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Saturday, December 21, 2013

Refusing $1 Million: Judge Marshall "Thinks Twice" ... Wonder Why?

The Drug Court of Scioto County run by Common Pleas Judge William T. Marshall turned down the  State of Ohio's offer of  a $1 million grant as its share of the  $5 million from House Bill 59 in the state budget. In his "wisdom," Scioto County Common Pleas Court Judge William T. Marshall has decided since "his" drug court is not broken, there is no need to fix it.

Why the controversy? The grant would have allowed the use of Vivitrol, an injected drug that eliminates the effects of opiates and has recently been approved for treatment of opiate addiction.

The U.S. Food and Drug Administration (FDA) approved Vivitrol’s use for opiate addiction. It is referred to as an opioid antagonist, meaning that it blocks the receptors in the brain that give an opiate addict a high. One injection of Vivitrol lasts roughly 30 days.

In essence, Vivitrol helps free people from the compulsion to start using again. There is no point of shooting up if nothing’s going to happen, so it helps some focus on getting their lives together.
“We’re just saying it doesn’t fit the (Scioto County) Drug Court scheme,” Marshall said.

“I met with the entire drug court team, along with the (Portsmouth) Chief of Police, the (Scioto County) Sheriff, and went under a lot of debates,” Marshall told the Portsmouth Daily Times. “And the overall consensus in the end was that our drug court has been so successful without the use of any kind of drugs, that we’ve always maintained that we want to be a drug-free, alcohol-free drug court, and therefore we have chosen not to.”

In a puzzling comment, Marshall was quick to add that the Scioto County Drug Court is not saying it is wrong for other drug courts to utilize the program.

Why so puzzling?  There seems to have been a change of heart. What are the major reasons a county with a drug epidemic would decline a huge grant to stem the flow of drug abuse? Here are the actual quotes and the tone from Judge Marshall just a matter of a little over a week ago.

"'The judge and some of his drug court team have gone to one conference, and then, some of the probation officers with the drug court, went to another conference,' Yvonne Hale, of Marshall's office, said. 'There's a big meeting Thursday at 1 (p.m.), with a Vivitrol rep, the (Scioto County) Sheriff's Office, the (Portsmouth) Police Department, the (Scioto County) Prosecutor's Office, and they will be meeting about it (grant). I think the (Ohio) Supreme Court will be here too, so after that they will be going over our applications. It's looking good.'

"Marshall has operated the county's drug court for eight years, without one-cent in funding with one of the lowest rates of recidivism. Now, he is excited about being named one of five drug courts in the state to receive the funding.

"'The ones that are slipping through the cracks are the ones who don't have a medical card or insurance," Marshall said. 'Second Chance can take a lot of people, but Second Chance is only so big. Some of these people need longer term in-house treatment, which we can't pay for because we have no money, but that (state funding) would be wonderful. In drug court we try to help 25 or 30. Now, we could double it.'"

(Frank Lewis, "Marshall One Step Closer To Drug Court Grant."
 Portsmouth Daily Times. December 10, 2013)

Can you smell the politics, the certain unmentioned personal influences, the "good old boy" regime, and corporate profits as possible reasons for the sudden change of heart? I am very saddened that any step to save lives could not be taken, properly administered, and added to the Scioto County drug court. Did Marshall cave because the public perception of being "soft on crime" is to provide vital, clinical-based interventions?

One question sticks in my craw: "If the controversy about administering this drug alcoholism centered on treating alcoholism as a primary addiction, would drug intervention likely be accepted?"

Guess what? The U.S. Food and Drug Administration approved Vivitrol for the treatment of alcohol abuse in 2006. Vivitrol is a medication that helps alcoholics maintain abstinence during the early period of recovery.

The stigma of differentiating types of substance addiction is clear. And, in one of the nation's most susceptible opioid addictive areas and in a county with a ranking as "the least healthiest county in the state," Scioto County must consider drastic measures for improvement.

Treatment in lieu of conviction is available to an offender who previously has not been convicted of or pleaded guilty to a felony offense of violence, according to Ohio law. The option allows the person to complete drug treatment while on probation, and if successful, the charges would be dismissed.

A "Scary Situation"

Needles and injections, unavoidable recidivism, drug criminals, junkies, prostitutes, government administration of drugs for treatment -- granted, the environment surrounding the use of Vivitrol makes for controversial, even "unpleasant" discussions of something relatively new and decidedly offensive to those in a conservative establishment.

Let me tell you, I have been involved in drug education and activism against abuse for many years. The necessary changes to keep Scioto County, Ohio, and the rest of America sober enough to survive the crises of health, economic, and criminal problems are not always "pretty." The killing fields are full of victims who might have been saved with treatment and education.

