Asking patients to be their own advocates when their treatment is interfered with by law enforcement is a tall order. But frequently, patients — especially those who are in treatment with methadone or buprenorphine — are left to their own devices when they are caught up in any kind of criminal investigation. Ultimately, they may be denied medication and go through withdrawal in jail, lose custody of their babies temporarily or permanently or be ordered off of medication by a judge.
Even drug courts have a reputation for being opposed to methadone and buprenorphine, and order patients off of medication-assisted treatment (MAT). The Substance Abuse and Mental Health Services Administration (SAMHSA) put a stop to that last year for those few drug courts that receive federal funds (see ADAW, Feb. 16, 2015).
There is a disconnect in many jurisdictions between the clinicians — opioid treatment programs (OTPs) and office-based opioid treatment providers — and the courts and law enforcement. “Criminal justice and child welfare officials commonly usurp the role of doctor and order individuals off MAT,” said Sally Friedman, legal director for the Legal Action Center. “Patients and programs can use the Legal Action Center’s tools to educate these officials,” Friedman told ADAW. “Their lawyers can also call the Legal Action Center for help.”
Last week, the Legal Action Center issued a groundbreaking report urging drug courts to endorse MAT (for excerpts from recommendations, see sidebar). Produced with the Center for Court Innovation and the New York State Unified Court System, the report, “Medication-Assisted Treatment in Drug Courts: Recommended Strategies,” specifically calls for counseling and other services, in addition to medication. The report contains familiar information for medical professionals, but material that will be educational to many in law enforcement — including Child Protective Services, which in most jurisdictions is run by law enforcement.
What MAT staff can do
Intervening once your patient is involved with the criminal justice system is important, but you can make it easier by paving the way — by interacting with criminal justice people in your area in general, and on behalf of all patients.
Shirley Mikell of NAADAC, the Association for Addiction Professionals (NAADAC), a social worker whose past experience includes working in an OTP, recommends that clinicians treating substance use disorders (SUDs) offer to discuss their work at law enforcement conferences. “There are conferences for judges, and for drug courts, and if there’s one in your region, you can ask to do a presentation,” she said. “Sometimes they’re very receptive.”
Similarly, if there is a regional conference that is sponsored by clinicians — social workers, marriage and family therapists, addiction counselors — invite the judges to attend, said Mikell.
Frequently criticized for staying within their own circles, SUD treatment providers should reach out to law enforcement, even if they think it’s intimidating. In fact, it’s rewarding, said Mikell. In addition, if you do present at a criminal justice conference, you’ll find a good audience, she said. “When they’re in a mix of their own people, they hear better,” she said.
Inviting law enforcement officials to your treatment program — during non-patient hours — is a good way to educate them as well. But even if they are not willing to physically come to the program, you can prepare a presentation and leave it for them on a thumb drive, said Mikell. “Develop something like a pamphlet that talks about patient responsibilities and counselor responsibilities,” she said. “We are therapists, we are supporting the clients, but we also want to be salespersons.”
Who should actually do the presentations at conferences — marketing or clinical people — depends on the personal styles involved, said Mikell. “There are marketing people who are not good trainers, and may not be the best people to present,” she said. “The most effective person might be the counselor who also has some training skills, who can present the information with passion,” she said. “You need to search your staff — it might be a nurse — it’s the person who has enough charisma to maintain the attention of the audience.”
Judges do have an emotional side to them, said Mikell, but she added that the presentation has to have substance and facts. “They don’t want a lot of fluff,” she said. “And you have to keep your message clear. No one wants to hear that they’re doing something wrong.”
Treatment professionals need to step out of their comfort zone to communicate with law enforcement on behalf of their patients.