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August 5, 2017

"Criminal justice reformers are hooked on drug courts, they should kick the habit"

The title of this post is the headline of this notable new commentary by Jasmine Tyler in The Hill. Here are excerpts:

With opioid overdose deaths hitting record highs throughout the US, and the White House Commission calling for declaring a state of emergency, many are looking for new solutions to addiction and overdose. But one proposal popular in some circles — the expanded use of drug courts — is not the perfect solution some make it out to be.

Drug courts are an old idea. Created in the 80s to expedite the overwhelmed court dockets created by the drug war, they have already enjoyed a great deal of fanfare and funding — from both sides of the political aisle. But despite the good intentions that often underpin them, they are a flawed solution.

These courts are squarely housed in the criminal justice system, where there is little medical expertise or care available but where punitive sanctions are plentiful. 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.

Interestingly, the White House Commission didn’t even mention drug courts in the interim report released on July 31, but they did support a number of cutting edge, public health centered, responses such as expanding harm reduction approaches like medication-assisted therapy.

Other solutions the commission should explore for their final report include promoting diversion programs to keep people out of the criminal justice system, making the overdose prevention medication Naloxone available over the counter, and decriminalizing possession of drugs for personal use....

A recent broad study found that there is no evidence that compulsory treatment is effective and may do more harm, and even the Government Accountability Office has found the purported cost-savings difficult to substantiate.

In my days working as a sentencing advocate with public defenders, clients would frequently ask for jail time in lieu of drug courts. This wasn’t because they had no concerns for their own health and well-being, but the opposite. They were deeply concerned with their own health and well-being and felt drug courts would cause more problems for them in the long run....

Beyond the many questions about their effectiveness, drug courts do not address the fundamental reality that any kind of criminal sanctions are simply inappropriate for the overwhelming majority of drug offenders, whose only crime is the personal use of drugs or possession of drugs for personal use. In fact, by offering a notionally “softer” kind of criminalization, drug courts may actually help entrench that fundamentally untenable paradigm....

Drug courts might be a tool in the toolbox of a better system if they are focused only on offenses other than drug use or possession — for example, property crimes committed in connection with drug dependence. But even in that case, they should only be considered if they are set up to provide treatment that is medically appropriate, as well as other social supports, and if — and this is a big if — courts would truly take high risk, high need defendants as the National Association of Drug Court Professionals says they should.

Our communities deserve 21st century solutions and drug courts are, at best, a better version of a broken and outmoded system. They may sometimes have a useful place in the reality we’re stuck with, but they certainly aren’t the way forward. Instead of looking back at a criminal justice solution that has failed, the commission should stay on the right track and focus on health-based programs that address the opioid crisis.

August 5, 2017 at 11:57 PM | Permalink


"they did support a number of cutting edge, public health centered, responses such as expanding harm reduction approaches like medication-assisted therapy."

AKA as buprenorphine. Replacing a drug of addiction with another one. It used to be methadone now it's this "cutting edge" medication. There's been no progress in the tx of drug addiction for the past 40 years.

Posted by: flop | Aug 6, 2017 8:13:51 AM

"sometimes have a useful place in the reality we’re stuck with"

Key point. Yes, the criminalization model is misguided, including as a matter of public health.

Posted by: Joe | Aug 6, 2017 9:54:31 AM

Translation, my clients were unwilling to give up using drugs (in many cases to self-medicate bipolar disorder). I have seen drug courts be quite successful for those who wanted to quit drugs. Of course, the bottom line of the post is that we should decriminalize all controlled substances. The current opioid epidemic involving the misuse of legal drugs shows why decriminalization is a bad idea.

Posted by: tmm | Aug 6, 2017 12:26:49 PM

The piece cites the "overwhelming majority of drug offenders, whose only crime is the personal use of drugs or possession of drugs for personal use."

I am not sure if this means "we should decriminalize all controlled substances," which would entail more than personal use or possession.

Nor, do I think that would be the way to handle the opoid epidemic as compared to treatment, civil penalties and dealing with supply, particularly distribution. Alcohol abuse has led to serious problems over the years, but criminalization of possession and/or use to me would not be the solution.

Posted by: Joe | Aug 6, 2017 3:14:27 PM

Treatment is more difficult than prison.

Posted by: David Behar | Aug 6, 2017 3:33:45 PM

Flop. Perhaps, diabetics are addicted to insulin. Perhaps, people with pneumonia are addicted to antibiotics. Perhaps, you are addicted to your car. It should be taken from you, and you should be forced to walk if you want to go to Pittsburgh. Perhaps, you are addicted to the internet.

What you are saying is we should end the benefits of technology to avoid dependency. By the way, on your way to Pittsburgh, shoes are technology, as are roads, clothing, tap water, served food. You should be made to go to Pittsburgh naked of all avanced technology, through bear country.

Posted by: David Behar | Aug 6, 2017 3:38:14 PM

This would seem to be an article that is making perfect the enemy of good, or at least an improvement.

Medicine doesn't offer great solutions to addiction, arguably no better than "social science," e.g. 12-step programs and cognitive treatment. I believe I am inclined to treat these arguments with skepticism.

Posted by: Fat Bastard | Aug 7, 2017 11:07:12 AM

Decriminalization would help unclog the drug courts with petty drug offenders that may or may not be addicts. What would be really helpful is recognition that many petty and not-so-petty, but first-time, offenses are directly and proximately caused by drug addiction and offering a non-incarcerative alternative for these offenses, in the proper situation.

Posted by: Fat Bastard | Aug 7, 2017 11:11:35 AM

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