Editorial: Courts and doctors must cooperate on addiction
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The opioid epidemic is not like influenza or covid-19.
It is a medical issue that affects the body and threatens lives. It also is a social problem that ends up in court either because of crimes or because of issues such as custody.
It is rare that a case of the flu would end up in a courtroom. In a meningitis outbreak, a judge is unlikely to overrule a doctor on a course of treatment.
Opioids, however, can bring the legal and medical spheres into conflict.
That happened this month when the U.S. Department of Justice sent a letter to the Administrative Office of Pennsylvania Courts explaining that policies in at least two counties — Jefferson and Northumberland — violated federal law by telling people to stop taking life-saving addiction medications. The policies violate the federal Americans with Disabilities Act, according to the Justice Department.
The letter notes that the Allegheny County Court of Common Pleas Mental Health Court requires court approval for these types of medications and that approval is rare.
Opioid Use Disorder is the name for a federally recognized condition for people physically and psychologically dependent on opioids including prescription painkillers and street drugs such as heroin or fentanyl. OUD has a variety of treatments that might include prescriptions for things including buprenorphine, methadone or naltrexone that can counter the cravings for opioids. In fact, the federal Substance Abuse and Mental Health Services Administration helps connect people with information about these treatments.
“Medications used for (medication-assisted treatment) are evidence-based treatment options and do not just substitute one drug for another,” the SAMHSA website says.
That means limiting access to the treatment is standing between a person with a mental health diagnosis and physician-directed treatment. That’s a problem.
But before doctors get on their high horses about interference, they have to remember that overprescription of opioids is part of the reason we are deep into an opioid epidemic that has been decades in the making.
This is just the most recent example of the ongoing conflict in how to treat the opioid-addicted individuals who come into court. Their addiction should be treated as a disease, and to do that, a doctor’s recommendations can’t be subject to court overrule. But the actions that bring them to court can’t be dismissed because of a diagnosis, either.
Instead, courts and doctors have to find a way to work together to bring about the best resolution for the addicted individual, the affected family and friends, and the victims who are frequently overlapping circles and the community at large.