Issue Background
The Importance of Medication-Assisted Treatment
Scientific literature has shown that medication-assisted treatment (MAT) for opioid use disorder brings cost savings by reducing incidences of opioid-dependent births, overdoses, intoxication-related injuries (e.g., drugged driving), and more. According to research published by Pew Trust:
“Patients who use medications to treat their OUD remain in therapy longer than people who don’t; they are also less likely to use illicit opioids. In addition, MAT helps to decrease overdose deaths and improve other health outcomes, such as reducing the transmission of infectious diseases, including HIV and hepatitis C.” [1]
In addition to the cost of human life, data shows the financial costs imposed on society as a result of substance use disorder, misuse, and overdose are much greater than the costs of treatment:
“An analysis suggested that the total costs of prescription opioid use disorders and overdoses in the United States was $78 billion in 2013. Of that, only 3.6 percent, or about $2.8 billion, was for treatment.” [2]
Evidence for the Collaborative Approach
The judicial and medical communities often bring different perspectives to the treatment and oversight of persons with substance use disorders[3]:
While drug courts attempt to treat drug use as a health issue, they are also required to enforce laws criminalizing drug use; punishment sometimes becomes a priority over treatment.
Medical authorities refer to drug dependence as a chronic, relapsing condition: most people need to undergo treatment more than once or try several forms of treatment. Therefore, punishment for relapse can pose a significant problem.
Many times, MAT may be clinically indicated, but not all physicians are properly trained to work with high-risk justice-involved patients. It is important for physicians to understand the unique challenges faced by their patients in drug courts. As noted in Drug Courts: A Primer for Family Physicians[4], drug court is a criminal process, and the consequence to patients for not following the rules is incarceration. Therefore, the coordination of medical interventions with the conditions of patients’ court programs is critical to the long-term recovery process.
This project is based on the recognition and acknowledgment that the judiciary should not make medical decisions in a bubble, but instead with the education and support of medical professionals. Likewise, medical professionals benefit from a greater understanding of the judicial system and the treatment court program process, so they can recommend the best possible course of treatment for patients.
Physicians and other clinicians, with proper education and networking, can assist treatment court judges who are required to make clinical care decisions. Otherwise, without such input, court decisions about care may be misguided:
Actual treatment decisions are frequently based on a judge’s belief or intuition, rather than an experienced health professional’s recommendation.
Although the World Health Organization (WHO) and other reputable health policy bodies endorse the benefits of medication-assisted treatment (MAT) for opiate dependence (which uses stabilizing medicines such as methadone and buprenorphine) many judges and drug courts reject this treatment, sometimes calling it, incorrectly, another form of addiction.[5]
Drug policies should be aligned with evidence and public health principles.[6]