Merging Legal, Clinical and Medical Issues for the Most Effective Treatment Outcomes

Drug courts began in Miami-Dade County Florida started a maverick program to combine rehabilitative substance abuse treatment within the justice system sanctions. Since that time, 2,743 drug courts have been developed across the country. This was a progressive initiative that has proven to be successful in that 75% of participants do not re-offend1 very likely because the model recognizes addiction as a disease that requires treatment as opposed to a crime or a lack of willpower.

In spite of these progressive goals and impressive outcomes, there seems to be a disparity in how drug court participants who are opiate dependent receive treatment. In many courts, the participant is not allowed to utilize medication supported recovery as a treatment method and are required to taper completely prior to completing their mandate.

It begs the question of how a progressive judicial system meant to decrease criminal activity through treatment would prevent participants from taking part in a form of treatment that could support their recovery. An even larger question is whether the decision to maintain someone on medication supported recovery should be taken from the treating physician and placed in the hands of a judge.

Since its implementation in the 1960s Methadone treatment has proven to be an effective treatment method for those who are opiate dependent. A Treatment Outcome Perspective Study (TOPS) conducted by Condelli and Dunteman showed that clients on long term methadone demonstrated a reduced heroin use rate from 100% to 40%.2 Moreover, the Drug and Alcohol Services Information System (DASIS) report shows that those maintained on methadone are two times more likely to be employed than those who are not.3

With an almost 50-year proven track record of success, one must wonder what the clinical and medical implications might be for those forced to abandon this form of treatment. For one, research shows that those who taper from methadone have upwards of an 80% rate of relapse within one year of tapering from methadone.4 This relapse will then likely lead to further dangerous consequences as rates of HIV infection increase 1.5 times for every 3 months someone is out of methadone treatment.5 In addition, SAMHSA and OASAS have worked together with treatment providers to greatly increase and improve services and accountability provided in methadone programs, eliminating the “cop and go” model many still ascribe to this form of treatment. Thus, when a client is forced off of methadone they lose additional recovery supports; including clinical groups, individual counseling sessions, peer to peer support, medical and psychiatric services as well as a daily structure and routine critical to maintaining a life of recovery.

As addiction leaders we must question the legal implications of mandating individuals off of methadone and whether the courtroom is the place to make what is essentially a medical and clinical decision. In fact, Judge Karen Freeman, the Director of the National Drug Court Institute wrote a letter to her drug court colleagues imploring them to “examine their own personal opinions and biases” and how when she did her research she understood “the use of drugs to address opiate addiction was often necessary to assist clients in their efforts to sobriety” and was a “matter of life and death.”6 Her words speak to continued opportunities for improved outcomes when two long-standing evidence-based practices collaborate to promote treatment and recovery.


  2. Condelli WS, Dunteman GH. “Exposure to methadone programs and heroin use.” American Journal of Drug and Alcohol Abuse 1993; 19:65-78
  3. Substance Abuse and Mental Health Services Administration (SAMHSA). Planned Methadone Treatment for Heroin Admissions. Office of Applied Studies, Substance Abuse and Mental Health Services Administration, 2002.
  4. Boucher, Rebecca. “The Case for Methadone Maintenance Treatment in Prisons”. Drug Policy Alliance.
  5. Serpollonie, G, Carrieri MP, Rezza G, Morganti S, Binkin N. “Methadone Treatment as a determinant of HIV risk reduction among injecting drug users: a nested case-control study”. AIDS Care 194; 6:215-220

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