drug of choice to buprenorphine and then ween that person off over the six months before they enter the abstinence based drug court proper.

The ONDCP's requirement feels like they are trying to do a good thing without taking the time to actually figure out how things work in the real world. Thus, they are doing more harm than good. Will some drug courts take their poison pill? Sure. Drug courts can be expensive and any money that is found from any source can be extremely helpful.  However, those who do will be poorer programs for taking the King's shilling.

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