Letting Drug Court Participants Use Methadone Reflects Changing Approach

Andrew Kitchenman | August 12, 2015 | Health Care
Christie’s signing of law reflects growing understanding of effectiveness of medication-assisted treatment of addiction

When Gov. Chris Christie signed into law a measure allowing drug-court participants to use medication-assisted therapies like methadone, it reflected a growing consensus in healthcare that such therapies are effective.

Under the law, S-2381/A-3723, people who test positive for methadone or buprenorphine (the main active ingredient of the controlled drug Suboxone) will still be able to graduate from drug court, which provides an alternative to jail for nonviolent offenders with substance-abuse disorders.

It marks a sea change from decades in which these therapy drugs were often marginalized. While these medications are opioids and cause physical dependence, they also suppress the highs caused by other opioids. While some patients are able to stop using these medications after a limited course of treatment, others use them for an extended period of time but without experiencing the damaging effects of addiction.

Alan Oberman, CEO at the John Brooks Recovery Center in Atlantic City, said the aversion to using these drugs was often based on emotion rather than science.

“Some people view it as substituting one addictive drug for another – methadone for heroin – and they’re not truly in recovery,” said Oberman.

Oberman said Christie’s decision to sign the law was “terrific,” but said the next challenge will be enforcing the law. This will require teaching people who work in the criminal justice system that medication-assisted treatment has been proven to reduce recidivism – the rate that criminal offenders commit more crimes.

Oberman said he understood why some people in criminal justice have a gut level aversion to these treatments.

“Part of the stigma is that there are people on methadone who will continue do other drugs” such as benzodiazepines, marijuana, and alcohol, even if they stop using opioids, he said. “Some of them aren’t really going to be drug-free.”

Oberman said drugs like methadone should be seen more like antidepressants than addictive opioids.

“It would be nice if we looked at it like other psychiatric medications; it stabilizes brain function,” he said, noting that patients who receive methadone also undergo psychological counseling.

Christie also signed a bill that requires state colleges to dedicate housing for students who are in recovery.

“These measures are another bold step to help people reclaim their lives,” Christie said, thanking Sen. Joseph F. Vitale (D-Middlesex) for his advocacy efforts.

Vitale said in a hearing on the bill that it didn’t make sense to prevent people using these medications from completing drug court. The treatments “maintain one’s sobriety, (and) allows them to function, go to work, have a family, drive a car, be productive citizens,” he said.

While Vitale said he’s heard concerns about people who use methadone for a long time, “those are not decisions that legislators should make – those are decisions that doctors and patients should make together.”

He sponsored the Senate version of the bill along with Sen. Raymond J. Lesniak (D-Union).

[related]Assembly sponsors included Herb Conaway Jr. (D-Burlington), who said, “Medication-assisted treatment is an evidence-based practice widely recognized by public health and addiction professionals as one of the best options in helping manage opioid addiction.”

Enactment of the law doesn’t resolve all of the policy issues raised by medication-assisted treatment for those charged with or convicted of crimes.

For example, the ability of jails to provide methadone to inmates – or even to store the drug – varies widely by county, Oberman said. So for those who violate the terms of their drug-court-mandated treatment, a return to jail can mean a disruption in treatment. In addition, the contracts that jails have with private medical providers traditionally haven’t included medication-assisted treatment.

“Jails aren’t set up to dispense methadone,” Oberman said, adding that in Atlantic County, officials are open to it but the courts lack funding to do it.

Roseanne Scotti, state director for the Drug Policy Alliance, said that while the state is experiencing “a change in how medication-assisted treatment is perceived, I think we still have a ways to go.”

For example, the Administrative Office of the Courts (AOC) expressed concerns about the bill Scotti said.

“This bill should have been a no-brainer” for the AOC, she said, noting that the Senate passed it 39-0 and the Assembly approved it 76-0.

“Drug use should be a public health issue, not a criminal justice issue,” said Scotti, who added that without treatment, some people are going to commit more crimes, “and they’re going to wind up back in jail, which costs a lot more money than drug treatment costs.”

The federal government has embraced these treatments, with Michael Botticelli, acting director of the Office of National Drug Control Policy, calling for them to become the standard for addiction treatment.

And the federal Substance Abuse and Mental Health Services Administration has announced that no state will receive federal funding for drug courts if it bars participants from using the medications – although Scotti said this didn’t affect New Jersey directly, since it doesn’t receive this funding.

“When you have the leading national government substance abuse entity saying they’re not going to tolerate drug courts not allowing medication-assisted treatment, it just sends a powerful message,” she said.

Scotti also noted that the National Association of Drug Court Professionals, a nonprofit trade group, supports medication-assisted treatment.

In a resolution, the organization’s board noted that scientific studies have shown the drugs “improve addicted offenders’ retention in counseling and reduce illicit substance use, re-arrests, technical violations, re-incarcerations, hepatitis C infections, and mortality.”