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to this Magazine

All Rise
RESTORING LIVES, REUNITING FAMILIES AND MAKING COMMUNITIES SAFER
Celebrating
of
20 Years
Drug Court
page 8-10
Summer 2009
INSIDE:
An Opening Session Like
No Other! – pg. 5
National Drug Court Month
Highlights – pg. 8-9
Mexico Embraces Drug Courts – pg. 18
For Veterans, Help is on the Way
– pg. 19
Opioid Dependence, the Criminal
Justice System, and BuprenorphineMedication Assisted Therapy – pg. 21
See full contents on page 2 for more.
NADCP Holds Day Long
Celebration on Capitol Hill
The day-long event, made possible by a generous donation from
the Bob Timmins Foundation, began with a press conference in the
U.S. Capitol where the 20th Anniversary milestone was recognized
by Congressmen Allen Mollohan
(D-WV) and Rick Larsen
(D-WA). Congressman Allan
Mollhohan, D-WV, showing his
support for Drug Courts.
See page 8
Table of Contents
4ALLRISE.org Launches to
Tremendous Approval
5 An Opening Session Like No Other!
6 NCDC On The Move
7National Drug Court Institute
Training Updates
8-9 National Drug Court Month
– NADCP Holds Day Long Celebration on Capitol Hill
– 20th Anniversary of Drug Courts Honored in Miami, Florida
10Celebrating 20 Years of Drug Court,
Photo Highlights
11NADCP Board of Directors
Selects New Chair
12NADCP Welcomes Three New
Corporate Members!
16 Hill Corner
17Celebrating 20 Years of Drug Court,
More Photo Highlights
18Mexico Launches Nation’s First
Drug Court
19 For Veterans, Help is on the Way
21Opioid Dependence, the Criminal
Justice System, and BuprenorphineMedication Assisted Therapy
Photo on cover: NADCP
CEO West Huddleston
blows out twenty candles
while Phish frontman
Trey Anastasio looks on.
NADCP Board of Directors
Ron Brooks
San Francisco, CA
Peter Carlisle
Honolulu, HI
Hon. John Creuzot
Dallas, TX
Robert DuPont, MD
Rockville, MD
Hon. Rogelio Flores
Santa Maria, CA
Hon. Richard Gebelein
Wilmington, DE
Hon. Bob Helfrich
Hattiesburg, MS
Scott Henggeler, Ph.D.
Charleston, SC
Earl Hightower
Studio City, CA
Hon. Jamey H. Hueston
Baltimore, MD
Norma Jaeger
Boise, ID
Hon. Kent Lawrence
Athens, GA
Hon. Leonia J. Lloyd
Detroit, MI
Mike Loeffler
Bristow, OK
Attorney General Patrick
Lynch
Providence, RI
Hon. Melanie May (Emeritus)
West Palm Beach, FL
Wanda Moore
Trenton, NJ
Connie Payne
Frankfort, KY
Hon. Louis Presenza (Emeritus)
Philadelphia, PA
Chief Justice William Ray
Price, Jr. (Chair)
Jefferson City, MO
Hon. Robert Rancourt
Center City, MN
About this Publication
Resource Consultants
The contents of this publication are the
property of NADCP and shall not be
reproduced without its written consent.
For more information, please call Rob Foster,
Associate Director of Membership at ext.
33 or Chris Deutsch, Associate Director of
Communication at ext. 12.
Hon. Peggy Hora
Senior Judicial Fellow (510-688-0998)
Gen. Barry R. McCaffrey (ret)
Senior Policy Analyst
Hon. William G. Meyer
Senior Judicial Fellow (303-572-1919)
EDITORS
The National Association of Drug Court
Professionals seeks to reduce substance
abuse, crime and recidivism by promoting
and advocating for the establishment
and funding of Drug Courts and providing
for collection and dissemination of
information, technical assistance, and
mutual support to association members.
Kelly Curtis, Carson Fox,
Chris Deutsch, and Rob Foster
CONTACT US!
4900 Seminary Road, Suite 320
Alexandria, VA 22311
Phone:
703-575-9400
Toll Free: 877-266-1374
Fax:
703-575-9402
2
Hon. Robert Russell
(Emeritus)
Buffalo, NY
Terree Schmidt-Whelan
Tacoma, WA
Hon. John R. Schwartz
(Emeritus)
Rochester, NY
Hon. Chuck Simmons
Greenville, SC
Hon. Keith Starrett
U.S. District Court, MS
Hon. Jeff Tauber (Emeritus)
Berkeley, CA
Lee Webber
Honolulu, HI
Rev. Dr. James White
Washington, DC
All Rise | www.ALLRISE.org
NADCP/NDCI Staff
Percy Brooks
Registrar
Laquetta Butler
Administrative Coordinator
Oriana Casadei
Associate Director of Conferences
Jennifer Columbel
Director, Public Policy
Kelly Curtis
Training Coordinator
Janet Davis
Chief Financial Officer
Chris Deutsch
Associate Director of Communications
Natalie Edwards
Leonora Fleming
Research Coordinator
Robert Foster
Associate Director of Membership
Carson Fox
NADCP Director of Operations
Carolyn Hardin
Director, National Drug Court Institute (NDCI)
West Huddleston
Chief Executive Officer
Linda Jalbert
Public Policy Advisor
Clifford Jacobs
Dana Jenkins
Statewide Program Director
Brie Johnson
Austine Long
Technical Assistance Director
Jennifer Lubold
Meeting Planner
Douglas Marlowe, Ph.D., J.D.
Chief of Science, Law and Policy
Stephanie Speer
Receptionist
Frank Stewart
Special Assistant to the CEO
David Wallace
Director, National Center for
DWI Courts (NCDC)
Meghan M. Wheeler
DCPI Adult Director
“Drug courts perform their
duties without manifestation,
by word or conduct, of
bias or prejudice, including,
but not limited to, bias or
prejudice based upon race,
gender, national origin,
disability, age, sexual
orientation, language or
socioeconomic status.”
The Magazine of the National Association of Drug Court Professionals
3
ALLRISE.org Launches to
Tremendous Approval
That’s right, NADCP is proud to announce our new home on
the web. www.ALLRISE.org launched July 7th to an extremely
grateful field who has longed for a website where they can
easily access all things Drug Court.
Looking for the latest research, headlines, videos & PSA’s,
publications, trainings, or how to take action to help put a
Drug Court within reach of every American in need? Look
no further than www.ALLRISE.org. No matter what your role
is in or out of Drug Court, this site is designed to meet your
needs.
Become a member of NADCP today and take full advantage of our new Members-Only benefits. There’s even an all
new membership category for Drug Court Alumni so please
pass the word on to your Alumni groups.
We designed the new site with both the public and you,
the professional, in mind. As always we love your feedback
and suggestions and welcome any comments on the new site.
Please feel free to write us with any questions or concerns.
To ensure delivery of all NADCP communications, please
add nadcp-info@nadcp.org to your email address book or list
of approved senders!
