CRIMINAL JUSTICE SYSTEM: PRACTICE IMPLICATIONS

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1 PROVIDING MAT Key Moments in NADCP IN THE History CRIMINAL JUSTICE SYSTEM: PRACTICE IMPLICATIONS DOUGLAS B. MARLOWE, JD, PHD NATIONAL ASSOCIATION OF DRUG COURT PROFESSIONALS

Positive opioid test after 3 to 12 months of treatment among offenders * Sources: Cornish et al. (1997); Coviello et al. (2012); Coviello et al. (2010); Gordon et al.

2 Positive opioid test after 3 to 12 months of treatment among offenders * Sources: Cornish et al. (1997); Coviello et al. (2012); Coviello et al. (2010); Gordon et al. (2008); Gryczynski et al. (2012); Kinlock et al. (2009); Lee et al. (2013); Magura et al. (2009); Mitchell et al. (2013). *Only comparisons against non-mat counseling were statistically significant. 2

3 Availability Key Moments in of NADCP MAT: History % 90% 80% 70% 60% 50% 40% 30% 56% 38% Nearly half of drug courts did not offer MAT in %* Other settings were even worse 20% 10% 0% 17% 13% 7% 4% Drug Court Probation Community treatment lowest published rate highest published rate Sources: Chandler et al. (2009); Friedmann et al. (2012); Matusow et al. (2013); SAMHSA (2014a).

4 Drug Court Knowledge 48% 47% Yes No 51% 41% Yes No Don't know Don't know 6% Buprenorphine reduces drug use? 8% Buprenorphine reduces crime? 40% 41% Yes No Don't know 19% Methadone reduces crime? Matusow et al., 2013

Key Moments Legal Standards in NADCP History Loco parentis Prisoners; convicted jail inmates; discretionary parolees Probationers; mandatory parolees Pretrial jail detainees; pretrial supervisees

5 Key Moments Legal Standards in NADCP History Loco parentis Prisoners; convicted jail inmates; discretionary parolees Probationers; mandatory parolees Pretrial jail detainees; pretrial supervisees Discretionary funding or authorization condition Unbridled discretion Deliberate Indifference Rational Basis Test Substantial state interest Reasonably related to the person s crime, rehabilitation needs, or public safety Strict Scrutiny Compelling state interest Narrowly tailored No discretion Medically indicated Proven effective Generally accepted Medically necessary Proven effective Generally accepted Acceptable risk/benefit ratio No better alternatives Appropriate level & intensity Statutes (e.g., ADA) and professional best practice standards can increase the level of scrutiny, but cannot decrease it.

6 Key Best Moments Practice in NADCP Standards History Affirmative obligation to learn the facts about MAT No blanket prohibitions for entry or graduation Particularized inquiry Stated rationale Obtain medical consultation

$Poorer Minimizing CJ Outcomes Diversion Observed administration Adherence monitoring Random call-backs Failure to abide by these conditions is a proximal (willful) infraction, and merits a$

7 Poorer Minimizing CJ Outcomes Diversion Observed administration Adherence monitoring Random call-backs Failure to abide by these conditions is a proximal (willful) infraction, and merits a higher-magnitude sanction Medication event monitoring system (MEMS) Pre-approval, full disclosure, and release of information for new prescriptions Prescription drug monitoring program (PDMP) Abuse-deterrent formulations

Choice of Medication Patient preference Past performance in treatment Age of onset and length of drug use Family history (genetic predisposition) Comorbid medical or psychiatric disorder; adaptive

8 Choice of Medication Patient preference Past performance in treatment Age of onset and length of drug use Family history (genetic predisposition) Comorbid medical or psychiatric disorder; adaptive stability Side effect profile (e.g., addiction and intoxication potential; respiratory suppression; driving hazard) Reduced tolerance Street value (diversion) Specialized training and regulations Progressive tapering Ambiguous diagnostic picture

court Past performance in treatment Age of onset and length of drug use Family history

