Tennessee Judge O. Duane Slone began offering options to defendants battling drug addictions that many judges, particularly in rural jurisdictions, were averse to extending: medication for opioid use disorder, (MOUD.) 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. Monica Christofferson of the Center for Justice Innovation says there has been a “huge shift” among judges, prosecutors, and law enforcement agencies away from the stigma associated with medication treatment, KFF Health News reports. Simply put, “MOUD works,” Christofferson asserted. By 2022, more than 90 percent 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. The study found that 65 percent of drug court program staffers have received training in medication for treatment, and similarly have arranged for clients to continue receiving medications while serving jail time for program violations. Still, almost 1 in 4 programs told researchers they overrule medication decisions. Federal legislation has lowered the barriers to it and the Bureau of Justice Assistance funding for treatment-court programs now mandates that medication for substance use disorder be provided. In 2013, Judge Slone introduced medication as an alternative to incarceration for pregnant women. By 2016, he had fully embraced it even as most judges, he said, “still believed that it was substituting one drug for another.” 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. A drug recovery court, which he co-founded in his 4th Judicial District in 2009, was a first step. It allows defendants with nonviolent drug-related charges to avoid jail time by entering treatment and counseling. They’re closely monitored by a team that includes a judge, case manager, public defender, prosecutor, and probation officer. If the participant violates the terms of the agreement, the first step is a reassessment of treatment needs. Slone also introduced the Tennessee Recovery Oriented Compliance Strategy, or TN-ROCS, 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. Over its first five years, all 34 pregnant women in the program gave birth to healthy babies, and 30 kept custody of their children. TN-ROCS is now being replicated across the state.
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