4
AN OPENING SESSION LIKE NO OTHER!
Actor Tobey Maguire Brings
Attendees to Their Feet!
Tobey Maguire brought down the house at the Opening Session of the NADCP 15th Annual Training Conference! Following a powerful address by ONDCP Director
Gil Kerlikowske, Tobey Maguire, critically acclaimed
star of such films as Spiderman, Cider House Rules, and
Seabiscuit, took the stage.
Maguire, the final speaker of the Opening Session,
congratulated Drug Court professionals, and praised the
work done by Drug Courts, “I am really grateful this exists and that you are out there doing this every day to help
change people’s lives and ultimately change the world.”
“I really am in awe of the work you do. It’s been amazing seeing this because what I see is something that will
hopefully grow. It seems like a real solution. It seems like
the approach of actually trying to help people change their
lives as an effective way to do things for our society and
our world.”
ONDCP Director
Gil Kerlikowske Addresses
Opening Session
Only a few weeks after taking the job as the Director of the Office of National Drug Control Policy, Gil
Kerlikowske traveled to Anaheim to address the Opening
Session of the NADCP 15th Annual Training Conference.
Director Kerlikowske, whose career in law enforcement began as a police officer in St. Petersburg, FL;
then Police Chief of Ft. Pierce and Ft. St. Lucie, FL;
and the City of Buffalo, NY, Police Commissioner; and
most recently included eight years as the Seattle Police
Chief, spoke of the Administration’s commitment to
Drug Courts; “The President, Vice President and all of
us who work for them are firmly committed to providing
strong federal support to increase the capacity for Drug
Courts and other problem solving courts and to treatment
providers. It’s a comprehensive tool for reducing the public
health and public safety threats of drug abuse and as the
police commissioner of Buffalo I witnessed the value of
this approach firsthand.”
“The President’s budget request for Drug Court and
other problem solving courts will establish new courts
and expand treatment services in the existing ones allowing thousands more to break the cycle of drug abuse and
crime.”
The Director finished up his day by visiting Judge
Wendy Lindley’s court in
Orange County.
“This isn’t about being soft on the
problem. It’s about being smart on
the problem.”
“The opening session was extremely moving, reaffirming my
commitment to my work. I have been to the last three NADCP
conferences and the opening sessions keep getting better. The
‘All Rise’ campaign is brilliant and we are ready to jump on
board as best as we can here in Missouri. But what really struck me during the opening session was the speech by Tobey Maguire. He was as real and transparent as one could
have hoped for, simply amazing.”
Michael Princivalli, Coordinator,
Columbia, Missouri, Problem Solving Courts.
5
NCDC on the Move
IN ANAHEIM
It has been a busy and
exciting few months for the
National Center for DWI
Courts. At the 15th Annual
NADCP Training Conference held in Anaheim, California, Beam Global Spirits
& Wine, Inc., and Robby Gordon, NASCAR® driver and
team owner of the No. 7 car were awarded the NADCP
Ambassador Award. Beam Global and Robby Gordon
have partnered with NCDC since 2007 to bring national
attention to the effectiveness of DWI Courts in addressing
hardcore drunk driving.
Also at the NADCP Annual Training Conference one
of the pioneers of DWI Courts, the Honorable J. Michael
Kavanaugh, was presented the DWI Court Leadership
Award. This award is given to those persons that demonstrate significant personal leadership and exemplary
performance in the advancement of DWI Courts either in
a local or regional jurisdiction or beyond at the state and
national level.
Robby Gordon receives Ambassador Award
from the Honorable Kent Lawrence.
AROUND THE COUNTRY
NCDC has been training new courts across the country holding a 3 ½ day training program at the DWI Academy Court in Athens, Georgia, and three 1 day training
programs in Lansing, Michigan, and Kansas City, Kansas,
and Boise, Idaho. Speaking of DWI Court training programs, the applications have gone out for courts that are
interHonorable J. Michael Kavanaugh.
ested
in
becoming a DWI Court for next year’s training! To get a
copy of the application, go to NADCP’s newly redesigned
website and download it at: www.dwicourts.org/resources/training-programs.
ONLINE
With the new NADCP website, there is a whole section devoted to the NCDC and DWI Courts. The site is
designed for the DWI Court practitioner, as well as the
casual web-surfer to provide the answers and material that
is needed by each of these individuals. Someone that goes
to the web site can now:
• Obtain information on training programs held by NCDC
• Understand what DWI Courts are and how they differ
from Drug Courts;
• Download publications from the NCDC, including past
DWI Court Bulletin newsletter editions;
• See who has endorsed DWI Courts;
• Learn about the DWI Court Task Force.
The list can go on and on. To really see what it is all
about go to: www.dwicourts.org. That will take you to the
main page and from there you can explore the NCDC site.
It is an exciting time to be involved in the DWI Court
field, and NCDC looks forward to ensuring that you have
the tools needed to do the work and make our communities a safer place to live.
NADCP Welcomes Opinions
NADCP welcomes the diversity of methods and opinions shared in this newsletter. NADCP does not,
however, endorse any product or service. The publication of items in this newsletter should not be
construed as an endorsement of any product, service, or company by NADCP, nor that NADCP agrees with
the representations contained within all contributed articles.
6
National Drug Court Institute Training Updates
Free Training for Juvenile Courts!
The National Drug Court Institute in collaboration
with the Office of Juvenile Justice and Delinquency
Prevention (OJJDP) and the Center for Substance Abuse
Treatment (CSAT) has the capacity to provide Juvenile
Drug Court MET/CBT 5 Training and Certification to
OJJDP-funded juvenile drug courts and other juvenile drug
courts to implement Brief Intervention and Referral to
Treatment (BIRT) with combined Motivational Enhancement Therapy and Cognitive Behavioral Therapy (MET/
CBT 5) procedures.
This is a five-session treatment composed of two
individual sessions of Motivational Enhancement Therapy
(MET) and three weekly group sessions of CognitiveBehavioral Therapy (CBT). The MET sessions focus on
factors that motivate participants who abuse substances to
change, while in the CBT sessions, participants learn skills
to cope with problems and meet needs in ways that do not
involve turning to marijuana or alcohol.
Topics include, but are not limited to:
Overview of addition treatment for youth
Epidemiology of co-occurring disorders
Prevalence rates for youth
Social psychology of addictions
Developmental psychology
R
eview the theory and rationale for
MET and CBT strategies
• Specific session procedures for MET and CBT
• Certification Procedures
•
•
•
•
•
•
In order to receive the training agencies must agree
to the certification process. For additional information,
please contact Austine Long at along@ndci.org or 1-877507-3229 ext. 30.
This program was developed and presented by the
Office of Juvenile Justice and Delinquency Prevention
(OJJDP), U.S. Department of Justice in collaboration with
the National Drug Court Institute.
The Preeminent Drug Court Training Series
in the Nation has 3 More Trainings in 2009!
