How Opioid Courts Can Help Addicts Begin the ‘Long Road to Recovery’

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Editorial cartoon by Rob Rogers, Pittsburgh Post-Gazette, 2016, via Flickr

Suspending prosecution and making an early assessment of the treatment needs of substance abusers are among the critical measures for success in opioid-intervention courts, according to a review by the Center for Court Innovation.

While these relatively new courts vary in the specifics of their procedures, they represent a critical front line in meeting the “special challenges” posed by the opioid epidemic, the Center said.

The pioneering courts offer “specialized programs designed to save lives by offering immediate linkage to evidence-based treatment and intensive supervision and support,” according to a pamphlet that identified what it described as “the ten essential elements” for success.

“These essential elements can help courts achieve the goal of preventing overdose deaths while offering individuals and families impacted by opioid use disorders the support they need to start down the long road to recovery.”

The pamphlet was one of two publications released this month aimed at providing researchers and court officials with examples of “best practices” in opioid intervention, but it’s “not intended to be the final word” on the courts, Aaron Arnold, Director of Technical Assistance for the Center, said in his introduction.

“As practitioners implement more opioid intervention courts and researchers evaluate the model, the field will learn lessons about what works,” he continued.

opioid courtsThe recommendations were based on the proceedings of a roundtable convened in Washington, D.C. earlier this year with 37 practitioners and experts, ranging from doctors to judges and senior federal officials, involved in all areas of opioid treatment and intervention.

In the second pamphlet, the Center listed examples of successful courts, starting with the first such court developed in Buffalo, N.Y., in 2017.

The elements that drove success for the Buffalo model included:

        • Accessibility of the intervention programs to a broad range of charges—from misdemeanors to felonies;
        • An immediate, post-arrest screening for risk of opioid overdose.
        • Offering detained individuals who screened positive for the risk the chance to consent to participating in the programs after consultation with defense counsel.

Buffalo served as a “groundbreaking model” that persuaded New York authorities to plan opioid intervention courts in each of the state’s 13 judicial districts.

After a participant provides informed consent, and ideally within a day of the arrest, opioid court participants get a clinical assessment followed by the beginning of a treatment program that takes into account the individual’s mental and physical needs.

Medication-Assisted Treatment is a central part of the program, accompanied by cognitive-behavioral approaches, group therapy, and other forms of recovery support services.

According to the Center’s review of the essential elements in opioid court’s operations, as participants make their way through treatment, their progress should be monitored and supervised by a judge via interviewing and random drug-testing—returning to court ideally every weekday for at least 90 days.

Participants should also have case managers to support them and communicate with the court in this period. Before leaving the program, participants should be assessed once again and be offered continuing support.

Throughout each of these processes, the Center notes that intervention programs should involve data collection and annual reviews for improvement. These elements serve as a guideline for these programs but can be utilized in various ways through opioid courts or diversion programs.

The Buffalo opioid intervention court, for example, relies on “day-of-arrest intervention” and a judge-led program. Other courts have made variations while still following the general model.

The Cumberland County (Pennsylvania) opioid intervention court requires only 30 consecutive weekday court appearances and uses sanctions on participants not following their treatment plans—including jail time.

In Arizona, the Gila County opiate treatment court utilizes a “‘medical model’ that prioritizes treatment over daily court appearances.” This program limits eligibility to high-risk individuals with an opioid-use disorder and who agree to medication-assisted treatment.

A more long-term program based on the Buffalo model is Tennessee’s Fourth Judicial District’s “recovery-oriented compliance strategy.” This program involves individual screening before the arraignment and allows participants to opt in at various points in the legal process. Once in the program, participants check in with the court regularly for two years or more.

Similar to these opioid intervention courts are diversion programs such as Connecticut’s Treatment Pathway Program which aims to utilize less court resources and “eliminate the practice of incarcerating people because they are sick,” by redirecting those with non-violent drug-related crimes from jail or prison towards help from social workers at courthouses, treatment agencies, and recovery coaches.

Throughout New York State and particularly in the Bronx and Manhattan, Overdose Avoidance and Recovery programs with narrow eligibility criteria and shorter length connect low-level offenders with treatment services directly following the arrest, and dismiss charges upon completion of the program.

Additionally, the Heroin Overdose Prevention and Education initiative in New York City’s Bronx and Staten Island boroughs, allows eligible participants to meet with a peer recovery specialist at a police precinct who explains the program and provides overdose prevention tools before an arraignment.

If participants meet with a case manager at a treatment agency within seven days of their arrest, the case is adjourned for 30 days and their cases can ultimately be dismissed after successful completion of the program.

Overdose deaths have increased by double-digit percentages each year since 2014, with more Americans dying of an overdose every year than were killed in the Vietnam, Iraq, and Afghanistan wars combined.

More than 70,200 Americans died from drug overdoses in 2017, and more than two-thirds of these deaths involved opioids. Although the number of opioid-related fatalities started to dip in 2018 and 2019, the widespread availability of other opioids such as fentanyl has posed new dangers.

“To complicate matters, fentanyl is increasingly contaminating the supply of cocaine, methamphetamine, and other drugs—often without users’ knowledge—putting even more people at risk of opioid overdose,” the Center said.

Read The 10 Essential Elements pamphlet here, and examples of successful opioid intervention courts here.

Additional Reading: Minnesota’s Hybrid Courts Offer Addicts an Alternative to Jail, The Crime Report, July 12, 2019

This summary was prepared by TCR news intern Yotam Ponte.

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