As momentum to scale back the drug war has grown over the past decade, drug courts have spread across the country. While drug courts are often referred to as an “alternative to incarceration,” in practice they merely serve as an adjunct to incarceration – and available research does not support their continued expansion. Most drug courts are no more effective than voluntary treatment; do not demonstrate cost savings, reduced criminal justice involvement, or improved public safety; leave many participants worse off for trying; and often deny proven treatment modalities, such as medication-assisted treatments that have long been widely endorsed by the medical establishment.
On a conference call yesterday with reporters, acting Drug Czar Michael Botticelli announced that the federal government plans to expand access to the medication Suboxone and signaled a willingness to push back against the abstinence-only approach that has stifled its widespread adoption. Under this new plan, state drug courts that refuse to allow people access to medication to treat opiate addiction will be stripped of federal funding.
Suboxone is a semi-synthetic opioid that is effective at preventing overdoses and doesn’t cause intoxication when used correctly. Botticelli said the drug czar’s office would coordinate with the Substance Abuse and Mental Health Services Administration to make sure the policy is fully implemented.
"We've made that clear: If they want our federal dollars, they cannot do that," said Pamela Hyde, SAMHSA’s administrator. "We are trying to make it clear that medication-assisted treatment is an appropriate approach to opioids.”
Abstinence-only ideology often obstructs appropriate treatment placement, particularly with respect to opioid addiction. Despite endorsements by Centers for Disease Control and Prevention, the Institute of Medicine, SAMHSA, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the World Health Organization, and even the National Association of Drug Court Professionals, many, and perhaps most, drug courts continue to prohibit maintenance therapies because of an ideological preference for abstinence.
According to the National Academy of Sciences’ Institute of Medicine, “methadone maintenance has been the most rigorously studied [treatment] modality and has yielded the most incontrovertibly positive results.” Maintenance treatments are well-documented to reduce crime and disease while saving between $498 and $3,799 per dollar invested.
The denial of this highly successful treatment for opioid dependence nearly guarantees that most opioid-dependent individuals will fail in drug court. Ultimately, struggling drug court participants are severely punished for the inadequacies of the treatment system.
As the Drug Policy Alliance asserted in our 2011 report and 2014 position paper, drug courts must undergo several major changes of course. Specifically, drug courts should not receive public funding unless they also:
Botticelli’s move should be applauded – but we must recognize that it’s only a first step toward implementing science- and health-based drug policies.
The vast majority of scientific data shows that voluntary treatment is more effective than the coerced, involuntary treatment offered by drug courts. While there has been overwhelming support for “treatment-instead-of-incarceration” for well over a decade now, we’ve reached the point where the public needs to be better educated about the benefits of providing treatment outside the criminal justice system.
It’s long past time for public safety and health advocates to foster a more informed public debate on the 25-year-old drug court phenomenon, and for policymakers to embrace drug policies based not on ideology but on science, compassion, health and human rights.
Jag Davies is the director of communications strategy at the Drug Policy Alliance.