Visit NDCI.org for registration forms
for all NDCI trainings
Drug Court Judicial
Training II
October 19-23 ∙ Reno, NV
Drug Court Treatment
Provider Training
November 9-13
Annapolis, MD
Drug Court Community
Supervision Training
November 30-December 4
New Orleans, LA
A comprehensive training for judges
with the assistance of the National
Judicial College and Drug Court judges
from across the country. This innovative training includes:
• r ole specific training, including
advanced substance abuse issues,
• drug testing,
• incentives and sanctions,
• community resources,
• ethics and confidentiality,
• the Drug Court environment,
• judicial styles,
• leadership and the role of the Drug
Court judge.
NDCI has brought together Treatment
Providers working in Drug Courts from
across the United States to develop a
comprehensive training for other Drug
Court Treatment Providers. Treatment
Providers will:
• gain a better understanding of their
role in Drug Courts,
• learn about cultural awareness,
• learn the skills necessary to adequately and effectively treat clients,
• identify behavioral patterns, and
• discuss the most recent findings
pertaining to the administration of
substance abuse treatment.
Probation and Law Enforcement Officers with expertise in the Drug Court
field have developed this comprehensive training for Community Supervision Officers. Attendees will learn how
to:
• integrate case planning,
• work together in a team
environment,
• implement drug testing protocols,
• promote a balanced approach to the
role of the community supervision in
Drug Court, and
• incorporate intervention and
enforcement strategies
7
National Drug Court Month: Twenty Years of…
Restoring Lives, Reuniting Families and
Making Communities Safer
NADCP holds day long celebration
on Capitol Hill
Phish Frontman Trey Anastasio Visits Capitol Hill to
Support Drug Courts and Calls on Congress to Put a
Drug Court Within Reach of Every American in Need
Trey Anastasio, lead singer of
the rock band Phish and proud Drug
Court graduate, visited Capitol Hill
on May 6 to participate in a daylong celebration marking the 20th
Anniversary of Drug Courts and
honoring members of Congress with
the NADCP Congressional Leadership Award for their support of Drug
Courts in the Fiscal Year 2009 appropriations bill.
Trey Anastasio, lead singer of the rock band
Phish
The event, made possible by a
generous donation from the Bob
Timmins Foundation, began with a
press conference in the U.S. Capitol
where the 20th Anniversary milestone was recognized by Congressmen Allen Mollohan (D-WV) and
Rick Larsen (D-WA). Also on hand
was acting-Director of the White
House Office of National Drug
Control Policy Ed Jurith who read a
letter from President Obama praising
Drug Courts.
8
In the afternoon, Trey Anastasio
visited with Senators Richard Durbin
(D-IL) and Ben Nelson (D-NE). Mr.
Anastasio spoke with them about
his experience in Drug Court and
presented them with the NADCP
Congressional Leadership Award.
NADCP CEO West Huddleston
kicked off an evening reception with
a rousing call to action, Members of
Congress looked on: “We are here
today to celebrate the 20th birthday
of Drug Courts: Twenty years of
restoring lives, reuniting families and
protecting public safety,” he said, “It
is my request that you join NADCP
as we all rise and put Drug Courts
within reach of every American in
need.”
“I would like every community
in America to have the option of
sentencing drug offenders to Drug
Court,” said Trey Anastasio, “When
we imprison people for minor drug
offences, we waste money —and we
waste lives. Prison will turn a
person with a substance abuse
problem into a lifetime felon.
Drug Courts can change that
same person into a sober
citizen, someone who takes
responsibility for their actions
and who stands ready to help
others.”
Assistant Attorney General Laurie Robinson spoke
about the administration’s
support of Drug Courts, saying “the President and the Attorney
General are both committed to the
notion that Drug Courts have transformative power.”
Fifteen members of Congress
attended the event and received the
National Association of Drug Court
Professionals Congressional Leadership Award. “For twenty years [Drug
Courts] have provided an extraordinarily effective service to this country,” said Senator Jack Reed (D-RI)
upon receiving his award, “The real
fact is, we don’t have enough [Drug
Courts].”
Congressman John Boozman
(R-AR) echoed many of his colleagues in attendance in expressing
his gratitude to the Drug Court field.
“What this does for me,” he said,
“is redoubles my will to go back and
Continued on page 12.
Representative John Boozman (R - AR)
endorses Drug Courts on Capitol Hill
Judge Chuck Simmons and West Huddleston
meeting with Senator Richard Durbin, D-IL
May 2009
20th Anniversary of Drug Courts Honored in
Miami, Florida
Retired Judge Herbert Klein, one of the
architects of the nation’s first Drug Court,
addresses the crowd.
This year, Drug Courts celebrated
National Drug Court Month with the
theme: Celebrating Twenty Years of
Drug Courts: Restoring Lives, Reuniting Families and Making Communities
Safer. To mark the 20th Anniversary,
NADCP hosted a national press conference at the site of the nation’s first
Drug Court: Miami-Dade, Florida.
The event coincided with National
Drug Court Commencement Day.
General (ret.) Barry McCaffrey,
leadership from the National Association of Drug Court Professionals,
and pioneers from the nation’s first
Drug Court were on hand for the
event which was webcast to Drug
Courts around the state and nation.
The Miami-Dade Courthouse
provided a magnificent backdrop for
the event. Judges in their robes joined
corrections officers in their uniforms
on the stage, emphasizing the collaboration that Drug Courts bring
about.
“We cannot incarcerate our way
out of our nation’s drug problem,”
said former U.S. Drug Czar General (ret.) Barry McCaffrey, adding
“That represents the old way of
doing things. Drug Courts represent
the new way of doing things. Drug
Courts have shown us that when
treatment is combined with accountability and close judicial supervision,
they work. They are our best hope of
breaking the cycle of addiction and
crime. It is without a doubt in the
best interest of our communities, our
nation’s addicted population and their
families, as well as every tax paying
American, to put a Drug Court within
reach of every American in need.
Drug Courts are a solution for us all.”
“I stand before you today on
behalf of the 25,000 dedicated Drug
Court professionals who work day in
and day out in 2,301 Juvenile, Family and Adult Drug Courts located
in every state and twenty countries
worldwide,” said NADCP CEO
West Huddleston. “None of this
would have been possible had the
Miami-Dade County Drug Court not
launched twenty years ago and taught
the rest of the nation and the world
what it means to be a Drug Court.
120,000 drug using offenders each
and every year, as well as millions of
people over the past two decades, owe
a huge debt of gratitude to the founders of this great Miami-Dade Drug
Court.”
Retired Circuit Judge Herbert
Klein and retired Chief Judge Jerry
Wetherington, architects of the
Miami-Dade Drug Court, were on
hand to celebrate the event. “The
Drug Court is an acknowledgment
that treatment works,” said Judge
Klein, “and is a statement by the most
powerful in our society to those in
trouble that we care about you and
want to help.”
