Medication-assisted treatment is increasingly cited as a way to curb the opioid epidemic. However, only 23 percent of publicly funded treatment programs offer it, according to the Pew Research Center.
The 86th District Court allows for some medication treatment, and whoever wins the race for district court judge next week will have a say on using other drugs going forward.
Relapse and recovery
Jeff St. Amour tried opiates for the first time when he was 14. His friend was prescribed hydrocodone for a foot injury and he gave Jeff a pill.
Jeff says he liked it so much that he stole the rest of the prescription.
“I moved to [intravenous] drug use pretty quickly, mainly morphine and oxycodone,” Jeff says. “By the age of 17 I was a full-blown intravenous heroin addict.”
Jeff tried to quit cold turkey a couple times over the next few years. Each time, Jeff says he was hit with crippling withdrawal symptoms like back pain.
“I remember laying in bed and just moving to even turn the channel was almost excruciating,” Jeff says. “The worst flu I ever had, too; I felt very nauseous, I had a fever and the only thing that would get rid of that was opiates.”
Between withdrawals and cravings, Jeff says opiates quickly took over his life.
“I actually ended up shooting myself in the foot with a pellet gun because I knew that -- worst case scenario -- I would be getting narcotics from it,” Jeff says.
When he was 17, Jeff heard about medication-assisted treatment, or MAT. This involves prescribed medication that suppresses cravings and withdrawal symptoms. So he found a doctor who prescribed him a drug called Subutex.
Every day Jeff takes a pill; they’re small white tablets that look like Altoids. It’s helped him kick heroin for good. He’s six years clean.
“I started going to meetings, and then the next morning I woke up and I was able to put a pill under my tongue and I was able to go about my business just like a normal everyday person,” Jeff says.
Jeff says without his medication, he couldn’t live a normal life. That idea is gaining traction.
Debate in Legal Circles
Last year President Trump’s commision on opioid use recommended that medication-assisted treatment be used in corrections facilities, but it’s still controversial.
Locally, the Grand Traverse county courts have been hesitant to use it in their drug court -- a treatment program for nonviolent drug offenders. Voters will have some input in next week’s election. Two candidates are running to be the new district court judge.
One of them is Grand Traverse County Prosecuting Attorney Bob Cooney. In the drug court, Cooney says he sets up plea deals.
“As a prosecutor I’ve had kind of a front row seat to the epidemic … and so I’ve tried to take a little bit of a leadership role in this,” Cooney says.
Cooney’s opponent is defense attorney Paul Jarboe. He is on the other side of the court defending clients facing drug charges.
“My role as a defense council currently is to guide people and help choose people that qualify for [the drug court],” Jarboe says.
The district drug court does allow some medication-assisted treatment. Participants can take a monthly injection of a drug called Vivitrol, but some in the medical community say there’s better medication. Subutex and its relative Suboxone are more commonly prescribed for long term addiction treatment but they are not allowed in the drug court.
Long-term treatment for a short-term program
Bob Cooney was curious about those other medications, so he met with pharmaceutical reps to hear more about them. He says he was impressed but he is concerned about how long people rely on them.
“It is unusual that anyone who is in [that] program is able to be weaned off that drug in less than something like 12 to 14 months,” Cooney said.
Cooney says there is some room for Subutex in the court but they don’t want anyone still on it by the end of the program. That’s tricky because patients in recovery can be on Subutex and Suboxone for years, and in some cases for the rest of their lives. The drug court program lasts three years; that is the point where Cooney says most convicts don’t re-offend.
So even if your medication is a condition of your sobriety, the court may not see it that way.
“If your definition of success is that that person is now addicted to a narcotic drug for a substantial period of time … that doesn’t seem to be a goal that fits with what the criminal justice system is trying to accomplish,” Cooney says.
Pills on the street
Cooney’s opponent Paul Jarboe is also open-minded on medication-assisted treatment, but he has concerns. For one, Jarboe says a lot of medication, whether it’s for pain or opiate recovery, leaks out and gets sold on the street.
“Clearly our medical community hasn’t been responsible in terms of the opioids that have been dispensed,” Jarboe says.
Jarboe says the medication that’s supposed to help addicts could become a problem on its own. He says doctors already over-prescribe painkillers and they could do the same with opiate medication, even if it’s court-ordered.
“It’s a more difficult presentation because of the overall problems we have in the community,” Jarboe says.
Medical community is behind MAT
Studies have shown that recovering addicts on medication like Subutex and Suboxone stay in treatment longer than people that quit cold turkey.
While Bob Cooney and Paul Jarboe say they are open to the idea, they both have lingering concerns. However, if MAT is going to be used in the district’s drug court it may need strong advocacy. That’s because Circuit Court Judge Thomas Power gets the final say.
While he says he’s open to being persuaded, he doesn’t support medication-assisted treatment.
“You tell the addict ‘you can go to a treatment program in which we will give you skills and classes on how to resist the temptation … or you can do to this other treatment program we got in which we’ll give you free narcotics,’” Power says.
“Which one do you think do you think the narcotic addict will choose?” Power says.
Judge Power isn’t up for re-election for another two years, but come January he’ll be working with a new district court judge on the drug court.