How should officials view medication-assisted treatment in drug courts? And how can better drug testing help?

January 23, 2024

Drug courts are often the first step in an individual’s recovery journey. Drug-related convictions regularly include sentencing requirements for sobriety, but not all requirements provide the support necessary to reach full and lasting recovery. In the past, many drug courts have maintained a start-clean-stay-clean policy, but research has demonstrated clear advantages of medication-assisted treatment in drug courts.

Still, drug courts remain divided on the best way to help drug court participants reach recovery with the increasing caseload of drug-related convictions. But with better tools and methodologies, medication-assisted treatment in drug courts is not only possible but overwhelmingly beneficial for its participants.

What Is Medication-Assisted Treatment?

Medication-assisted treatment (MAT) uses both psychosocial and pharmacological support elements to better treat substance use disorders and addiction. While unassisted treatment relies on a “cold turkey” method of simply abstaining from the primary substance of abuse, medication-assisted treatment (MAT) uses a scaffolded support system to reduce recidivism and relapse.

Within this support system, medication-assisted treatment in drug courts can include counseling, observation, support from case managers and court officials, inpatient programs, and medication-assisted detoxification. The support offered within each drug court will differ, and it depends largely on the presiding judge’s discretion.

Counseling for MAT in Drug Courts

One of the most important components of recovery is psychosocial counseling. By providing specific support for mental conditions like addiction and substance use disorders, drug courts can help participants overcome some of the obstacles that contribute to continued addiction cycles.

Social groups, past use patterns, contributing habits, and even geographical associations can lead to relapses in recovery efforts. Counseling and psychosocial support help break these patterns and habits through treatment systems like cognitive behavioral therapy.

Court Officials and Advocates for Improved Outcomes

One of the most significant determining factors for recovery is a good relationship with invested parties within the drug court. Research has shown that drug court participants maintain their recovery efforts better when they have strong relationships with judges, legal advisors, court officials, and case managers involved in their cases. When judges communicate with and advocate for drug court participants, the participants develop better personal motivation for their success.

Accountability Measures

Drug courts require accountability for each participant’s recovery efforts. This accountability comes in many forms, but the most common are drug testing and in-person meetings. These accountability measures coincide with specific compliance requirements for participation in the drug court, and when these requirements are not met, participants could be expelled from the program and incarcerated.

Pharmacological Support

Some drug courts offer MAT plans, although drug court judges are not in complete agreement on these options. These treatment plans involve the use of chemical substances that can aid in both acute detoxification and continued maintenance of sobriety.

For many judges, MAT is considered another form of addiction. Using medications like methadone, buprenorphine, and certain benzodiazepines to assist in detoxification and maintenance may carry additional risks. However, the risks of these medications are often less dangerous than the risks associated with the primary substances of abuse.

What Is Medication-Assisted Detox?

MAT sometimes involves the use of substances to minimize the symptoms of withdrawal during detoxification. Detoxification without medical observation or support is possible, but it does come with risks. This is especially true when detoxifying from illicit substances.

Most medication-assisted detox processes include both psychosocial and pharmacological support elements, helping users detoxify with proper counseling for psychological symptoms as well as reducing the physical effects of withdrawal through the use of medications that help the brain and body adjust more gradually to the absence of the substance of abuse.

The Purpose of Medication-Assisted Detox

Medication-assisted detox is intended to reduce the risks associated with withdrawal symptoms. When substance users begin recovery efforts, they can encounter many severe symptoms. Some of these symptoms can even be life-threatening.

An Acute Treatment for a Chronic Condition

While some may see detoxification as an endpoint, it’s only an early step in the process of recovery. Detoxification is typically less than 30 days, although this timeframe can change according to several different factors:

  • The amount of substances consumed by the individual
  • The severity of the withdrawal symptoms
  • The physical and mental functioning of the individual

For context, medication-assisted alcohol detox lasts from 2 to 8 days on average, while opioid detox can last anywhere from 0 to 120 days, according to one source.

Medication-assisted detox, then, is merely a starting point for many individuals seeking long-term sobriety. Relapses can still occur both during and after detoxification efforts, but the added support can provide a safer route to recovery than unassisted detoxification.

What Is Medication-Assisted Treatment?

MAT plans go beyond detoxification, helping drug court participants maintain sobriety for extended periods. However, when the detoxification process is not successful, medication-assisted treatment in drug courts could be necessary.

In MAT, participants receive drugs like methadone and buprenorphine for extended periods to help reduce the risk of relapse. These maintenance plans must be closely monitored to prevent abuse of the medications. Still, they offer a way to maintain abstinence from illicit substances in participants who struggle with withdrawal symptoms.

When is MAT Necessary?

For short-term use cases, medication-assisted treatment in drug courts may not be necessary. In these cases, withdrawal symptoms may be minimal, and individuals may be able to control cravings for the substance. However, for chronic use cases, detox and treatment efforts often require intervention and support to be safe and successful.

Long-Term Use

Chronic substance use creates a buildup of chemicals in the body that can make detoxification more difficult. Medication-assisted detoxification as part of an MAT plan helps chronic substance users eliminate these chemicals safely.

Uncontrollable Cravings

Certain substances create extreme cravings, making recovery incredibly difficult. Stimulants like methamphetamine and opioids like heroin are well-known for their addictive qualities, and detoxification for these substances requires extra support.

