Will Kentucky drug courts allow opioid addicts to take prescribed medications or not? The jury's still out.

Will Kentucky drug courts allow opioid addicts to take prescribed medications or not? The jury's still out.

Kentucky’s state drug court program has introduced new rules to allow opioid addicts to continue taking prescribed drug treatment medications, such as methadone, Suboxone and Vivitrol, rather than making them quit such drugs as a condition of the program. Until this past March, Kentucky insisted that to participate in drug court, addicts must taper off any treatment meds they were on within six months. The only treatment options allowed were abstention, usually in a 12-step program. But as we reported a month or so ago, the Substance Abuse and Mental Health Services Administration (SAMHSA) ruled that federal funding for drug courts will be denied if they make offenders stop taking legally prescribed medications to treat opioid addiction.

SAMHSA was pressured into the rule change by unnamed sources (some say the White House) after a news article in Huffington Post claimed to show that abstention is not an effective treatment approach to opiate addiction. In fact this is becoming a popular refrain at high levels in spite of the fact that a majority of Americans favor traditional detox and rehabilitation according to a recent national survey, and thousands of people reclaim drug free lives every year through abstention programs. It was a fact that most drug court judges in the country have traditionally opposed giving methadone or Suboxone to addicts as treatment – what’s called Medication Assisted Treatment or MAT by its proponents. Judges tend to view such approaches as simply replacing one drug addiction with another, with little positive changes in addicts’ attitudes, behavior or desire to seriously and permanently get clean.

Not only that, MAT drugs like methadone and buprenorphine are frequently diverted for illicit use. Unwilling to change its drug court system, Kentucky was subsequently sued by two law firms on behalf of Stephanie Watson, a Johnson County nurse with an opioid addiction. Johnson, who had been arrested on burglary and drug charges, was barred from taking medications to treat her addiction even if prescribed by her doctor. Watson’s lawyers argued that Kentucky’s refusal to allow her to take her prescriptions violated the federal Americans with Disabilities Act. They claimed Watson’s addiction was an “illness” similar to someone with diabetes who needs insulin. The court would never disallow the insulin, they said, so why should they disallow her MAT? There was no report in the media that her lawyers also argued that their client’s criminal behavior was part of her “illness.” Before the Watson suit was settled, the ruling from SAMHSA arrived, and Kentucky’s drug courts immediately changed the rulings about MAT. The state said that the Watson case was now “moot” because of the SAMSHA ruling. But Watson’s lawyers have not yet set it aside. Since Kentucky’s drug court judges have long favored abstinence-only treatment, leaving it to the judge's discretion may mean “little change on the ground,” Huffington Post reported. Although one judge is already allowing defendants to take Vivitrol, an opioid antagonist that is injected periodically to block cravings and prevent withdrawal symptoms, it’s not clear yet what the new rules will actually mean for opioid addicts entering Kentucky’s judicial system.

Kentucky is said to be “looking to expand the use of Vivitrol” and roughly two dozen drug court judges are expected to begin allowing it soon. Judges are inclined to favor Vivitrol because, unlike methadone and Suboxone, it can’t be diverted or abused and doesn’t interfere with drug tests. In the case of those drugs that are routinely diverted, Kentucky’s judges are likely to be less open to their use. According to Huffington Post, the SAMHSA rule means judges likely will consider allowing or disallowing MAT on a case-by-case basis. And new addicts arriving in the system probably will continue being ordered to abstinence-only programs.

A lawyer for Stephanie Watson says the state’s policy change is “window dressing that won’t change how opioid addicts are actually treated.” He predicts that drug court judges will still forbid MAT and order abstinence-only programs. “Most judges are philosophically against Suboxone and methadone,” he told Huffington Post. The lawyer added that the Watson case will go forward “because the state’s rule change doesn’t go far enough. It’s really a battle between the courts and the doctors. The doctor-patient relationship is sacrosanct. The courts should get out of the way.” That may be a more difficult prospect than one expects.

Kentucky’s judges and those in many other states have seen with their own eyes the pros and cons of treating drugs with more drugs, versus getting off drugs right now. It may seem a lot easier to a doctor to just write a prescription. But that does nothing to get at the root of addiction. The factual success of modern medical drug detox, such as that provided here at Novus, is clearly undeniable. Abstention from the drugs or alcohol that’s been ruining one’s life is the goal, and it starts with Novus detox. Followed by long-term and effective rehabilitation, a life free from drugs is truly possible, and it starts the day you arrive at Novus. If you or someone you care about is in trouble with drugs or alcohol, don’t hesitate to call Novus right away. We’ll answer all your questions and ensure you get started on exactly the right program to begin a life free from drugs.

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