Pubdate: Sun, 29 Mar 2015
Source: Pittsburgh Post-Gazette (PA)
Copyright: 2015 PG Publishing Co., Inc.
Author: Jeffrey Benzing


In Allegheny County, Common Pleas Judge Lester Nauhaus Sees His Drug 
Court As an Alternative to the Carnage of the Drug War.

Drugs drive crime. But locking up addicts doesn't stop crime. Nor 
does it stop drug addiction.

"Nail 'em and jail 'em wasn't working," Judge Nauhaus said. "All it 
was doing was costing everybody a fortune."

Instead of locking up defendants, drug courts allow prosecutors, 
public defenders, judges and others to work together to get 
defendants to much-needed drug treatment.

But there are clashing opinions about how drug courts should operate.

Many judges, including Judge Nauhaus, ban drug court participants 
from using treatments like methadone and buprenorphine, calling such 
medications a "chemical crutch." He requires participants to focus on 

That puts the judge and his court in direct conflict with national 
drug court standards and federal officials, who condemn the banning 
of medications.

To Judge Nauhaus, medication is simply replacing one drug with 
another. And that drug can be abused, just like heroin, and sold on the street.

So a heroin addict in Pittsburgh has to give up medications that help 
stave off addiction to get treatment through drug court.

Both the federal government and the National Association of Drug 
Court Professionals say that approach ignores science.

"Saying 'we are abstinence only' is in direct violation of the best 
practices," said Doug Marlowe, chief of science, law and policy at 
the national association.

And though the state estimates that more than 70 percent of all 
inmates suffer from untreated addiction, only 32 Pennsylvania 
counties currently have adult drug courts. The state's remaining 35 
counties have little choice but to lock offenders up.

Pennsylvania spends $5.3 billion on the costs of addiction.

'Grow up'

On a slushy, bitterly-cold Monday in March, dozens of offenders 
who've battled addiction fill benches on the fifth floor of the 
Allegheny County Courthouse.

Most are in street clothes, a sign that they're back in the community 
or living in treatment facilities. In addition to close monitoring, 
they check in once a month to be sure their recovery is on track.

The process is informal, with Judge Nauhaus acting less like a 
traditional judge and more like a counselor. He talks with offenders 
about their progress and failings. They chat about everyday things 
like jobs and the dismal weather.

Applause erupts for two defendants who snip off ankle bracelets - an 
indication that they've complied with strict supervision and 
abstinence requirements and the court now trusts them.

Others appear in red jail suits, handcuffed and shackled. Judge 
Nauhaus is not impressed.

"You need to grow up," he tells a defendant who was locked up after 
being thrown out of a treatment facility. "You need to mature. You 
need to get a grip on life."

Drug courts offer defendants a bargain. Enter treatment, stay off 
drugs and avoid jail and prison, at least in the long run. Or serve 
your time, miss out on treatment and return to the life of an addict 
that brought you to court.

Since 1998, scores of serious but non-violent offenders in Allegheny 
County have been given that choice every year.

Success means keeping offenders out of court - and jail - in the future.

"I generally don't see them back in the system," said Rebecca Hudock, 
an assistant public defender who has been involved in Allegheny 
County's drug court for six years.

Another measure of success is the taxpayer money saved. For 2012, 
supervising an inmate on probation cost an average of $3.20 per day, 
according to the court. Jail time would cost $68.17 each day. State 
prison would cost $116, the court said.

Last year, the Allegheny County drug court had 235 total 
participants. Of those, 54 offenders failed or withdrew, 28 
graduated, and 153 were still in drug court at the end of the year.

Offenders can stay in drug court for more than two years. Those who 
fail get sentenced for their crimes, to which they've already pleaded guilty.

Success varies from court to court. The national association says 
three-quarters of all drug court graduates are arrest free after two 
years. The state has yet to publish statistics.

Allegheny abstinence

With very few exceptions, all of Allegheny County's drug court 
defendants are required to be abstinent. No medications to help with 
their cravings, though offenders can be accepted to the program on 
medication if they agree to taper off.

Court officials and treatment experts say the meds are dangerous. 
Suboxone, for instance, is a heroin-replacement pill to lessen 
cravings. It's not supposed to get a user high.

But Ms. Hudock said it's commonly sold on the street. An addict can 
get a prescribed dose, buy more illicitly, and get high.

"They're so high, you might as well just have shot up and come into 
the courthouse," she said.

Allegheny County's tough approach is not rare.

WITF, the NPR station in Harrisburg, recently examined a strict 
policy in York County that prohibits methadone and Suboxone and 
requires participants to get off addictive medications, even if 
they're used to treat mental health problems.

