Rural court officials shift from abstinence-only approach to drug defendants to medication-assisted treatment

A strip of Suboxone film, an opioid-addiction medication (Photo by
Craig F. Walker, The Boston Globe, Getty Images via KFF Health News)

Rural judges and other court officials are shifting their stance on medication-assisted treatment programs for addicts facing drug charges. "A study conducted a decade ago found that barely half of drug-treatment courts offered medication treatment. Those that didn't cited uncertainty about its efficacy and noted political, judicial, and administrative opposition. But research in the years since has persuaded many of the most insistent abstinence-only advocates," reports Taylor Sisk of KFF Health News. "By 2022, more than 90% of drug courts located in communities with high opioid mortality rates that responded to a survey said they allow buprenorphine and/or methadone, the medications most commonly used to treat addiction. . . . Federal legislation has lowered the barriers to it. And Bureau of Justice Assistance funding for treatment-court programs now mandates that medication for substance use disorder be provided."

Judge Duane Slone

The evolution of Judge O. Duane Slone is an example. As a prosecutor in charge of drug cases in Cocke, Grainger, Jefferson and Sevier counties in East Tennessee, who becanme a judge in 1998, "Slone believed abstinence was the only path to recovery. But in 2013, after consulting with substance-use-disorder experts, he relented, introducing medication as an alternative to incarceration for pregnant women. . . . Building from evidence-based research, Slone has launched programs that show how a judge, and a region, can trade an abstinence-only, lock-’em-up approach for one that offers a full range of paths to recovery."

Eventually, Slone founded a drug-recovery court. "It allows defendants with nonviolent drug-related charges to avoid jail time by entering treatment and counseling," Sisk reports. But this type of court was so "resource-intensive, relatively few people can be enrolled. So in 2013, Slone introduced the Tennessee Recovery Oriented Compliance Strategy, an alternative to jail for those who aren't considered at high risk of recidivism but are deemed in urgent need of treatment. Many are pregnant women or mothers of young children. . . . Both the recovery court and TN-ROCS offer three medication options: buprenorphine, methadone, and naltrexone. . . . Since TN-ROCS' launch, Slone said, his community has seen a decrease in property crimes and its jail population."

Monica Christofferson, director of treatment-court programs at the Center for Justice Innovation, told Sisk she has seen a "huge shift" among judges, prosecutors, and law enforcement agencies away from the stigma associated with medication treatment, but rural areas still face unique challenges. "The relative unavailability in rural areas of medication treatment is certainly a problem. A shortage, Christofferson noted, is not only an issue in itself but also a barrier to overcoming stigma," Sisk reports. "More openings available [in treatment programs], more success stories. More success stories, less stigma. Fewer provider options also mean one bad actor — a provider who overprescribes or is otherwise negligent — perpetuates the stigma. Strict oversight is essential."