The Massachusetts trial court has agreed to stop ordering and pressuring its drug court defendants to take specific medication for opioid use disorder, and will instead let the medical decisions to licensed prescribers and treatment programs.
The office of Massachusetts U.S. Attorney Rachael Rollins received a complaint that drug courts violated the Americans with Disabilities Act by discriminating against people with opioid use disorder, a disability recognized by federal law. The complaint alleged that staff forced drug court participants to stop taking other prescribed medications in favor of naltrexone, known under the brand name Vivitrol, without individual medical evaluation to determine if it would be the best treatment option. . Rollins’ office and the court reached an agreement on the allegations Thursday.
Drug courts provide alternatives to incarceration, including compulsory treatment, for people charged with non-violent drug-related crimes. Massachusetts’ first drug court opened in 1994.
“Judges are experts, but they are not doctors,” Rollins told GBH News. “Essentially what would happen is that when you were in drug court, there would be staff who are not medical professionals or licensed providers, who would encourage individuals or compel individuals exclusively to [take] Vivitrol, as opposed to the three different types of FDA-approved drugs prescribed by licensed medical providers to help opioid use disorders.
Dr. Andrew Kolodny, medical director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School for Social Policy and Management, said it’s common in the United States for drug court staff and judges develop specific treatment plans, including medications to be taken. .
“Even though, of course, they weren’t licensed or they didn’t go to medical school, but they were prescribing treatment,” Kolodny said. “And maybe it would have been less of a concern if they were prescribing the right treatment, but they weren’t.”
Vivitrol, which is made by Waltham-based Alkermes, blocks the effects of opioids with an injection once a month. Other FDA-approved medications for opioid use disorder are buprenorphine and methadone. Both of these drugs are taken by mouth, daily or sometimes twice daily, and work by delivering controlled doses of long-acting opioids that do not create a high.
Kolodny said the evidence for the efficacy and safety of buprenorphine and methadone is much stronger than for Vivitrol, but those first two drugs are stigmatized.
“Sometimes they are mistakenly seen as mere substitutes for one drug for another, not really being a treatment,” Kolodny said, “whereas this monthly injection was certainly more appealing to criminal justice personnel; and the pharmaceutical company that makes Vivitrol aggressively marketed it within the criminal justice system and heightened the bias against the use of buprenorphine and methadone as treatment.
Kolodny also said that buprenorphine in particular is considered the first-line treatment for opioid use disorder. It can be picked up at a pharmacy, and it is considered safer and has fewer side effects than methadone, which is dispensed in clinics.
“The evidence supporting the effectiveness of Vivitrol is much weaker,” Kolodny said, “and there is evidence that in patients with severe opioid use disorder, exposure to naltrexone [the active ingredient of Vivitrol] could potentially increase the risk of death.
In a statement, a spokesperson for Alkermes said the company believes people living with opioid use disorder should have access to all FDA-approved medications because “no medication is suitable to everybody”. The release also says the company believes medications should be decided in conjunction with a health care provider.
The settlement between the state’s trial court system and Rollins’ office clarifies that while the courts will not admit violating the ADA by discriminating against people with opioid use disorders, the Drug courts will implement a new policy within 30 days that includes banning drug court staff. interfere with treatment plans, assessments or medications decided by an approved prescriber or treatment program.
Rollins emphasized that there was no “ill intent” on the part of Massachusetts drug court staff and that she was personally aware of the system’s many successes.
“I’ve attended so many drug court graduations as a district attorney — and quite frankly, as a sibling or loved one of someone who was also battling drug use disorder. opioids,” she said.
Rollins said she believes Massachusetts drug courts can now be the “gold standard” for how drug courts should operate across the country.