As Drug Court Proponents Rally Around Capitol Hill, Legislators Beware
By Christine Mehta, Physicians for Human Rights
Today, judges, court staff, and addiction counselors from all over the United States will storm Capitol Hill to tout the virtues of expanding drug courts as an alternative to incarceration for people arrested on drug-related charges. What they will fail to address is the intense debate surrounding the efficacy of drug courts and the need for policy reforms that will allow people to access treatment outside of the criminal justice system.
The National Association for Drug Court Professionals (NADCP) — an industry group established in 1994 to support the expansion of drug courts — has organized an annual conference since 1996 to bring together thousands of drug court staff from across the country. One of the main goals of the conference is to send drug court professionals to their respective members of congress on a dedicated “Capitol Hill Day” to “ensure drug courts … remain a funding priority in Congress.”
As members of congress grapple with addressing the opioid crisis, expanding drug courts is an attractive option for legislators who want to avoid appearing “soft on crime” in their attempts to prevent overdose deaths. But while drug courts may satisfy political optics, they are a poor substitute for robust, community-based treatment options. They often deliver ineffective, poorly-resourced treatment options and services that are often not based on medical evidence and set their participants up for failure, sometimes landing them behind bars, an outcome drug courts claim to prevent.
While drug courts may play a role in providing treatment for some truly high-risk, high-need individuals — the population the NADCP argues should be prioritized for access to drug court programs — many people are disqualified in practice. The courts in general are vastly overused and unduly popular as a way to address all problem drug use in the United States, not just those who are high-risk and high-need.
Drug courts are designed to provide court-supervised treatment for problem drug use. But, in addition to treatment, participants are often required to sign a contract that obligates them to abstain from using all substances, including alcohol and prescription medications, even if those medications are prescribed to them by a doctor.
Drug courts have increasingly come under fire for endorsing outmoded practices — namely punishing relapse with jail time and stigmatizing medication-assisted treatment, or even banning it outright. This comes as harm reduction approaches like needle exchanges, “housing first,” and law enforcement-assisted diversion programs have gained recognition in the United States.
In 2015, the NADCP released two publications outlining “best practice standards” meant to bring evidence-based practice to more drug courts. Key best practices included targeting high-risk, high-need populations for drug court participation; responding to relapse with therapy, not jail or punishment; and allowing the full spectrum of medication-assisted treatment (like methadone, buprenorphine, and naltrexone). Given that the NADCP is a non-profit organization and has little leverage over individual drug courts, the best practice standards are spottily implemented at best, and in some courts there is little awareness of their existence.
In a study published this year, Physicians for Human Rights (PHR) found that, across the board, drug courts struggle to update their practices, even when attempting to incorporate the NADCP’s recommended standards. PHR found vast inconsistencies between drug courts in funding, resources, treatment options, and methods of accountability for treatment compliance. Lack of resources, including health insurance for participants in particular, affected access to quality, evidence-based treatment.
PHR also found a critical lack of case management services like housing, transportation, education, and health care unrelated to problem drug use — all services that drug court staff told PHR were not only key to successfully completing drug court programs, but also to long-term recovery. On the whole, PHR reported that drug courts still prioritize surveillance and abstinence rather than examining the participant’s needs and providing the support necessary for long-term recovery.
As members of congress meet with drug court professionals today, they should keep in mind that funding for drug courts should first and foremost go to treatment, and that funding should come with strings attached — namely adherence to medicine and evidence-based practices. Legislators should remember that drug courts are not a cure-all, and that community-based treatment and case management services outside the justice system are necessary to truly support long-term recovery.
Originally published at physiciansforhumanrights.org.