David, a 1994 graduate of the
Miami-Dade Drug Court, spoke
eloquently about his Drug Court
experience and sense of service he
Continued on page 10.
Above: Former Miami-Dade
Drug Court Judge Jeffrey
Rosinek with
Gen. Barry McCaffrey and
West Huddleston.
Left: Gen. Barry McCaffrey
speaks.
National Drug Court Month
By The Numbers
600+Total number of Drug Court graduates during the month of May
50Number of states participating in National Drug Court Month by
holding a graduation ceremony
33Number states that held a commencement ceremony on May 15,
National Drug Court Commencement Day.
120Local news stories featuring Drug Courts during the month of May
9
May 2009
“Drug Courts Honored” continued
from page 9.
gained following his graduation.
“Drug Court did more than save my
life and give me a second chance,” he
said, “the lasting and permanent benefit of Drug Court is what I have been
able to build after I graduated- family,
career and self-respect. It provided me
with the foundation to live a drug-free,
recovery-based lifestyle for the past
fifteen years.”
Following the press conference
was a ceremony in the Miami-Dade
County Commission Chambers that
kicked of graduation ceremonies
throughout the state as part of the
10th Annual Statewide Drug Court
Graduation. Around the nation Drug
Courts tuned in to the ceremony via
webcast before holding their own
graduations. In all, Drug Courts in
33 states held a graduation ceremony
during the day.
During the ceremony General
(ret.) Barry McCaffrey spoke to graduates saying “Every successful Drug
Court graduate is living proof that
when we combine sciencebased, effective treatment with the
structure and authority of our justice
system, recovery is possible. Each one
Above: Miami-Dade Drug Court Judge
Deborah White-Labora speaks to the press.
Left: Miami Mayor Manny Diaz.
Below: West Huddleston looks on as
National Drug Court Commencement Day
gets underway.
of you is a testament to the effectiveness of a system that treats people
with compassion while holding them
responsible accountable. And each
one of you is a testament to the fact
that for individuals involved in the
criminal justice system as a result of
addiction, Drug Courts work.”
Conference Draws Big Names to
Celebrate 20 Years of Drug Court
Picture Highlights from Anaheim: Friends of Drug Court show up to Celebrate
Below: Timmins
Foundation Director
Jeff McFarland
Right: Tom Arnold
Above: Tobey Maguire
Right: Denny
Siewell former
drummer for Paul
McCartney and
Wings
Right: ALL RISE PSA
Director Nick Gillie
Below: Tommy Davidson
Above:
Gen. Barry
McCaffrey
Right:
Martin Sheen
Far Right:
Kelleigh
Bannen
10
Simmons
Ends Successful
Tenure as
NADCP
Board Chair
The NADCP 15th Annual Training Conference marked the end of
Judge Charles “Chuck” Simmons’
tenure as the Chairman of the
NADCP Board of Directors. During
Judge Simmons, time as Board Chair,
he led the NADCP Board through
training and restructuring, while
positioning it as a nonprofit with
national presence. During his tenure,
the Board developed and implemented ten internal policies and five
external policies or positions—a
first for NADCP. In his first year as
Chair, Drug Courts received a fifty
percent increase in federal funding,
and in his second year as Chair, Drug
Courts received its largest increase
in federal funding in its twenty year
history—250%! As the Board Chair
Judge Simmons and family with
Tobey Maguire’
of NADCP, Judge Simmons spoke
at dozens of national forums, wrote
editorials, and educated lawmakers
on the efficacy of drug courts and
other problem-solving courts.
“Being the Chair of the Board of
NADCP has been one of the highlights of my professional career. I was
absolutely amazed to see first-hand
all that the staff of NADCP does
Continued on page 12
Missouri Chief Justice Takes the
Reigns of the NADCP
During its bi-annual meeting in
Anaheim, the NADCP Board of
Directors elected Missouri’s longest
serving Supreme Court judge, Justice
William Ray Price, Jr., as the new
Chairman of the NADCP Board.
“I am honored to have been
elected to this important position,”
Chief Justice Price said, “A decade
of research has demonstrated that
Drug Courts are the most effective
and cost-efficient way to fight illegal
drug use, reduce crime and make
significant improvements in the
outcomes of substance abuse treatment. By helping people in trouble
face their problems and turn their
lives around, Drug Courts transform
the lives of more than 120,000 people
each year in this country into drugfree, productive citizens, helping to
break the cycle of addiction.”
On July 1, only weeks after becoming NADCP Board Chair, Justice
Price was appointed Chief Justice
of the Missouri Supreme Court. He
joins only a handful of judges with
the distinction of twice serving as
chief justice of a state supreme court.
A long time champion of Drug
Courts, Chief Justice Price has
worked tirelessly in Missouri and
across the nation towards the implementation and institutionalization of
Drug Courts. He was instrumental
in developing Missouri’s first Drug
Court, and since has helped Missouri
achieve the distinction of having
more Drug Courts per capita than
any other state.
Chief Justice Price has since
pushed for legislation to formalize
the Missouri Drug Court system,
and he founded the Statewide Drug
Court Coordinating Commission.
During his previous term as chief
justice, from July 1999 through June
2001, Justice Price advocated for
continued and increased funding of
the state’s Drug Court program. In
April 2006, the Missouri Association
Chief Justice William Ray Price, Jr.
of Drug Court Professionals honored
Justice Price with its annual Claire
McCaskill Award for his strong advocacy on behalf of Missouri Drug
Courts. Nationally, in addition to
his work on the NADCP Board of
Directors, Chief Justice Price also
serves as Chair of the Conference
of Chief Justices’ Committee on
Problem-Solving Courts.
“It is an honor for the National
Association of Drug Court Professionals to call Chief Justice Price
our board chair,” said NADCP CEO
West Huddleston, “This is a first for
NADCP and an important linkage
to the highest seat of the judicial
branch. His tenure on the Missouri Supreme Court and two terms
as chief justice communicates his
loyalty and commitment to effective
public service. Due to his leadership,
thousands of people have had the
opportunity to transform their lives in
a Missouri Drug Court. Chief Justice
Price understands the critical role
Drug Courts must play within our
justice system, and as our new board
chair he will help bring Drug Courts
within reach of every American in
need.”
11
NADCP Welcomes Three
New Corporate Members!
We are pleased to announce our
latest Silver Corporate Members,
BI Inc. and the California Association of Alcoholism and Drug Abuse
Counselors (CAADAC). We are
also pleased to welcome Any Lab
Test Now as our most recent Bronze
Member.
New Silver Members
Established in 1978, BI Incorporated is the leading technology and
supervision company in community
corrections today. BI has contracts
with more than 1,000 governmental
agencies nationwide, supporting
them with a full continuum of intensive supervision technologies and
community-based counseling, treatment services, and reentry programs
for adult and juvenile offenders. BI’s
national monitoring center, owned
and operated by BI, provides 24/7
expert support supervision services
exclusively for governmental agencies. BI works closely with local
public corrections officials to cost effectively reduce recidivism, promote
public safety, and strengthen the
communities it serves.
