FREQUENTLY ASKED QUESTIONS SERIES: Admitting to Drug Court Persons Using Prescription Drugs for Underlying Medical Conditions

Transcription

1 JUSTICE PROGRAMS OFFICE SCHOOL OF PUBLIC AFFAIRS FREQUENTLY ASKED QUESTIONS SERIES: Admitting to Drug Court Persons Using Prescription Drugs for Underlying Medical Conditions Subject: Admitting to Drug Court Persons Using Prescription Drugs For Underlying Medical Conditions From: BJA Drug Court Clearinghouse Project Date: February 2, 2010 QUESTION Judge Carol Hubbard of the Oklahoma County, Oklahoma (felony) Drug Court, requested information on how other drug courts deal with opiate addicts who have a legitimate underlying medical condition for which they may receive pain medication on an ongoing basis but are also involved with illegal drug use and are referred to a drug court program on criminal charges that may include prescription forgery, possession of heroin, and bogus checks (to get money to buy opiate drugs off the street). Norma Jaeger Statewide Drug Court Coordinator njaeger@idcourts.net RESPONSES IDAHO [All responses from Idaho were sent to Norma Jaeger and then forwarded to the BJA Drug Court Clearinghouse.] Cyndy Hawkley Adult Felony and DUI Courts Sixth Judicial District, Bannock County cyndyh@bannockcounty.us In our Felony Drug Court we have on occasion limited the client to only one or two doctors because there is so much prescription seeking. We print reports that allow us to see the amount and types of prescriptions they re purchasing. We ve sent one client to another city to learn how to manage pain with out prescriptions. We also have them work with their doctor to look at alternative medications in lieu of narcotics and benzodiazepines. In our court when they see a physician they must provide the physician with a letter we ve drafted which states that they are in a recovery program and if at all possible to please prescribe non-narcotics and no benzodiazepines; the doctor signs that he s read the letter. They return the letter and any prescriptions to our drug tester and P.O. We ve

2 found that this helps manage the prescription seeking and enforces the client s accountability on their prescription usage. Linda Polhemus, Coordinator Adult Felony Drug Courts Third Judicial District of Idaho (Adams, Canyon, Gem, Owyhee, Payette, Washington Counties) Dcc3@3rdjd.net It may sounds harsh.but we insist at the time of eligibility screening that, if the defendant is still using a narcotic, the defendant goes to their physician (and I stress one physician) to ask if there is a non narcotic, non addictive alternative to their current narcotic pain reliever. If the applicant and doctor agree there is.we ask for a written titration plan from the doctor for the narcotic and of course the name of the alternative non narcotic. It isn t common, but does happen, that the defendant decides he/she doesn t want to participate in drug court.because they really don t want to or don t know how to quit their drug. Sadly, they often go on a regular community supervision caseload which most likely won t insist they get off the drug. Our protocol is that we never mandate or override a doctor s order for someone to quit a medication. I make a huge point before they leave my office to hear me I am telling you to stay on your medication until you meet with your doctor and formulate a possible plan for an alternative. I am not asking you to quit in order to get into drug court unless you and your doctor agree it is safe. We have several Rx addicts in our program each year. Drug Court is a choice, one option within the judicial system so if the person won t or can t quit their drug due to legit medical reasons.then we have no way to test if they are using the drug as prescribed or abusing it. Thus they are not eligible. One note is that we have a Tramadol (Ultram) addict currently in treatment. Many physicians in our area seem to believe that Tramadol is not addictive.perhaps because it doesn t show up on a normal opiate drug test panel. However abuse of Tramadol is more common than we used to see.it takes a special lab test to detect it but this particular client was determined to kick it. Tanya Reynolds Felony Drug Court First Judicial District Kootenai County treynolds@kcgov.us We require that they ask for non-narcotic pain meds & get a note from a doctor that they asked. If the doctor feels that only a narcotic will work, we feel that we can t tell them not to take it so it s allowed. The probation officer will do random checks on the participant s use of the prescription to make sure it s being used as directed. Rita Wickham Kootenai County DUI Court Coordinator rwickham@kcgov.us We make them get on a non-narcotic unless their doctor feels that they need to be on that particular prescription. If that is the case we make them get a letter from the doc with the name, strength, and how many times a day they are to be taking it. That information is given to the drug testing lab and they give us a new cutoff level for that particular drug that is consistent with that prescription. If the person's tests above the cutoff level then we assume that they are abusing and sanction for it. MAINE Hartwell Dowling Diversion and Rehabilitation Coordinator Administrative Office of the Courts