One thing is certain: the old "Just Say No" advice and "cold turkey" jail terms do not work well. I also know something about drug court. You cannot plump up statistics meant to impress lawmakers and review boards and declare victory. Instead, real "success" is counted in numbers one-by-one according to each precious life saved -- be it a judge's child, a law enforcement officer's child, a lawyer's child, or the child of a prominent parents. The people here know reality too well.

The courts should tread lightly upon those who have been convicted, incarcerated, and done time for drug crimes -- that is, tread lightly upon those who honestly seek and continue to maintain sobriety. All they have to do is look at their own loved ones and know better than to deny something that saves lives.

Some abuse from those in high circles has been hidden from the public eye -- opioid addiction doesn't respect social or economic boundaries. We all know the truth. It is our problem, and we have the responsibility to do better to heal people with the disease of substance addiction -- all people, not just the privileged and the chosen few, not just the people sitting in positions of authority, fame, or power. And, I believe this habit of excusing offenses and forgiving "the right people" without giving them punishment and rehabilitation adds to the honest perception of a double standard that has stained the county too long. 

Damn it, people are dying. Your loved one may need any means available to beat addiction. Drug dependency and addiction are at the heart of the social problems in the United States. Treatment is in extremely high demand, and it is grossly underfunded by the government. I always judge a possible intervention -- counseling, incarceration, chemical treatment -- by its ability to save a life. And, I always place myself as someone who risks losing a loved one unless these cutting edge, research-approved treatments are available to be used as a last resort. I know so many who have lost loved ones who would be alive with proper care.

The Obvious Need For Better Care

* On average approximately five people died each day in Ohio due to drug overdose. 

* In 2007, unintentional drug poisoning became the leading cause of injury death in Ohio, surpassing motor vehicle crashes for the first time on record. This trend continued in 2010.

* From 1999 to 2011, Ohio’s death rate due to unintentional drug poisonings increased 440 percent, and the increase in deaths has been driven largely by prescription drug overdoses.

* In Ohio, there were 327 fatal unintentional drug overdoses in 1999 growing to 1,765 annual deaths in 2011.

* Heroin has tightened its grip on Ohio, especially in the Southern region, creating a surge in overdose deaths and doubling seizures of the drug during the past year. Criminal heroin indictments also are rising.

* For example, authorities say Dayton is a heroin hub featuring cheap prices and a meeting place for dealers to distribute the drug to suburbs and smaller towns. The greater Dayton region has seen at least 281 people die from heroin-involved overdoses in less than five years.

* According to Greene County Adult Probation Director Melissa Litteral. “Heroin is a huge problem right now,” said Litteral, noting that 208 people in her probation program tested positive for heroin in 2012. From January 1 to February 11 of 2013, another 25 Greene County probationers tested positive for heroin.

Why Turn Down a $1 Million Grant?

I believe people use some of the following logic:

1. Criminals will use Vivitrol and sell it for profit.

Vivitrol, compared with other addiction medicine, is different in that it doesn’t require a daily dose and doesn’t have street value. Yet, from the criminal-justice perspective, probably the most attractive  plus is that it’s non-divertable like methadone -- in other words, no one’s going to take this needle and sell it on the street. No one wants a drug that’s going to take away the effect of their drug.

2. The administration of Vivitrol amounts to trading addictions and treating a drug addict with a drug that likely needs to be sustained.

But, Vivitrol is nonaddictive. It’s up to the individual to go back for that second shot. And if they choose not to, there’s no medical problem, there’s no detoxification. It just simply wears out after 30 days. I hear your concern now: the new drug is not always effective and could be denied, then addicts will return to heroin or OxyContin. In my mind, too many dependent offenders already inhabit our county and repeatedly abuse the populace, costing the public pain, suffering, and loss of life. I believe Vivitrol would save lives, money, and cut criminal activity.

3. Giving a criminal treatment for drug abuse is like "giving an incorrigible  thief money from my pocket to support his or her horrendous habit.

Many dependent felons, especially those who are young, went straight from Oxycontin to heroin, and eventually they started stealing to support their habit. Many have yet to "hit bottom." In general, they don’t have a great deal of focus, and all they want to do is run.

And some do run -- from the law and from participation in drug court. The court requires that participants show up to regular counseling sessions  In some courts where Vivitrol has been used,  Vivitrol recipients never showed up.

All in all, for most people, the cravings are diminished substantially where they’re at a stable place emotionally to take on the benefits of the counseling, the meetings and the structure this program has to offer. They don’t feel they need to run out and use.

Anyway, the current state of affairs already experiences this "running" and considers it "business as usual." It can't get much worse. Changing the county one person at a time reaps substantial benefits as friends and family see and report gains and progress. I believe Vivitrol would help do this. Surely, the court can devise successful procedures for administration and rules for continuing delivery.

