treatment and the war on drugs

“We know addiction treatment saves lives, reduces drug use, reduces criminal activity and improves employment. The data is there, the evidence is in, but our public policy has not caught up with the science.”
— Paul Samuels, President and Director of the Legal Action Center
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Methadone Maintenance Therapy and Racial Disparities in Accessing Buprenorphine

Methadone maintenance treatment (MMT) programs began to operate in communities of color in New York City in the 1970s. While methadone treatment allows opioid dependent people to manage their addiction through the suppression of withdrawal symptoms and the reduction of cravings, its use is restricted by federal regulations. MMT programs are sequestered within regulated clinics -- wherein clinicians directly observe patient dosage. Further, patients are subject to random drug testing and cannot obtain a multi-day dose without permission.

Alternatively, buprenorphine, which has shown to improve both treatment retention and health outcomes among low-income, socially marginalized populations, is inequitably distributed among opioid maintenance treatment patients. New York City has attempted to promote increased access to buprenorphine by encouraging physicians to become certified. Despite these efforts, buprenorphine prescribers are more likely located in high income, predominantly White areas of New York City, while methadone treatment clinics are concentrated in low-income, predominantly Black or Latino areas.

 

 

drug court and COERCIVE treatment

Defendants Screened Who Became Participants in Drug Treatment Court (2009) Source: New York State Unified Court System

After decades of advocacy, the Rockefeller Drug Laws were reformed in 2009. Rockefeller Reform led to the implementation of Article 216 CPL allowing for restructured sentencing guidelines, expansion of judicial discretion for individuals convicted of nonviolent, B,C,D,E class felonies and court-mandated substance abuse treatment.While this was a welcomed policy shift, the implementation of drug law reforms were not seamless. Communication challenges, in conjunction with the criminal justice system’s expanded role as mediator for treatment,  threaten the efficacy of court diversion.

Drug courts have made the criminal justice system more punitive toward addiction – not less. Drug courts have adopted the disease model of addiction but continue to penalize relapse with incarceration and ultimately to eject from the program those who are not able to abstain from drug use for a period of time deemed sufficient by the judge. Participants with drug problems are also disadvantaged by inadequate treatment options. Drug courts typically allow insufficiently trained program staff to make treatment decisions and offer limited availability to quality and culturally appropriate treatment.


Racial Disparities in Drug Treatment

Racial disparities are apparent when evaluating access to treatment programs for opioid dependency in  New York State. Despite the volume of unintentional overdose in New York’s predominately Black and Latino communities, the two groups are underrepresented in treatment programs. While adequate substance misuse treatment is needed, studies show that Blacks are significantly less likely than Whites to complete a treatment episode across all types of substances. Researchers have found that socioeconomic barriers coupled with a dearth of culturally competent, evidenced based treatment facilities in communities of color are factors leading to low rates of program completion. Additionally, treatment modalities are limited in communities of color, leaving individuals dependent on restrictive forms of medication-assisted treatment.

Average Daily Enrollment in NYS OASAS Certified Programs. Percentage by Race (2015) Data Source; NYS OASAS Date Warehouse