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Scientific Evidence Resources: Opioid Crisis
The goal of this series is to equip federal judges and other system stakeholders with the information they need to perform their critical roles in countering one of the most destructive public health crises we have seen as a nation.
Judge Irene M. Keeley (N.D. W. Va.) introduces this series, designed to provide judges with a basic understanding of opioid use and its effect on the federal courts, and outlines the objective: to equip judges with a series of takeaways they can readily apply in their respective courts.
Dr. Robert DuPont, an expert in drug-abuse prevention and treatment for fifty years, served as the first director of the National Institute for Drug Abuse (NIDA) and as the second White House Drug Chief under Presidents Nixon and Ford. Dr. DuPont discusses why it’s important to address not only opioid abuse, but other substances too, and provides a historical perspective on the current epidemic and prior drug crises. He explains how the profile of the typical addict and the use of heroin have changed over time, and the interventions and treatment options available. Dr. DuPont emphasizes the value of cooperation between the criminal justice system, treatment providers, and prevention programs.
Dr. Cathy Thompson, National Chief of Drug Treatment Programs at the Federal Bureau of Prisons (BoP), discusses Medication-Assisted Treatment (MAT) in conjunction with a range of evidence-based programs offered at BoP facilities for the estimated 65% of inmates with substance use disorders, and also seeks to dispel some of the myths surrounding MAT use in BoP institutions.
In this module, Chief Judge Ricardo Martinez (W.D. Wash.) relates lessons from his extensive experience running drug court programs in both state and federal courts. He shares stories and offers tips for judges who may have an interest in drug court operations as a means of addressing the opioid crisis in their own jurisdictions. As he notes, there is not a manual judges can rely upon to guarantee success—there are, nevertheless, lessons gleaned from his experience that can benefit other judges and courts.
Chief Magistrate Judge M. Page Kelley (D. Mass.) and Deputy Chief Probation Officer Joseph LaFratta (D. Mass.) discuss the structure, commitment required, and lessons learned from their court’s experience with a successful drug treatment court program.
Chief Justice Loretta Rush (Indiana Supreme Court) shares her experience as a chair of the National Judicial Opioid Task Force, presenting the findings of the task force as well as new resources and a call for enhanced cooperation between federal and state courts in addressing the opioid crisis.
Dr. Robert Redfield, director of the Centers for Disease Control and Prevention (CDC), identifies drug use disorder as the public health crisis of our time. He mentions the focus on pain control as one driver, cites recent progress in educating both health-care professionals and the public about the scope and extent of drug use disorders, emphasizes that drug use disorder is a chronic, relapsing medical condition—not a moral failing—and offers that judges exercise a critical role. In dispensing justice, judges can also enable participation in programs that facilitate long-term recovery.
Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse (NIDA), explains what judges need to know about the biology, neurobiology, and chemistry of opioid use disorder. He introduces drug therapies to include methadone, buprenorphine, naltrexone, and naloxone, and explains how opioid tolerance and dependence are manifested and affect the brain. Dr. Compton covers the influence of individual and environmental factors in addiction. He concludes with a brief discussion on the complementary roles of judges, who work within the public safety system, and those who work within the public health and treatment community, and the need to work together.
Dr. Christopher Jones, U.S. Public Health Service and Centers for Disease Control and Prevention (CDC), reviews current options (to include methadone, buprenorphine and naltrexone) in Medication-Assisted Treatment (MAT) for those with an opioid use disorder. He also discusses laws and regulations related to the use of controlled substances in treatment, and highlights some of the challenges in implementing opioid treatment programs in criminal justice settings. He notes the important role judges exercise in setting social norms on how medications improve the lives of those with an opioid use disorder.
Dr. Kelly Dunn, from the Johns Hopkins University School of Medicine, explains how psychologists treat individuals with opioid use disorder and chronic pain, which includes techniques such as cognitive behavioral therapy (CBT). She observes that those in the justice system can issue referrals and work with psychologists to ensure that comprehensive treatment programs, including medications and psychological counseling, are made available to incarcerated individuals.
Lou Ortenzio, a former physician who lost his career and his marriage in his struggle with opioids, shares his experience assisting others who seek to recover from substance use disorder in his home town of Clarksburg, West Virginia.
In concluding remarks, Judge Irene Keeley (N.D. W. Va.) reinforces the goals of this program: imparting new ideas to bring back to your courts, coupled with an understanding of both the science and the practical aspects of opioid addiction, enabling you to better address opioid use disorder defendants as they present on your dockets.