One of Trump's first major solutions to the opioid crisis could actually make the problem worse by Michelle Mark and Harrison Jacobs on Oct 31, 2017, 4:45 PM Advertisement
 - President Donald Trump's opioid commission plans to recommend that drug courts be established in every federal judicial district.
- Drug courts are meant to divert some defendants with substance abuse disorders into treatment programs rather than prison.
- But public health experts say drug courts are a harmful way of incorporating the criminal justice system into addiction treatment.
The White House Opioid Commission will recommend on Wednesday that drug courts be established in every federal judicial district in an effort to combat the opioid crisis, according to a draft report obtained by STAT News.
Thousands of drug courts have sprung up across the country since the first was created in 1989, with the goal of diverting certain defendants with drug abuse and addiction issues to treatment, rather than prison. The White House commission's report, however, found that fewer than one-third of federal judicial districts and just 44% of US counties had drug courts as of 2015. Drug courts are geared toward criminal defendants arrested on low-level possession charges, or other drug-driven crimes that could carry criminal penalties, Chris Deutsch, communications director for the National Association of Drug Court Professionals, told Business Insider earlier this year. The push towards drug courts, Deutsch said, is part of a larger movement toward tailored, evidence-based criminal justice programs that serve different populations and needs. "Rather than entangling someone in the system for a low-level possession, they can be diverted," Deutsch said. "We need systems in place that — no matter where you are in the system — you are being diverted based on an assessment. There should be an evidence-based program for you." Deutsch declined on Tuesday to comment on the White House commission's draft report before its formal release. Drug courts have come under scrutiny by public health experts who say that incorporating the criminal justice system into treatment for a disease such as opioid-use disorder is harmful and can often result in punishing participants by sending them to prison if they relapse, as most people addicted to opioids do. Many of the cases that come before drug courts shouldn't touch the criminal justice system at all, according to Mae Quinn, director of the MacArthur Justice Center in St. Louis, a public interest law firm that uses litigation as a tool to provoke criminal justice reform. "When we try to put a criminal justice overlay over what should be a public health issue, it's not a good match," Quinn told Business Insider earlier this year. "We need community-based voluntary options. You shouldn't have to be arrested to get access to a program." Mixing healthcare and criminal justice  Drug courts are also notorious for providing neglectful care to their participants, according to David Patterson, a public health expert at Washington University in St. Louis.
Patterson, who has worked on drug courts in Kentucky and has worked in treatment for more than 15 years, said he has seen drug courts that push participants into signing contracts that bind them to questionable treatment methods such as writing papers, attending boot camps, and various forms of therapy that, in some cases amount, to "pseudoscience." Another pitfall is that in the drug court system, judges essentially take on the roles of "clinical treatment directors," Patterson said, allowing them vast discretion to determine treatment options or jail or prison time, based on participants' adherence to the court's rules. "There is such political branding of drug courts that they are able to treat people however they want to," Patterson told Business Insider earlier this year. Andi Peterson, a 26-year-old Utah resident, was one such participant. Peterson told Business Insider last year that she was in and out of drug court for nearly two years after a felony arrest for narcotics possession, where she repeatedly relapsed, was put in jail for months at a time, and eventually faced up to 15 years in state prison. Peterson said she was unable to stay off opioids in drug court, despite the treatment provided. She eventually was successful while serving a year in prison, after which she was released. She has stayed in recovery since. Stories like Peterson's, said Patterson, are what make him wary of drug courts. "[The court takes] custody of people with a medical illness and they treat them like it's a criminal issue. That's malpractice," Patterson added. "This would never happen to people with cancer, but because they are an addict they get away with it." Vivitrol and drug courts 
One issue in particular that has sprung up over the last five years has been the proliferation of drug courts that mandate participants use Vivitrol, a monthly injection that blocks opioid receptors in the brain. Though a recent study suggests some success for Vivitrol, most addiction experts reccomend maintainence treatments like Suboxone or methadone despite those treatments having some potential for diversion or abuse. "The #1 reccomended treatment across the world is indefinite maintainence treatment on Suboxone or methadone. It's not controversial except in the minds of people who don't like science," Mark Willenbring, a leading addiction psychiatrist who runs Alltyr, a treatment clinic in Minneapolis, told Business Insider last month. The pharmaceutical company Alkermes, the company behind Vivtrol, drew headlines recently after investigations by ProPublica, The New York Times, and the Associated Press reported how the company grew its business from $30 million in 2015 to $209 million a year later, primarily by marketing Vivitrol directly to hundreds of drug courts, particularly to judges in areas hard-hit by opioids who are wary of maintainence treatment. It is as yet unclear how or when the federal drug courts would be established or what kind of treatment modality they would use. Establishing more drug courts was just one of 53 recommendations contained in the commission's report, according to STAT News. President Donald Trump on October 26 declared the opioid crisis a "national public health emergency" and announced several measures the federal government plans to take to address the issue. SEE ALSO: Trump just declared the opioid crisis a 'public health emergency' — here's what that means DON'T MISS: Recovering heroin addict explains why it's so hard to stay clean — even in rehab
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