Making Government Work

The Long, Strange Journey of U.S. Drug Courts

October 24, 2017
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The Long, Strange Journey of U.S. Drug Courts
Drug courts are one solution to help people recover from opioid addiction rather than face incarceration. Photo by Drew Angerer/Getty Images
The first treatment court was established in 1989 to keep addicts out of prison and in sobriety. Thirty years later, the model is finally gaining bipartisan acceptance.

The United States isn’t exactly an international role model when it comes to incarceration; out of all developed countries, we imprison the most people, and not very cheaply.

Close to half of those incarcerated in federal and state prisons are there because of drugs, but that hasn’t solved the nation’s ongoing drug crisis. And even though America is safer now than ever before, putting a glut of people behind bars isn’t the reason why.

The failures in the American justice system to tackle the drug epidemic — now in the form of prescription opioids and heroin — has forced the hand of lawmakers to reach across the aisle to find bipartisan solutions. Whereas prison reform used to be relegated to Democrats and libertarians, many Republicans have started to recognize the need for a change in a judicial system whose costs have far outpaced state and local spending on education.

One of these bipartisan solutions has been the implementation of drug treatment courts, an alternative to the traditional court system in which low-level offenders are kept out of prison. Under close supervision of a judge, addicts agree to undergo up to 18 months of mandatory sobriety meetings, group therapy sessions and random drug testing.

A COURT MADE FOR TREATMENT

In 1986, President Reagan signed the Anti-Drug Abuse Act, which allocated hundreds of millions of dollars to build prisons and funnel money into treatment, but the most impactful (and most covert) aspect of the bill was imposing mandatory minimum sentences on drug users.

In 1982, before anti-drug measures were signed into law, there were just under 41,000 people serving time for drug offenses. That number skyrocketed throughout the 1980s and ’90s. By 2015, close to 470,000 people were incarcerated for drugs, according to The Sentencing Project, a nonprofit advocacy group that analyzes U.S. Bureau of Justice data.

But incarcerating drug users didn’t help reduce crime.

In response, the first drug courts popped up in Miami in 1989, a time when the scourge of drugs and crime had made the nation’s most powerful CEOs rank the city as one of the worst places to establish a business, much less a place they wanted to live.

The drug courts started small at first, with only 42 programs in place by 1994, according to a report produced by the Government Accountability Office (GAO). Less than two decades later, by 2010, the number of programs had reached 2,500. But despite that growth, as of 2008, only 3.8 percent of all arrestees considered at risk for drug dependence were actually diverted to a drug court for treatment.

SUCCESS, WITH A SIDE OF SKEPTICISM

Initially, the jury was out on the impact of drug courts, though a 1997 GAO report found an incredibly wide margin of success. For example, out of the 65,000 people examined in 1997 who had gone through drug courts, between 8 and 95 percent had completed the program, and retention within the program ranged from 31 to 100 percent.

But as the drug court system matured and grew, so did its effectiveness. When it was analyzed again in 2011 by the same office, the rearrest rates of those who had completed their drug court mandates were significantly lower — up to 58 percent less — than those who hadn’t. The report concluded that “drug courts produce statistically significant reductions in drug use [and] in self-reported crime.”

A graduate of the Cheshire County Drug Court in Keene, N.H.Photo courtesy of the National Association of Drug Court Professionals

However, the success (and failure) of drug courts relies heavily on the kind of treatment it administers. In other words, because of ideological differences in how to best treat addicts — which pits medical intervention against a cold-turkey approach — and the varying state laws, not all drug court programs have been created equally.

When courts recommend medically assisted treatment, or MAT, addicts are provided methadone or buprenorphine to help wean them off opiates. The practice is recommended and well-regarded among numerous world and national coalitions, including the World Health Organization and the United Nations. The research backs it up: In Baltimore, for instance, access to methadone and MAT reduced overdose deaths by 50 percent, according to a 14-year study published in the American Journal of Public Health.

But methadone, which has been used for treating opioid dependency for over 50 years, has its detractors. There is evidence that some people stay on methadone for years, leading critics to argue that these addicts are simply swapping one drug for the other.

A 2010 survey of U.S. drug court programs found that just more than half, or 56 percent, provided MAT. And though that figure is higher than in 1999, when only 39 percent offered the treatment, that’s still a wide gap considering methadone treatment has been shown time and again to reduce overdose deaths.

In giving reasons for their opposition to MAT, one survey respondent said that “Our drug court team feels that allowing our participants to take medication in order to ‘detox’ from one substance could result in new addiction to another substance.” Another court surveyed claimed that “When these drugs are used people are substituting one high for another.”

The aversion to methadone and buprenorphine has led some judges to enforce immediate sobriety. But that approach is highly ineffective, says the National Association of Drug Court Professionals, and only heightens the risk of future drug overdoses and deaths.

A BIPARTISAN SOLUTION

The promise of drug courts has led to some unlikely alliances. Liberal commentator Van Jones and Newt Gingrich, the conservative former speaker of the House, have teamed up to speak out on the opioid epidemic — and the political establishment is carefully watching their efforts to see how bipartisanship could help solve the crisis.

In a recent op-ed for TIME, both men made an argument for drug courts, writing, “What started as an experiment has now become a successful method for helping people with serious substance use disorders get on a path to long-term recovery.”

In New Hampshire last year, then-Gov. Maggie Hassan, a Democrat and current U.S. senator, signed a law that directed $2 million in matching state grants to drug courts — a move that was widely praised, even by the conservative think tank American Legislative Exchange Council (ALEC).

“Saving taxpayer dollars is a central pillar of a public official’s duty, and given the overall criminal justice cost of opioid dependence is estimated to be $5.2 billion annually, measures that seek to reduce that cost are necessary, especially if such measures simultaneously reduce crime rates,” wrote Ronald. J. Lampard, director of the Criminal Justice Reform Task Force at ALEC.

And there are more across-the-aisle measures being introduced. Earlier this month, a bipartisan bill was introduced that would reduce sentences for low-level drug crimes and give inmates with drug problems more access to treatment. If it passes, it could be another important footnote in the fight for prison reform — and for recognizing that treatment, not prolonged incarceration, is the best way to address addiction in a more meaningful, and effective, manner.

GO DEEPER WITH THESE MUST-READS ON THE STATE OF AMERICA’S DRUG COURTS:

How Treatment Courts Can Reduce Crime,” The Atlantic
How America Overdosed on Drug Courts,” Pacific Standard
How to make drug courts work,” The Washington Post

Homepage photo by Tomas Nevesely/iStock.

 

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