The California Association of Alcoholism and Drug Abuse Counselors (CAADAC) is the largest AODA
counseling certification (CCBADC)
organization in California. Since its
origination in 1979, it has conferred
certification upon thousands of counselors who have successfully treated
clients struggling with the disease
of addiction. CAADAC counselors
are recognized for their professional
training and education in the field of
alcoholism and drug abuse and are
considered experts in treatment and
treatment management.
Below: Trey Anastasio speaks with Senator
Richard Durbin, D-IL, about his experience
in Drug Court as his case manager Melanie
Vaughn looks on.
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‘Simmons’ continued from page 11
and to see the impact of NADCP across our great country and, quite literally,
around the world. Without the guiding hands, passion and drive of NADCP,
Drug Courts as we know them simply would not exist,” reflected Judge Simmons.
Simmons, a Circuit Court Judge and Drug Court Judge in Greenville, South
Carolina, has been a leader in the Drug Court field for over ten years. As the
judge presiding over one of South Carolina’s first Drug Courts, Judge Simmons
has worked diligently on the local, state, and national level to increase awareness on the effectiveness of Drug Courts and other problem-solving courts.
As stated by new NADCP Board Chair, Missouri Chief Justice William
Ray Price, “Chuck Simmons led the NADCP Board to a new level of viability
and professionalism. With his warm smile and gentle South Carolinian grace
he has left a mark on the drug court movement that will guide us all for many
years to come. We will count on his continued presence and wisdom as we
carry the message and hope of drug courts forward.”
12
‘Capitol Hill’, continued from page 8.
do all that I can to support you out
in the in the field fighting the battle.
Thank you for your efforts and we do
appreciate you very much.”
The evening ended on a celebratory note, with NADCP CEO West
Huddleston blowing out the twenty
candles and Trey Anastasio serving
cake to eager guests.
Above: West Huddleston presents
Congressman John Barrow, D-GA,
with the NADCP Congressional
Leadership Award
Below: NADCP Board Members from
across the country at the May 6th press
conference.
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Attend the NADCP 16th Annual Training
Conference as an NADCP Member!!
5/26/09 11:52:18 AM
PROUD TO BE NADCP.
Join the
NADCP
We are determined professionals
making a difference.
We are Drug Court.
Together we:
Not only do you take part in spreading and increasing
the most effective justice system in the United States, you
also get:
• Help reduce crime.
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An Individual Membership to NADCP costs only
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15
Hill Corner
Drug Courts could receive $103.8 million next year!
Legislation introduced to serve veterans in Drug Court!
n DWI Courts remain a priority for Congress:
Upcoming reauthorization of the Department of Transportation
n
n
Drug Court Funding
Currently, there is legislation
pending in Congress that would
provide a total of $103.8 million for
Drug Courts in fiscal year 2010, a
$40 million increase over last year!
The House of Representatives and
the Senate are currently finalizing the
spending bills and will send send a
package to the President by October
1st.
We need your help to make this
happen! Your Members of Congress
need to hear from you again and
again! They need to be reminded
how important Drug Courts are to
your community! We need the Senate to support the high numbers we
received in the House! To learn more
or get involved go to: www.nadcp.
org/act
Here is a summary of the spending bills:
House of Representatives:
In June the House of Representatives approved
$45 million for the Drug Court Discretionary Grant Program
at the Department of Justice, a $5 million increase over
last year.
In July the House of Representatives approved $58.8 million for Drug Courts at the Department of Health and Human
Services, a $35 million increase over last year.
Senate:
The Senate has yet to bring their spending bills to the floor
for final passage.
In June the Senate Appropriations Committee
approved $40 million for the Drug Court Discretionary
Grant Program at the Department of Justice.
In July the Senate Appropriations Committee
approved $43.8 million for Drug Courts at the Department of
Health and Human Services, a $20 million increase over last year.
Veterans’ Drug Court Legislation
Introduced
ACT NOW &
GET INVOLVED
In 2008, Sens. John Kerry (D-MA) and Lisa Murkowski (R-AK) introduced the
Services, Education, and Rehabilitation for Veterans (SERV) Act to create veteran
drug treatment courts to support veterans combat the cycle of alcohol or drug
addiction. A companion bill to the SERV Act also was introduced in the House of
Representatives by Representative Patrick Kennedy (D-RI) in 2008. On Monday,
April 27, 2009, Senator Kerry and Representative Kennedy
reintroduced the SERV Act to the 111th Congress.
The SERV Act authorizes $25 million annually to
fund the development and implementation of veterans’
treatment courts or to enhance operational drug courts
to serve veterans. To be eligible for funding the veterans’
treatment court or drug court serving veterans must
effectively integrate substance abuse treatment, mental health treatment, mandatory drug testing, sanctions
and incentives, and transitional services in a judicially
supervised court setting with jurisdiction over nonviolent, substance-abusing offenders that have served in the
United States military.
VISIT WWW.NADCP.ORG/ACT
16
Department of
Transportation and
DWI Courts
NADCP in collaboration with the
Century Council, the National Judicial College, the American Probation
and Parole Association, the National
District Attorney’s Association, the
National Association of Prosecutor
Coordinators, and National Partnership on Alcohol Misuse and Crime
have put forth recommendations to
the Hill on the reauthorization of
the Department of Transportation
(DOT)/National Highway Traffic
Safety Administration (NHTSA)
to strengthen both DWI courts and
training and technical assistance for
prosecutors and judges. NADCP has
been working over the past year with
our partners to strengthen support
for DWI Courts on the Hill and have
been meeting with Members of both
the House and Senate to garner their
support.
Early this year, NADCP in collaboration with the Century Council,
the American Probation and Parole
Association, and the National District
Attorney’s Association, the National
Association of Prosecutors participated in a Congressional briefing
that highlighted the efficacy of DWI
Courts. NADCP Board Member,
Judge Kent Lawrence testified at the
briefing and was accompanied by
a drug court graduate. The briefing
was widely attended and the DWI
Court presentation was extremely well
received.
The House and Senate have begun
working on the reauthorization of
the Department of Transportation.
Currently, the House draft includes
the recommendations but forth by
NADCP. The Senate has not released
a draft. The Administration has asked
to postpone the reauthorization for
18 months. It is unclear at this time
whether or not the reauthorization
will be considered this year. NADCP
will continue to work with our partner
organizations to strengthen DWI
Courts at NHTSA.
Celebrating 20 years of Drug Court
Picture Highlights from Anaheim
Left: Beth Coombs, a Drug
Court graduate from the first
graduating class of Rochester
Drug Court on January 17, 1997,
expresses her gratitude.
Judge Manley receives award from outgoing Board Chair Judge Chuck
Simmons.
Liana Romero (OraSure) laughs as John
Brady of Sherman TX (right) wins the
HDTV Giveaway Sponsored by OraSure.