4. Vivitrol does have a high price tag because now pharmaceutical companies claim it is not an easy medication to make.

Remember we turned down a grant that would save citizens money. Yes, after further consideration, Judge Marshall decided Scioto County Drug Court is too effective to advance any positive changes and take the money. My, oh my. Possibly some progress and current meager funds are viewed as "enough."

The drug overdoses we suffer are associated with high direct and indirect costs. Unintentional fatal drug poisonings cost Ohioans $3.5 billion on average each year; while non-fatal, hospital-admitted drug poisonings cost an additional $31.9 million. These costs include medical, work loss and quality-of-life loss. Please understand -- you and I pay these tremendous costs already.

Of the 2.3 million inmates in the U.S., more than half have a history of substance abuse and addiction. Most receive no treatment.

Dr. Josiah Rich, a professor of medicine and community health at Brown University who also treats people in prison, is worried that, by refusing or neglecting to provide treatment to addicts, many U.S. prisons are missing the best chance to cure them—and in the process to cut down on future crime. Treatment can reduce recidivism rates from 50 percent to something more like 20 percent, according to the DEA. Yet it is not widely provided.

“Our system has taken the highest-risk and most ill people and put them in a place where they have constitutionally mandated health care,“ Rich says. “What a great opportunity to make a difference. Are we just trying to punish people? Or are we trying to rehabilitate people? What do we want out of this?”

(Mary Carmichael. "The Case for Treating Drug Addicts in Prison." Newsweek. June 28 2010)

The irony  is that by lowering recidivism, the programs themselves save money in the long run. The NIDA report released last year cited a remarkable statistic: heroin addicts who received no treatment in jail were seven times as likely as treated inmates to become re-addicted, and three times as likely to end up in prison again.

For every dollar spent, the programs save $2 to $6 by reducing the costs of re-incarceration, according to Human Rights Watch. Looked at this way, the programs can save the justice system about $47,000 per inmate. 

(Mary Carmichael. "The Case for Treating Drug Addicts in Prison." Newsweek. June 28 2010)

5. People don't morally approve of helping weak-willed individuals because addicts are responsible for their suffering, and they deserve to pay dearly for their sins.

The biggest problem with treatment is  an ideological one, not a practical one. In spite of all of the proven clinical and social and economic benefits of pharmacological treatment, people really have a moral opposition to it. They believe by providing offenders treatment, the legal system is not addressing their addiction in an appropriate way. They think people who have addictions deserve what they get, and that the only way to treat addiction is abstinence: nothing could be further from the truth.

Bob May, associate director of the Association of State Correctional Administrators, says,“We know from the research that with people who go through drug treatment, even if they still use drugs afterwards, their crimes are less violent and less frequent. Even if it’s not a 100 percent change, it’s a good thing.”

(Mary Carmichael. "The Case for Treating Drug Addicts in Prison." Newsweek. June 28 2010)

The public doesn’t necessarily think treatment is bad, either; a recent poll found that more than two thirds of Americans would support state laws requiring treatment—not jail time—for first- and second-time drug offenders.

Hell, I have heard people blast the needle-exchange program in Portsmouth, which, by the way, is helping to cut down the highest rate of hepatitis in the state. Giving out needles is drastic -- not in the circumstances here.

6. The Scioto County Drug Court is working just fine.

I have had conversations with many who have attended drug court. It is a good, vital part of the justice system. According to some, it has its problems. This is not to say it is ineffective or even seriously flawed, but the drug court needs to be committed to saving lives and not to caving to obvious pressures from those who believe they have their thumbs upon public perception. Some institutions may gain from denying Vivitrol. Without sick individuals .... You, like me, can speculate.

Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), lauded the approval: “Vivitrol obviates the daily need for patients to motivate themselves to stick to a treatment regimen—a formidable task, especially in the face of multiple triggers of craving and relapse.…NIDA is continuing to support research on Vivitrol's effectiveness."

(Raphael Rosen. "Vivitrol: A Shot in the Dark." The Fix.

The prevailing treatment philosophy is that no single approach is best for everyone. Tailoring the treatment to the individual is the standard of care, even if doing so can involve trial and error.

"Vivitrol is no magic bullet. But like other drugs for alcoholism or heroin—starting with antabuse in the ‘50s and methadone in the ‘70s—the medical community has welcomed it as an additional tool in a skimpy arsenal. It is widely viewed as a significant advance over naltrexone because it appears to solve that one-a-day pill’s glaring drawback: the problem of compliance. Addicts had difficulty staying on it. Surrounded by environmental cues and hindered by bad habits, many people “forgot” to pop it. By contrast, Vivitrol, a monthly injectable (the needle is stuck in your butt), requires only a monthly doctor visit."

(Raphael Rosen. "Vivitrol: A Shot in the Dark." The Fix.

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