Severe Withdrawal Symptoms

Some drug use can create dangerous, and even deadly, withdrawal symptoms, even with only short-term use. Increased tolerances and heavy use also make withdrawal symptoms more extreme. MAT is typically necessary in these situations to prevent the most dangerous scenarios during detoxification.

What Medications Are Used for Medication-Assisted Treatment and Detox?

Federally licensed treatment centers can offer MAT methods to mitigate withdrawal symptoms. These methods are specific to the substances the individual uses, as each substance has different chemical actions within the body.

Methadone

Methadone has been used for medication-assisted detox since the 1960s, as well as a treatment for heroin dependence. As a fully-activated opioid, methadone comes with the same risks as heroin. The difference is that methadone dosages can be carefully monitored, controlled, and safely tapered.

Naltrexone

Naltrexone blocks the uptake of heroin, eliminating its withdrawal symptoms. But this medication comes with extra risks and side effects, including dysphoria, depression, and insomnia. These effects make it harder to complete detoxification with this medication, so it is only recommended for individuals who are committed to completing the process.

There is also an increased risk of overdose if individuals attempt to overcome the blocking effects with higher doses of an opioid like heroin. Naltrexone can be used for both opioid and alcohol withdrawal assistance, and there is an injectable version (Vivitrol) that lasts longer than the daily-use oral tablets that are typically used.

Buprenorphine

The oral form of buprenorphine, suboxone, has been approved for drug-assisted detoxification since 2002. As a partial activator of the opioid receptor, it comes with fewer risks than methadone. There is also an injectable version, Sublocade, that can offer longer-lasting effects.

In all cases, abstinence from the primary substance is crucial to detoxification and recovery. Both Naltrexone and buprenorphine require 7-10 days of abstinence to begin use, and naltrexone requires sobriety for 70 days for medication-assisted treatment in drug courts and treatment programs.

Why Include Medication-Assisted Treatment in Drug Courts?

Many drug courts rely on sobriety mandates as part of their sentencing structures. Without proper support, however, relapses are common. Even with probation and parole officers for accountability, many individuals will still experience setbacks in their efforts that could result in dangerous consequences.

Drug courts can minimize these risks with the inclusion of MAT. Medication-assisted treatment in drug courts can have lasting impacts on rehabilitation efforts, which will improve the success rates within drug court programs.

Safer for Participants

Medication-assisted treatment, and medication-assisted detox in particular, reduces many of the risks associated with detoxification. Drug court participants experience fewer and less severe withdrawal symptoms, making the detoxification step of recovery safer and paving the way for long-term recovery.

Better Outcomes

Drug courts that include drug-assisted detox have better outcomes for their participants by providing the support necessary to safely detoxify participants and start them on a steady path to full recovery. According to NADCP, the use of medications within MAT programs improves success rates for almost every factor in drug court cases (page 44 of Adult Drug Court Best Practice Standards).

Less Stressful Case Loads

Case managers have seen a sharp increase in caseloads over the last decade, caused in large part by the opioid crisis. Relapses can prolong the recovery process, but offering better support at the start of the recovery journey can make the rest of the journey easier to maintain.

Why PharmChek® with Medication-Assisted Treatment?

A large part of the success of MAT is monitoring both primary substance use and maintenance medication use. PharmChek® offers drug detection to monitor several illicit and prescription substances while allowing more freedom, accountability, and reliability than conventional testing methods, making it an ideal tool for medication-assisted treatment in drug courts.

Reduce Relapse Risks

The PharmChek® Sweat Patch is designed to provide continuous sample collection for up to 10 days at a time, so it’s a perfect tool for providing better accountability in the early stages of MAT. When donors know they’re fully accountable for any substance use, they are less likely to resort to substance use during detoxification and recovery.

Monitoring for Medication-Assisted Detox

Medication-assisted detox in drug courts frequently relies on initial sobriety to be successful. Those first ten days without use are required to start many of the medications used to reduce severe withdrawal symptoms. The 10-day wear time of each PharmChek® Sweat Patch provides clear and dependable proof of abstinence so donors can safely start a detox medication regimen.

Monitoring for Post-Detox Maintenance

When working with chronic use cases or in cases where detoxification is not possible, medication-assisted maintenance may be an option. In these cases, the simple collection system employed by PharmChek® allows donors to remain accountable for longer periods without frequent sample collection appointments. Our panels include methadone and buprenorphine detection, allowing drug courts to monitor long-term recovery efforts beyond the initial detoxification process and well into the MAT plan.

Better Detox and Recovery with PharmChek®

As drug-related court cases continue to increase, drug courts need a solution that gives case managers better solutions for monitoring and support. Alongside psychosocial and pharmacological support, drug testing is a key component of a successful program. But where other drug testing methods fall short, PharmChek® excels.

With continuous monitoring and a tamper-evident design, the PharmChek® Drugs of Abuse Sweat Patch can make medication-assisted treatment in drug courts simpler and more effective without multiplying the workload of case managers. And with more than 30 years of court-supported results, court officials can trust PharmChek® for reliable testing and confirmation that supports both treatment and detoxification efforts.

For more information on how the PharmChek® Sweat Patch provides better outcomes for medication-assisted treatment in drug courts, contact us today.