Below: Florida wins National Drug Court
Month Statewide Contest.
Drug Court Grads and NADCP
CEO West Huddleston Kickoff
the Conference.
17
Mexico Launches Nation’s First Drug Court
Drug Court will make its first
appearance in Mexico when program
leaders in Monterrey, Nuevo Leon,
officially open their doors on September 1, 2009.
This historic event represents the
culmination of efforts by government
officials in Mexico to improve their
criminal justice system by implementing a program which provides
treatment alternatives to incarceration for persons convicted of crimes
while under the influence of drugs
or alcohol, or in furtherance of their
drug or alcohol addiction.
Representatives of the pilot
program, modeled after Drug Courts
in the United States, visited Drug
Courts in San Diego, California and
San Antonio, Texas, and attended
NADCP’s National Training Conference in Anaheim, California. The
National Association of Drug Court
Professionals, in a cooperative effort
with the U.S. State Department and
the Office of National Drug Control
Policy, assigned Judge Rogelio Flores
of Santa Maria, California, and Retired Judge J. Michael Kavanaugh of
Albuquerque, New Mexico, to assist
ONDCP Director Gil Kerlikowske, West Huddleston and members of NDCI’s faculty welcome
a delegation from Mexico to the 15th Annual Training Conference.
18
the delegation on their visits to San
Antonio and Anaheim. Judge Flores
is presently on the NADCP Board of
Directors and Judge Kavanaugh is a
former Board member, and both are
fluent in English and Spanish. The
judges provided technical assistance
in Spanish, explaining the philosophy, theory and structure of Drug
Court programs.
During the national conference,
Mexican team members were guests
at a luncheon meeting hosted by
White House Office of National
Drug Control Policy Director R. Gil
Kerlikowske. Director Kerlikowske
expressed his support for the efforts
being made by the Mexican government to address the issue of drug addiction and abuse within Mexico and
congratulated the delegation as they
proceed to implement a drug court
pilot program.
NADCP has been honored by
the Obama administration with the
responsibility of providing formalized Drug Court training to Mexico’s
team and, based on a needs assessment conducted by NADCP, it was
determined that a facilitated training
program would improve and enhance
the team’s readiness to roll-out their
program by September 1st. NADCP’s CEO, West Huddleston, along
with COO Carson Fox, and Carolyn
Hardin, NDCI Executive Director,
worked diligently to prepare a four
day curriculum designed to provide
the Monterrey team with a training
experience which takes into account
their needs as well as their progress
to date.
For Veterans, Help is on the Way
Support for Veterans Treatment Courts Continues to Grow
In early 2008, after witnessing
increasing numbers of veterans appearing on Buffalo city court dockets,
Judge Robert Russell launched the
nation’s first Veterans’ Treatment
Court to offer specific services to the
men and women of our armed forces
who become involved in the justice
system as a result of a substance
abuse disorder or a combat related
mental illness.
The success of the Buffalo Veterans’ Treatment Court has led to the
creation of eleven other Veterans’
Treatment Courts with dozens more
in the planning stages. “If society
is judged by how it treats its least
fortunate amongst them, how do we
want to be remembered for the treatment of our veterans?” says Judge
Sarah Day Smith, presiding Judge of
the Tulsa Veterans’ Treatment Court
which has been operating since last
December.
Veterans’ Treatment Court is
a hybrid Drug Court and Mental
Health Court that serves veterans
struggling with addiction, serious
mental illness and/or co-occurring
disorders. They promote sobriety,
recovery and stability through a coordinated response that involves cooperation and collaboration with the
traditional partners found in Drug
Courts and Mental Health Courts,
with the addition of the U.S. Department of Veterans Affairs health
(From left) West Huddleston, Jack O’Conner, Rep. Bob Filner, The Honorable Robert Russell,
The Honorable Charles Romani Jr., The Honorable Michael E. McCarthy, Jennifer P. Stergion
care networks, the Veterans’ Benefits
Administration, volunteer veteran
mentors and veterans and veterans’
family support organizations.
Already three states –Illinois,
Nevada and Texas – have passed
legislation calling for the creation of
statewide Veterans’ Treatment Courts
and at least four others have legislation pending. The U.S. Department
of Veterans Affairs has taken steps
to promote collaboration between
regional and local VA offices and the
courts.
The National Association of
Drug Court Professionals is working with national experts and federal
partners to help secure resources for
communities looking to implement
Veterans’ Treatment Courts. As part
of this initiative NADCP is working
with the Bureau of Justice Assistance
to establish a new training program for Veterans’
Treatment Courts and with
the support of the Center
Former NADCP board chair Judge
Chuck Simmons joins Rep. Patrick
Kennedy, Sen. John Kerry and
Judge Bernadette L. Sabra for the
announcement that the SERV
Act has been reintroduced to
Congress.
for Substance Abuse Treatment will
announce a new Mentor Court Network of Veterans’ Treatment Courts
Judge Sarah Smith’s Tulsa Veterans’ Treatment Court launched last December and is
already serving 45 veterans.
NADCP is proud to announce the
launch of the new Veterans’ Treatment Court Clearinghouse, available
at HYPERLINK “http://www.AllRise.
org” www.AllRise.org. Keep up with the
latest Veterans’ Treatment Court News
and be the first to know when funding
becomes available.
19
‘Vete;rans’, continued from page 19
by the end of the year.
Still, Veterans’ Treatment
Courts remain largely volunteer
efforts. In order for more jurisdictions to have the opportunity
to help veterans there must be
support from Congress, which
could soon be on the way. Early
this year the bipartisan HYPERLINK “http://thomas.
loc.gov/cgi-bin/bdquery/
D?d111:1:./temp/%7EbdiPIH::%7C/
bss/111search.html%7C” \o “http://
thomas.loc.gov/cgi-bin/bdquery/
D?d111:1:./temp/~bdiPIH::|/
bss/111search.html|” SERV Act
was introduced in both the House
and Senate. If passed, the SERV Act
would provide funding for communities with existing Drug Courts that
serve veterans or wishing to establish
new Veterans’ Treatment Courts (see
page 14).
Speaking before the House
Committee on Veterans’ Affairs on
September 16th, West Huddleston
told members of Congress that “this
critical legislation is key to providing
resources necessary to expand Veterans’ Treatment Courts throughout the
Buffalo Veterans’ Treatment Court judge
Robert Russell tells Congress that 115 out of
120 veterans have completed the program.
None of the program’s 18 graduates has
been re-arrested.
country.” After a powerful presentation from Huddleston and other leaders in the Veterans’ Treatment Court
movement, the Committee appears to
agree.
“These courts save money, but
more importantly, they save lives,”
said Rep. Bob Filner who chairs the
Committee on Veterans’ Affairs. “As
veterans graduate from these programs, our grateful nation stands behind them and celebrates their bravery
once again.”
