HOW AMERICA OVERDOSED ON DRUG COURTS
As a retired drug court judge who was interviewed for the piece, I was dismayed to read Maia Szalavitz’s recent article on drug courts (May/June 2015). I feel compelled to set the record straight on a couple important facts.
Szalavitz writes that drug courts “embolden judges to practice medicine without a license.” In reality, drug court judges work with an interdisciplinary team that includes treatment providers and clinicians. A core tenet of the drug court model is that determining the appropriate level of care for a participant must always be done by a trained and licensed or certified clinician.
She is absolutely correct that drug courts must allow medication-assisted treatment (MAT), but by highlighting a few examples of resistance she characterizes drug courts as being staunchly opposed. In fact, an individual in drug court is 10 times more likely to receive medication than one on probation or parole, and five times more likely than the typical patient in substance abuse treatment.
It is true that we must do a better job educating the legal community about the use of MAT and how it can be administered and monitored within the criminal justice system. But some of the best examples of this can be found in drug courts. We are starting to understand what separates high-performing drug courts from the few lowest-performing drug courts.
It is unfortunate that this article only served to distract from the critical work underway to expand treatment to those most in need.
—Hon. Peggy Hora, Superior Court of California (retired), Walnut Creek, California
If judges aren’t practicing medicine, why is maintenance banned so often? Peer-reviewed research has shown that two-thirds of drug courts do not allow ongoing MAT and require that it be tapered in order for someone to graduate. This means, in essence, that they don’t allow the treatment, since, under medical guidelines, MAT should be indefinite and determined by a patient’s need, not circumscribed by a court’s time limits. Fifty percent of drug courts don’t allow MAT at all, and only 40 percent are willing to include it as a component of the treatment they recommend.
While Judge Hora states that “treatment providers” are the ones who make the treatment decisions, the problem is that they, too, are often unqualified. According to research from Columbia University’s Center on Addiction and Substance Abuse, there are no educational standards for drug counselors who work with drug courts (they don’t even need to have a high school degree in many states). And these so-called professionals are often employed by prosecutor’s offices or by treatment organizations that may be beholden for funding to the courts, compromising the independence of their recommendations. They are rarely M.D.’s or Ph.D.’s, and obviously not making decisions based on the standard of care for opioid treatment: If they were, drug courts wouldn’t be banning maintenance in any opioid cases.
This article really struck a chord with me. I’m currently going through the Georgia DUI court program. It was presented to me as an option, but it was the only realistic option I had. It was either go through with the program or do 90 days in jail and lose my job and my apartment. The two treatment-session leaders are both unpaid interns. One is a teacher. One works as an insurance salesman.
—Name Withheld, Atlanta, Georgia
PROFESSOR, CAN YOU SPARE A DIME?
The adjuncts may be crying now, but their predecessors had opportunities to protect their interests: The American Federation of Teachers and the National Education Association both attempted to include part-timers and adjuncts into faculty units when full-time faculty sought collective bargaining status in the 1970s and '80s. If the faculty needed to strike to get the attention of management, we wanted part-timers included. In many cases adjuncts did not want to be included, many arguing—against their own interests—that they were professional and did not need a union, or that they wanted the flexibility of part-time, non-union status.
There is still the opportunity for them to seek protection through collective bargaining with either the AFT or the NEA, with both organizations likely eager to accommodate them, whatever the history.
—J. Kaye Faulkner, Former National Representative, American Federation of Teachers Bellingham, Washington
Since Bill Miller is worried about there being a market for his electricity in California, I was a bit surprised that providing power for ocean desalination or wastewater recycling projects wasn’t discussed.
California recently passed a water-bond measure that earmarked several billion dollars for water storage; the governor has also been pushing hard for water-transfer tunnels that will take a decade and billions of dollars to build.
Many promote desalination as a means to avoid all this, but desalination is expensive primarily because it requires a lot of electricity. It also can create a significant carbon footprint, which creates yet another environmental hurdle. But what if a company with a glut of clean wind energy, regulatory savvy, and the economic wherewithal to build desalination facilities stepped in? Anschutz and Miller could build desalination facilities (or partner with those that have already built them). They would be building a market for their own electricity—a market based on a product that will only be getting more valuable.
Those billions of dollars could be used for the proper placement and construction of desalination facilities. I am sure that the above idea has lots of hurdles, but at the core you have clean energy looking for a market, and a water market looking for a supply that can be created with electricity; the devil will be in the details. Then again, your article made Miller sound like a bit of a devil-whisperer.
—Dana Booth, Sacramento, California
Having just read your informative article “Without Christianity, What Year Would It Be?” (June 5th, 2015) I was surprised that no mention was made of the attempt to instigate the year 1950—the year carbon dating was perfected and became the accepted global standard for accurate scientific dating of all carbon-based life—as Year 1. For many years (in parts of the United States and some European countries) there was widespread enthusiasm for adopting this sensible, unbiased, and objective dating system, but alas, old habits die hard. Considering our present dating systems are based on a mixture of religious fantasy and guesswork, adopting an accurate system concerned purely with the dating of life surely makes good sense.
—Paul Stafford, South Africa
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