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Sooner Rather Than Later: The Preference for Abstinence Over Maintenance

The Huffington Post The Huffington Post 2/03/2016 Judge David A. Tapp

The national conversation concerning addiction is long overdue. There has been progress. For starters we all understand that incarceration for addicts, by itself, is not an effective intervention strategy. Resolution of this national crisis requires a wide ranging campaign which combines empirical research, education, enforcement, and diverse treatment options.
Effective treatment can take many forms. For some, twelve-step type programs have proven successful. Others benefit from individual or group counseling. For some, long term residential treatment is appropriate. And, for many, medically-assisted treatment (MAT) may be used in conjunction with any of the foregoing in clinically appropriate cases.
Kentucky, as many already know, is ground zero for heroin and controlled prescription drug abuse resulting in over 1,800 over dose deaths last year. As a general jurisdiction judge, my criminal caseload involves far too many serious and disturbing offenses and many defendants deserve imprisonment. My dockets also involve hundreds of non-violent low level offenders with substantial substance abuse issues which under our statutory scheme I am required to supervise within the community.
For these situations, my experience with MAT using non-addictive Vivitrol, an opiate receptor antagonist that blocks the pleasurable effects of opiates and alcohol, have been overwhelmingly positive. I have not observed similar success with defendants who utilize other forms of MAT such as buprenorphine (including Suboxone) or methadone which are themselves opiates and can prolong dependency.
While in some settings, Suboxone may be a viable treatment option, I am aware of little or no empirical research indicating its effectiveness within a criminal justice setting. In addition, we have done a poor job of confining the frequently dispensed Suboxone to legitimate purposes. According to the Center for Substance Abuse Research, the estimated number of drugs or paraphernalia arrests containing buprenorphine jumped from 90 in 2003 to 10,537 in 2010. (CESAR, Vol. 21, Issue 13).
The widespread diversion of Suboxone plays out in our treatment courts as well. In a recent ten month period, Kentucky's drug courts reported 2,695 positive tests for the illegal use of Suboxone and Methadone. In addition, numerous defendants self-report the abuse of buprenorphine products.
For these reasons, the MAT program used in my jurisdiction focuses on Vivitrol. This program is voluntary rather than court-ordered. It combines the advantages of a non-addictive medication with psychosocial counseling. Typically, opioid dependent patients who participate in counseling and receive Vivitrol are abstinent longer, stay in treatment longer, report fewer cravings, and are less likely to relapse.
Ultimately, treatment decisions rest with each defendant, aided by their counsel and treatment professionals. Although many addicted individuals refuse treatment, a fortunate few seek help during the pre-trial process. Most do so as part of their plea agreements or are offered treatment as part of their probation or other community release.
The opioid abuse epidemic is a significant burden to our families and communities. We all need to focuses on effectively treating the underlying illness of addiction. There is no magic medication, no single treatment strategy which is 100% effective. Every approach must take into account the individual and relevant factors which exist in the community. For me, in most instances, this means immediately pursuing long term abstinence over maintaining addiction.

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