Operational Veterans Treatment Courts
20
CITY/COUNTY
STATE
Anchorage
Alaska
Orange County
California
Santa Clara County
California
Colorado Springs
Colorado
Cook County
Illinois
Madison County
Illinois
Buffalo
New York
Rochester
New York
Tulsa
Oklahoma
Olympia
Washington
Rock County
Wisconsin
‘Mexico’ continued from page 16
A five person faculty team from
NADCP delivered a four day training program which was held August
18-21, 2009 in Monterrey. Members
of the faculty included Mike Loeffler,
Deputy District Attorney,
,
Oklahoma; Retired Judge Marie
Baca, Albuquerque, New Mexico;
Dr. Doug Marlowe, NADCP Director of Research; and Judges Flores
and Kavanaugh. The faculty members were unanimous in their praise
for the attendees of the training,
which included the Monterrey team
as well as other officials from Mexico
City, and elsewhere in Mexico.
Pilot program “drug court judge”
Licenciado Herlindo Mendoza Diaz
de Leon, Third Judge of the Oral
Penal Judicial Court, is looking
forward to a new way of approaching
his responsibilities on the bench. “A
judicial system with this new perspective offers an alternative to incarceration and gives the person who has
committed a crime as a result of drug
or alcohol addiction an opportunity
for therapeutic justice and therefore
true and long lasting rehabilitation.”
One of the team’s principal and
most effective leaders, Licenciado
Antonio Estrada Trevino, Director
of Studies and Legislative Matters
of the State Attorney’s Office, says
“Eligible participants will be firsttime offenders facing no more than
8 years in prison, and who have not
committed a serious crime involving
victims and who are addicted.” He
says he is looking forward to this
new, more enlightened approach to
criminal case processing which goes
far beyond the idea of punishment as
a solution to a very difficult problem.
Opioid Dependence, the Criminal Justice
System, and Buprenorphine-Medication
Assisted Therapy
Charles Ruetsch, Ph.D.
Overview
Clinical evidence shows that
opioid dependence (OD) is a chronic
debilitating disorder that can suddenly reoccur. Without proper treatment,
opioid dependent (OD) individuals
may not be able to refrain from illegal
opioid use for an extended period
of time (Wim van den Brink et al.
2006). Opioid dependent individuals
routinely expose themselves to more
risks to their health (medical and
psychiatric), the health of their loved
ones, their employment, and their
well-being compared to non-OD individuals. Also, many OD individuals
commit crimes, and at some point
enter the criminal justice system.
For the chronically addicted
within the criminal justice system,
buprenorphine-medication assisted
therapy has shown itself to be a
highly effective adjunct with other
treatment modalities for the OD population. Buprenorphine is effective in
managing the withdrawal symptoms
from OD and does not lend itself to
the addictive properties of full agonist opioids. Buprenorphine has been
shown to be highly effective in treating OD in a doctor’s office setting,
allowing for widespread adoption.
This paper gives an argument for
increasing the use of buprenorphine
as a treatment option in the criminal
justice system. Furthermore, results
of an economic analysis and clinical
trial of buprenorphine are presented.
Opioid Dependence in the
Criminal Justice System
The National Drug ControlPolicy
reported the cost to society of illicit
drug abuse is $181 billion annually.
In 2007 the National Survey on Drug
Use and Health states approximately
3.8 million Americans aged 12 and
older have reported using heroin at
least once during their lifetime; and
according to the Bureau of Justice
Statistics, 13.1% of State prisoners
and 9.2% of Federal prisoners reported regular use of heroin/opiates at
the time of offense in 2004. However,
most prisoners do not receive any
treatment. The National Criminal
Justice Treatment Practices Survey,
funded by the National Institute on
Drug Abuse, found that only 10%
of OD offenders receive treatment
in correctional facilities (USDHHS,
2007).
Opioid replacement therapy uses
medications to address the physical
symptoms associated with short and
long term detoxification in patients
with chronic opioid dependence,
helping to address the desire to misuse opioid analgesics, and enabling
the patient to engage in psycho-social
counseling. Replacement/maintenance drugs like methadone and
buprenorphine are not heroin/opioid
substitutes. They are prescribed or
administered under monitored, controlled conditions and are safe and
effective for treating OD when used
as directed (NIDA, 2009). Replacement/maintenance treatments help
to stabilize individuals, allowing
treatment of their medical, psychological, and other problems so they
can contribute effectively as members
of families and of society (NIDA,
2009).
The criminal justice system is a
unique intervention point that can be
utilized; and buprenorphine’s effectiveness, availability, and decreased
abuse potential make it a very attractive treatment option. Buprenorphine
is effective in maintaining individuals
in treatment post-release (Magura
et al. 2009). Also, under the Drug
Addiction Treatment Act of 2000,
Buprenorphine can be delivered in
a variety of outpatient based settings to create broad based access for
clients in a comprehensive approach
to criminal justice treatment. Finally
and maybe most importantly, buprenorphine’s unique pharmacologic
profile can potentially reduce concerns related to diversion and misuse
in this very compromised patient
population. Using buprenorphine
in the criminal justice system, could
lead to costs savings in medical costs,
substance/abuse, employment, and
criminal recidivism.
Data
To study the effectiveness of
buprenorphine from the perspective
of both the patient and the treatment
sponsor, Health Analytics conducted
two buprenorphine studies. The first
was an economic analysis examining the number and cost of expensive health services used by patients
diagnosed with opioid-dependent
patients treated with buprenorphine
compared to those who were untreated. The second study was a clinical
trial which examined the clinical and
social impact of buprenorphine in
combination with a support program
known as HereToHelp™.
For the economic analysis, service
utilization and costs were examined
by group: Buprenorphine patients
(n = 2031) vs. Non-Buprenorphine
patients (n = 5093). Patients receiving buprenorphine had lower overall
costs by an average of $12,985 (p <
.001). Patients receiving buprenorphine also had lower inpatient physiContinued on page 22
21
‘Opioid’, continued from page 21
cian costs and emergency department
costs.
The second study, the clinical
trial, consisted of 1426 opioid dependent patients new to buprenorphine.
Subjects included the commercially
insured and Medicaid/Medicare beneficiaries. All subjects were randomized to receive the HereToHelp™
program or the usual standard of
care. The HereToHelp™ program is
a confidential, outbound, telephonic
support program for patients receiving buprenorphine treatment for OD.
As part of the intervention, a “Care
Coach” contacted their patients up
to 8 times during the first 3 months
of treatment and provided encouragement, helped locate appropriate
providers, and facilitated treatment
problem resolution. All study subjects
completed a questionnaire known as
the Addiction Severity Index 5 times
over the course of 6 months. The
questionnaire measured how often
they took their buprenorphine and
the severity of potential treatment
problems in areas commonly affected
by alcohol and drug dependence.
Across all follow-up measurement
points, subjects in the HereToHelp™
group reported taking their Suboxone
(buprenorphine with Naloxone) significantly more often than the group
not receiving the HereToHelp™
program (p’s < .001).
