Drug Courts embraced
with unparalleled enthusiasm
1989: First “Drug Court” opens in Florida –
today approximately 3,400 throughout USA
Also: Drug Courts now in Australia, Austria, Belgium,
Canada, Ireland, New Zealand, Norway and UK – and
in process of being adopted in 10 Latin American
countries
Strong support also from African Union, European Union
and Organization of American States.
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
Drug Courts: What are they?
"Drug courts are ones in which the judge does not ask
whether the state has proven that a crime has been
committed but instead whether the court can help to
heal a perceived pathology. Drug courts adopted the
disease model that posits that people struggling with
drugs have a chronic disease that reduces their ability
to control their behavior."
http://www.drugwarfacts.org/cms/Drug_Courts#sthash.z6FLO0yz.dpbs,
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
Drug Courts = Involuntary “Treatment”
“Treatment” in the drug court system is not voluntary:
“I’ll make him an offer he can’t refuse” is blackmail
In case of conflict between interests of patients and
demands of CJS, patient’s well-being and wishes are
irrelevant
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
Drug Courts = Involuntary “Treatment”
“Drug treatment courts have the potential to [further!]
criminalize addiction. … [by] punishing a person if
he or she cannot recover from his or her addiction
… under the guise that it is their own fault because
they failed mandated treatment.”*
*Christie T, Anderson JF. 2003. Health Law in Canada. 23(4):70-79
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
“Mandatory treatment”:
treatment of what?
The premise: “addiction is a disease” …. but
“treatment” objectives generally much broader:
e.g.: case of Darryl Strawberry, sent to residential
facility in lieu of prison, abstained from all illegal
drugs, but was “… charged with violating 11 program
rules, including a ban on sex with a fellow patient,
smoking, selling autographed baseballs, misusing
telephone privileges, shaving his head …”*
Result: 18 months in prison.
*NY Times April 20, 2002
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
First step in “treatment”:
Making the diagnosis
In 2012, 40-45% USA drug court clients’ “drug of
choice”:
alcohol or marijuana
A Delaware study relying on urine testing as well as
self-reporting, “concluded that about one third of the
nearly 300 drug court ‘patients’ in the study did not
meet the criteria for drug dependence …”*
*Cited in Drug Courts: Equivocal Evidence on a Popular
Intervention. J Csete and D Tomasini-Joshi, Eds., 2015, Open
Society Foundations (NY)
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
Methadone maintenance:
overwhelming evidence of effectiveness
1983: National Inst. on Drug Abuse (US)
“To argue that methadone maintenance is not
effective is to ignore the results of the best
designed research studies and the consensus of
varied group of experts”
2008: WHO
“… therapies such as methadone remain the most
promising”
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
BUT for Drug Court Clients:
Evidence be damned
Survey of 186 drug courts throughout USA – 2010
Over half “failed to complete the survey”
Regarding the statement, “agonist medication (M or B) is more
effective than non-pharmacological approaches in retaining
patients,”
. Less than 15% of respondents agreed
Matusow H et al. 2013. J Subst Ab Treatm 44:473-480
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
BUT for Drug Court Clients:
Evidence be damned
Survey of 186 drug courts throughout USA – 2010*
. 40% refused to give M or B “under any circumstances”
. for clients receiving M or B when entering drug court, 78%
(M) and 69% (B) had it discontinued at once
*Matusow H et al. 2013. J Subst Ab Treatm 44:473-480
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
BUT for Drug Court Clients:
Evidence be damned
“In our recent study we found most judges in New York were
ordering patients to stop treatment with methadone or
buprenorphine as a condition of participation in, or graduation
from, the drug court. This practice is unjust, ungrounded in
medical evidence, and bad for patients and the public.”*
*H Catania and J Csete. “Drug Courts and Drug Treatment: Dismissing
Science and Patients’ Rights” 2014. Open Society Foundations, NY.
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
Methadone in Pregnancy:
Evidence is clear
SAMHSA (2006)
“Withdrawal for pregnant women is especially
dangerous because it causes the uterus to contract
and may bring on miscarriage . . . ”
World Health Organization (2009)
“For women who are pregnant and breastfeeding,
opioid agonist maintenance with methadone is seen
as the most appropriate treatment . . . Opioiddependent women not in treatment should be
encouraged to start … Pregnant women who are
taking opioid agonist maintenance treatment should
be encouraged not to cease it.”
“MMT is safe for the baby”
“MMT can save
your baby’s life
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
BUT for Pregnant Drug Court Clients:
Evidence be damned
“For pregnant drug court participants agonist availability is
even more restricted [than for others]”:
those currently enrolled when entering drug court:
75% denied continued maintenance
those in neither maintenance when entering drug court:
86% denied access to methadone maintenance,
78% denied buprenorphine
*Matusow H et al. 2013. J Subst Ab Treatm 44:473-480
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
The bottom line: Drug Courts …..
Claim that addiction is a disease, but ….
. Place clinical decisions regarding diagnosis as well as
treatment in the hands of judges and prosecutors
. Punish (with incarceration!) clients if they display signs
and symptoms of that disease ….. and/or violate
“program rules” that may have nothing to do with drug
use.
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
Drug Courts: Impact on incarceration
Meta-analysis published 2013*
“Drug courts significantly reduced the incidence of
incarceration … However, drug courts did not
significantly reduce the average amount of time
offenders spent behind bars. ….Any benefits
realized from lower incarceration rate are offset by
the long sentences imposed on participants when
they fail.”
Sevigny EL et al 2013. J Crim, Just 41:416-425
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com
Drug Courts: Prescience Down Under
“There are many warnings that drug courts may not turn
out to be the long-desired leap forward. … There is
concern that drug courts are really an attempt to
reinvent failed law enforcement, disguising an
ineffective wolf in sheep‘s clothing. Drug users are not
the only ones to have difficulty kicking an unproductive
habit.””
*A Wodak. Sydney Morning Herald (Australia). Sept. 8, 1998, p. 17
IALMH – CONGRESS 2015; rgnewmanmd@gmail.com