3 In Maine there is an understandable reluctance to admit these individuals. However, in the absence of other aggravating factors, such individuals may be admitted to the adult drug courts with heightened accountability measures, including increased contact by case managers with medication prescribers, pill counts, so on. Clients may be required to attend pain management in the community. MISSOURI Jeff Kushner [currently Montana State Drug Court Coordinator but formerly Drug Court Director, City of St. Louis Circuit Court] Thinking back to our experience in St. Louis, we did not exclude people from entering drug court because they needed pain medication in order to function (an opiate). We did verify with their doctor that no other pain medication (non narcotic) would work or that other non narcotic medication could be tried. And we monitored their urine test closely and at times would do a GC/MS to verify the opiate in their system. Additionally, in almost every case, the level of opiates in their system from a prescription was either below the cut off or much lower than levels of heroin or other opiates that would be abused. So we also constantly looked at levels in their urine. James E Sullivan Drug Court Commissioner 22nd Judicial Circuit State of Missouri James.Sullivan@courts.mo.gov Jeff's comments [above] continue to be accurate as to how this drug court deals with the medication/drug issue. We review any and all efforts of the participant in any pain management program in a community based service agency. We have directed participants to consult with their physician to determine whether a pain management regime may be of benefit to that particular participant's situation. We require a medical statement to reflect this consultation and a medical opinion/statement as to whether the pain reduction program would be of any value to the participant. Of course, an opiate based pain medication is normally prescribed "as needed", and the random GC/MS test will substantiate the origin of the positive urinalysis test. Haven't had the heroin addict switch his drug of choice to vicodin yet. Finally, I have a veteran in a rural drug court who was provided an alpha-stim device from the VA which he uses 3x a week that has reduced his pain levels dramatically. Angela Peinado Statewide Program Manager AOC aocaxp@nmcourts.gov NEW MEXICO We have had at least 3 with legitimate back injuries. We monitor their use of prescribed meds. They have to bring in each prescription before filling. We check the NM PMP Web to assure they are not doctor-hopping. We also have a medical release that each client signs when entering. With this release we can talk to doctors, pharmacies, etc. We know they are still able to get opiates off the street and we have caught a few through drug testing. Probation also catches them through their testing. Of these three clients, they finally went on non-narcotic pain meds and were not allowed hydrocodone, lortabs, etc. unless they had something from the ER. Two of them have gone to jail for short periods on violations because probation forbade them to take the opiates any longer. One went to rehab for opiate use and no longer takes opiates for her injury. UTAH

4 Judge Dennis Fuchs Drug Court Judge (Ret.) Salt Lake City In Utah we require them to seek an alternative program or slowly be weaned off of the opiates. They must be drug free to graduate. No one can be a participant in a drug court program that has to take a prescribed drug that will test dirty. Mary C. Taylor, MSW Program Manager King County Drug Court mary.taylor@kingcounty.gov WASHINGTON We don t have a great answer and probably could benefit from others procedures but here is the section on Rx medications from our participant handbook (see Appendix A below). Appendix A Prescription Medications As a general rule, you are expected to be drug free, including the use of mood-altering prescription medications. If you take prescription medications, or other mood-altering substances that would cause a positive urinalysis result while in DDC you may be sanctioned or terminated according to the following guidelines. Specific Situations A. Participants with chronic pain DDC participants with chronic pain requiring repeated use of prescription pain medication (opiate, opiate-based or benzodiazepine medications) are not good candidates for the DDC program. If you choose to participate in the DDC program you are required to work with your physician to detox from pain medication in a timeframe established by DDC. B. Participants who opt into the program and then experience an episode of acute pain. Participants who opt into drug court and then experience an episode of acute pain requiring prescription pain medication must have a special form completed by their doctor. The doctor must indicate on the form that he or she is aware that the participant presenting the form is in DDC and is expected to remain drug free except in extreme instances. Forms are available through the court and treatment. Completed forms should be provided to your treatment provider at your next appointment and should include the following: the doctor s name, signature and contact information; description of the medication prescribed; amount prescribed (including refills) reason for prescription and duration of treatment C. Participants on other medications Participants must get approval from their treatment agency for any over-the-counter or prescribed medication prior to using such medication.

5 D. Prescription Drug Offenders DDC participants charged with a prescription drug offense are prohibited from using any of the following types of medications: narcotics, tranquilizers, sedatives, muscle relaxants, stimulants, diet pills, or any scheduled drugs. Emergency exceptions will be evaluated on a case by case basis. Use of prescription drugs, (other than psycho tropics and antibiotics) may impact a participant s clean time and progress in DDC. You will be expected to sign a Prescription Drug Offender Prescription Drug Policy form indicating your understanding of this restriction. ********************** We welcome any additional information and/or perspective readers may have on this topic. BJA Drug Court Clearinghouse/Technical Assistance Project Justice Programs Office, School of Public Affairs American University 4400 Massachusetts Avenue N.W., Brandywine Suite 100 Washington, D.C Tel: 202/ Fax: 202/ justice@american.edu web: