Short Take: This Is Your Court On Drugs

If you squint hard enough, you could see the unicorns prancing in the rainbow well. Where was this miracle happening? Drug courts. It had the two things that make for a spectacularly successful pitch. First, the theory played into the visceral desire to help people who desperately needed help. Second, it fit neatly on the little piece of paper gently foldable within even the smallest fortune cookie. Drug courts. What could be bad?

Putting aside the price of admission, forfeiture of constitutional rights, maybe innocence and occasionally a few well-placed “distraction*” punches to the face while a gaggle of blue sit on your back to crush the air from your lungs, isn’t it worth it if addicts finally, finally, get treatment?

Also put aside that if there’s anyplace in the world where drugs are not just readily available, but ubiquitous, it’s a drug treatment facility. It’s the Willie Sutton theory, that’s where the addicts are. But you can’t stop capitlalism.

And then there’s pharma sales folk chatting up the drug court judge, because there’s no one more qualified to determine appropriate medication than someone who went to law school and has the hubris to believe that whatever pops into his head is real.

One reason for this preference is that Alkermes, the drug’s manufacturer, is doing something nearly unheard of for a pharmaceutical company: It is marketing directly to drug court judges and other officials.

The strategy capitalizes on a market primed to prefer their product. Judges, prosecutors and other criminal justice officials can be suspicious of the other FDA-approved addiction medications, buprenorphine and methadone, because they are themselves opioids. Alkermes promotes its product as “nonaddictive.”

If you can’t trust pharma sales folk and a judge to determine the efficacy of prescriptive choices, who can you trust? But put that aside too.

What shouldn’t you put aside? That’s is mostly feel-good malarkey.

Physicians for Human Rights recently reported that drug courts “routinely fail to provide adequate, medically sound treatment for substance use disorders, with treatment plans that are at times designed and facilitated by individuals with little to no medical training.”

And, even though relapse is an expected part of recovery, people brought before a drug court with a positive drug test are often jailed, and can end up serving lengthy periods of time—sometimes more than had they been prosecuted through the regular criminal system.

Some guy named Joe, whose only skill is preparing an RFP, takes the name “Uber Cool Drug Treatment Facility,” and scores the gig. First, he gets a great deal renting the former crack house. He then goes down to the 7-11, hires a few people who appear too frail to do gardening. Finally, he joins the Drug Treatment Professionals Association by passing its rigorous membership test of paying the fee, and, boom, you have a drug treatment facility!

No, it’s not quite this bad. There are legitimate facilities run by qualified and dedicated people that do their best to fulfill their mission. But there are scams as well, and lots of them. Most significantly, the rosy assumption born of “addiction is a medical condition, not a crime, and these poor addicts deserve better than prison” blinds us to questioning the efficacy of the concept and its programs.

Drug treatment can, and should, be a viable alternative to prison, both as a more effective means of reducing crime and as a more beneficial way of helping those suffering from addiction. But when it’s sufficient to link two words together, like Drug Court, without digging a little deeper, we don’t help addicts, we don’t protect society, we enable scammers at public expense and we delude ourselves into believing that we’re great humanitarians for mindlessly supporting the concept. We then pat ourselves on the back and go out for some beers to celebrate how wonderful we are, saving those poor addicts from themselves.

*Not to gild the lily too much, but by tossing in a cool, techicalish sounding word like “distraction,” cops get to beat the crap out of anybody they want with impunity and everybody will nod their head and go, “ohhhh. Okay, totally understandable then.” It’s brilliant for everybody but the person beaten.

8 comments on “Short Take: This Is Your Court On Drugs

  1. Patrick Maupin

    And, even though relapse is an expected part of recovery, people brought before a drug court with a positive drug test are often jailed, …

    Well, yeah, criminals gonna criminal, druggies gonna drug, recidivists gonna re-offend. The drug laws are stupid and draconian, but it’s arguably a feature that only those who can be scared straight will escape unscathed.

    1. SHG Post author

      But on the backend, you get jailed for not being easily enough cured. Remember, the addict must confess his sins to enjoy the munificence of treatment. Failure will not be tolerated.

  2. B. McLeod

    Scammer “drug treatment facilities” have become a major industry, greatly enabled by some features of the ACA. Even outside the drug courts, there are “finders” tasked with rounding up addicts who have coverage on their parents’ plans or can be signed up via ACA exchanges. Then it’s simply a matter of slapping them on a shabby cot in a “treatment center” flop, and keeping them high until they OD or coverage is exhausted.

  3. Connie Sage, MD

    I don’t think this is “greatly enabled” by ACA. It is largely a function of the US healthcare system, which unfortunately is very tolerant of poorly justified “fee for ‘service'” scams. For over 20 years, “finders” in South Florida, the Medicare fraud capital of the US, have rounded up elders with Medicare for sham or unnecessary procedures. The “pain ‘pill mill’ clinics” work largely on cash but they also will charge private or public insurance for prolonged chronic pain opiod treatment. It’s a scandal.

    1. SHG Post author

      You probably meant this as a reply, but since you didn’t use the reply button, it disappears from the discussion.

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