Defendants face a dilemma, the story notes. Either get help for a 
crippling addiction, or get help for other conditions.

The joint Union and Snyder County drug court has strict bans on 
certain medications, including many opiates, but it allows rare 
medication-assisted treatment.

"Our treatment policy is that every single person is evaluated 
differently," said Steve Diehl, treatment court coordinator for the 
combined judicial district.

The national drug court association found that that only 56 percent 
of more than 2,700 drug courts use medications like Suboxone. 
However, about 25 percent more would use them, they found, if 
medications were available locally or were more affordable.

In Pennsylvania, drug court rules vary by county.

The Administrative Office of Pennsylvania Courts oversees drug 
courts, but mostly lets them set their own rules. It does not take a 
stand on medication-assisted treatment. Neither does the Pennsylvania 
Association of Drug Court Professionals.

But both point to standards published by the national association. 
That organization takes a firm and explicit stance.

Recently, the White House, along with several federal health and 
treatment agencies came out against programs that ban 
medication-assisted treatment, going so far as to exclude drug courts 
with bans from federal funding.

In Montgomery County, Judge Steven O'Neill knows that drugs like 
Suboxone are abused on the street.

But that's not drug court.

If closely monitored - and coupled with therapy - medication can be 
effective. Judge O'Neill's drug court allows the meds, but it's not 
like they have bowls full of Suboxone, he said, that they pass around 
to defendants.

Addiction is a disease, he said. Willpower can't fix that.

An opioid addiction feeds itself by causing physical dependence. Not 
getting heroin or pills will cause violent physical sickness. He 
compares an addict's craving opiates to a diabetic whose pancreas has 
stopped producing insulin.

Both need medication.

"You're not going to say 'Toughen up. I'm not going to give them 
insulin,' " said Judge O'Neill, who previously served as president of 
the Pennsylvania association.

Taking a recovering addict off medication can lead to relapse, which 
can be especially deadly if the body has lost its tolerance for opiates.

Erica Bartlett, an assistant public defender in Philadelphia, which 
started the state's first drug court in 1997, said there's no 
justification for a blanket ban.

Each defendant should be evaluated individually to see if medication 
is appropriate, said Ms. Bartlett, who was a member of the state 
committee that developed accreditation criteria for drug courts.

Judge Nauhaus contends that his court has been effective without 
those chemical aids.

Not enough courts

The debate over medications that help with cravings is only relevant 
in places that actually have drug courts.

In most counties in the state, defendants have no choice but to go to 
court and jail, where many of them are destined to return. Over and over.

Judge Richard Masson has wanted to start a drug court for years.

But he is literally the only common pleas judge in both Cameron and 
Elk Counties.

"It would be very, very difficult to set aside time," he said.

Drug court depends on regular monitoring and hearings, and Judge 
Masson's district is so rural it can be tough to get defendants to 
court. The region is severely lacking in treatment facilities.

Judge Masson was hopeful that nearby counties would band together to 
create a traveling drug court. But that hasn't happened.

"The concept was not one that was shared by the entire region," said 
Karen Blackburn, the state's coordinator for drug and other 
problem-solving courts.

Elsewhere, it's a matter of political will and budgeting.

Treatment isn't cheap. Neither is monitoring. And a court can't work 
unless a judge is willing to take it on.

Currently, Westmoreland and Northampton Counties are planning drug 
courts, Ms. Blackburn said. Schuylkill County is considering it.

Who should pay?

If counties don't invest, taxpayers pay for addiction one way or the 
other. Remember that $5.3 billion number? Meanwhile, offenders don't 
get treatment.

Ms. Blackburn said she'd expect to see more drug courts if more money 
were available.

The Pennsylvania Commission on Crime and Delinquency contributes some 
money that can be used for drug courts. Federal money is also 
available, but grants are competitive, and officials have made clear 
that they won't give money to programs that don't agree to use 
medication-assisted treatment.

Meanwhile, the state budget gives little money to problem-solving courts.

So while drug courts are increasingly accepted as a normal part of 
the justice system, they exist only if they can be paid for by counties.

That's not true in neighboring New Jersey.

For years, the state has set aside millions for drug court staff and 
treatment funding and it recently expanded eligibility for offenders.

So crossing the Ben Franklin Bridge from Philadelphia to Camden, Ms. 
Bartlett, the assistant public defender, would move from a state 
where defendants in more than half the counties have no access to 
drug courts to a system funded directly by the state.

That system isn't perfect, but Ms. Bartlett and other advocates said 
mimicking New Jersey could lead to reduced crime, lower costs and 
more help for offenders.

"It's in their budget," Ms. Bartlett said. "I think that's what the 
commonwealth needs."
- ---
MAP posted-by: Jay Bergstrom