9 Tapering Successful tapers are typically after 18 to 24 months (correlational studies) Should not be a requirement for graduating from a 12- to 24- month program, such as a drug court Past performance in treatment Age of onset and length of drug use Family history Comorbid medical or psychiatric disorder; adaptive stability Protracted abstinence syndrome (PAS)

10 Poorer Locating CJ Outcomes Providers American Academy of Addiction Psychiatry find-a-specialist American Board of Addiction Medicine American Society of Addiction Medicine community.asam.org/search SAMHSA Behavioral Health Treatment Services Locator findtreatment.samhsa.gov SAMHSA Buprenorphine Treatment Physician Locator treatment-physician-locator

11 Medical Poorer Marijuana CJ Outcomes Positions NOT Medicinal: 1. National Academy of Sciences Institute of Medicine 2. American Academy of Addiction Psychiatry 3. American Academy of Family Physicians 4. American Academy of Neurology 5. American Academy of Pediatrics 6. American College of Obstetricians & Gynecologists 7. American College of Physicians 8. American Epilepsy Society 9. American Medical Association 10. American Osteopathic Academy of Addiction Psychiatry 11. American Psychiatric Association 12. American Society of Addiction Medicine 13. American Society for Pain Management Nursing 14. Australian Medical Association 15. Canadian Medical Association 16. National Association of Alcohol & Drug Abuse Counselors 17. National Association of Drug Court Professionals 18. National Association of School Nurses 19. National Center on Addiction & Substance Abuse 20. National Council on Alcoholism & Drug Dependence 21. Tuberous Sclerosis Alliance Source: Marlowe (2016) ABA Health Lawyer, 29(2)

12 Medical Poorer Marijuana CJ Outcomes Positions NOT Medicinal: 1. National Academy of Sciences Institute of Medicine 2. American Academy of Addiction Psychiatry 3. American Academy of Family Physicians 4. American Academy of Neurology 5. American Academy of Pediatrics 6. American College of Obstetricians & Gynecologists 7. American College of Physicians 8. American Epilepsy Society 9. American Medical Association 10. American Osteopathic Academy of Addiction Psychiatry 11. American Psychiatric Association 12. American Society of Addiction Medicine 13. American Society for Pain Management Nursing 14. Australian Medical Association 15. Canadian Medical Association 16. National Association of Alcohol & Drug Abuse Counselors 17. National Association of Drug Court Professionals 18. National Association of School Nurses 19. National Center on Addiction & Substance Abuse 20. National Council on Alcoholism & Drug Dependence 21. Tuberous Sclerosis Alliance Source: Marlowe (2016) ABA Health Lawyer, 29(2)

13 Medical Poorer Marijuana CJ Outcomes Positions IS Medicinal: 1. American Nurses Association 2. U.S. Pain Foundation Source: Marlowe (2016) ABA Health Lawyer, 29(2)

14 Medical Poorer Marijuana CJ Outcomes Research Probably Beneficial 1. Appetite stimulant 2. Reduction of nausea Likely attributable to THC Proof of Concept 1. Neuropathic or cancer pain 2. Spasticity associated with multiple sclerosis Likely attributable to CBD Probably Harmful 1. Substance use disorders 2. Anxiety, depression, or PTSD 3. Psychotic disorders including schizophrenia 4. Sleep disorders and insomnia 5. Immune suppression disorders Insufficient or No Evidence 1. Epilepsy 2. Glaucoma 3. Alzheimer s, Parkinson s, or Tourette s syndromes 4. Autism 5. Urinary tract or gastrointestinal disorders 6. Any other illness or disorder... Source: Marlowe (2016) ABA Health Lawyer, 29(2)

NOT BE A DRUG COURT... DOUGLAS B. MARLOWE, J.D., PH.D.

SIGNS Key Moments THAT YOU in NADCP MIGHT History NOT BE A DRUG COURT... DOUGLAS B. MARLOWE, J.D., PH.D. Advisory* *Points of view and opinions expressed in this presentation are solely those of the speaker,