Compliance with buprenorphine
was defined as taking the medication
at least 22 of the previous 28 days.
By month 3, all patients, compliant
and non-compliant, showed improvements in a number of functional
areas including criminality, employment, substance abuse, psychiatric
and family/social relations. Those
who were compliant with medication
showed the greatest improvement,
and these effects were still present
after 6 months (Table below). The
figure below highlights the difference
in drug use at month 6 between compliant and non-compliant patients
(p’s < .01.)
Taken together, these studies
highlight the cost effectiveness and
22
Figure 1
Figure 2
clinical utility of treating OD with
buprenorphine. Patients receiving
buprenorphine used fewer expensive
health care services which resulted
in an overall positive cost-benefit
conclusion. Results of the second
study showed that the HereToHelp™
intervention improved patient treatment outcomes through improving
compliance with buprenorphine.
Medication compliant subjects used
fewer licit and illicit drugs, and also
were less likely to engage in criminal
behavior.
Conclusion
Buprenorphine is effective, has
been shown to be safe and aligns
with treatment goals and outcomes,
reduces concerns for abuse and diversion as a result of its pharmacology;
and is readily accessible. Results of
the two recent studies are evidence
that buprenorphine is not only costeffective, but also promotes a healthier lifestyle. Medication assisted treatment and specifically Buprenorphine
is being grossly underutilized in the
criminal justice system today, and
Continued next page
and the severity of potential treatment problems in areas commonly
affected by alcohol and drug dependence. Across all follow-up
measurement points, subjects in the HereToHelp™ group reported
taking their Suboxone (buprenorphine with Naloxone) significantly
more often than the group not receiving the HereToHelp™ program
(p’s < .001; see Figure below).
if used effectively with chronically
opioid addicted individuals, could
significantly decrease the negative effects and costs that result from opioid
dependent offenders while increasing
the options available to providers and
patients. It is for these reasons that
Buprenorphine should be considered
for chronically opioid dependent
individuals in the criminal justice
system.
Taken together, these studies highlight the cost effectiveness and
clinical utility of treating OD with buprenorphine. Patients receiving
buprenorphine used fewer expensive health care services which
resulted in an overall positive cost-benefit conclusion. Results of the
second study showed that the HereToHelp™ intervention improved
patient treatment outcomes through improving compliance with
buprenorphine. Medication compliant subjects used fewer licit and
illicit drugs, and also were less likely to engage in criminal behavior.
References
1. Office of National Drug Control Policy (2004). The Economic Costs of Drug Abuse in the United States, 19922002. Washington, DC: Executive Office
of the President (Publication No. 207303)
Conclusion
2. Substance Abuse and Mental Health
Services Administration
(SAMHSA)
6, 2007). “New
Buprenorphine
should
be(September
considered
as National
a
primary
Survey Reveals Drug Use Down Among Adolescents in U.S.- Successes in Substance Abuse Recovery Highreplacement/maintenance treatment for opioid dependent individuals
lighted”. Press release. Retrived 2009-8-31. http://www.samhsa.gov/newsroom/advisories/0709043102.aspx
in the criminal justice system. In many cases, Buprenorphine is: more
3. Christopher J. Mumola, Jennifer C. Karberg, United States. Department of Justice: Bureau of Justice Statistics.
effective
successfully
treating
patients than abstinence; has been
Drug Use and Dependence, State and
Federal in
Prisoners,
2004. 2006.
Web. http://www.ojp.usdoj.gov/bjs/
shown to be safe and aligns with treatment goals and outcomes;
pub/pdf/dudsfp04.pdf
reduces
concerns
abuse
as a Abuse
result of its
4. United States. Department of Health
and Human
Services.for
NIDA
Survey and
Showsdiversion
Lack of Substance
Treatment Options for Offenders.pharmacology;
National Institutesand
of Health
News,
Web. http://www.nida.nih.gov/
allows
for2007.
greater
treatment accessibility than
newsroom/07/NR4-02.html.
methadone. Results of the two recent studies are proof that
5. Stephen Magura, Joshua D. Lee, Jason
Hershberger, Herman
Joseph,more
Lisa Marsch,
Carol Shropshire,
Andrew
buprenorphine
is not only
cost-effective
than other
treatments,
Rosenblum, “Buprenorphine and methadone
and post-release:
A randomized
clinical trial.”
but also maintenance
promotes ain jail
healthier
lifestyle.
Buprenorphine
is being
Drug and Alcohol Dependence 99(2009): 222–230. Print.
grossly
underutilized
in
the
criminal
justice
system
today,
and
if used
6. The National Institute on Drug Abuse, United States. Department of Health and Human Services. Principles of
effectively
couldNational
significantly
decrease
negative
effects
and costs
Drug Addiction Treatment: A Research
Based Guide.
Institutes
of Healththe
News,
2009. Web.
<http://
that result from under or mistreatment of opioid dependent offenders.
www.nida.nih.gov/PODAT/faqs3.html#faq19>
Baseline
Overall Sample
Month 3
Non-compliant
Compliant
Month 6
Non-compliant
Compliant
(%)
13.2%
18.6%
16.7%
52.2%
13.9%
6.1%
32.5%
23.5%
9.6%
33.0%
9.6%
(%)
7.0%
7.9%
14.9%
40.7%
20.1%
7.1%
31.6%
17.2%
9.6%
23.9%
7.0%
Item
(%)
Illegal Activities for Profit
20.1%
Bought/Sold Drugs
99.9%
Missed 5 Days of Work
32.7%
Experienced Drug Problems
84.2%
Problems w/ Spouse
27.9%
Problems w/ Friends
16.9%
Prescription Opiate Use
48.1%
Heroin Use
18.4%
Cocaine Use
11.4%
Experienced Depression
31.1%
Compared
Thoughtstoofsubjects
Suicidewho are non-compliant
8.7%with buprenorphine,
(%)
2.9%
2.9%
4.5%
22.5%
7.9%
2.1%
6.9%
2.6%
2.6%
16.7%
1.1%
(%)
2.0%
2.0%
5.1%
18.1%
8.7%
3.0%
6.3%
1.8%
1.9%
17.2%
1.2%
2009 Health Analytics, LLC
Proprietary and Confidential
Do Not Distribute Without Permission
proud To be
NADCP!
23
Reckitt Benckiser
Pharmaceuticals Inc.
maker of
Suboxone
®
B e c a u s e Tr e a t m e n t Tr a n s f o r m s L i v e s
proudly
supports the efforts of
The National Association of
Drug Court Professionals
Please visit us at suboxone.com
or contact us at 1-877-SUBOXONE.
For the treatment of alcohol dependence
VIVITROL...
there when they need it. And now FREE* when they need it.
,†
New patients are eligible to receive
FREE first dose*
6 months of co-pay assistance
for eligible patients, up to $100 per month (a value up to $600) †
Up to 7 months of therapy with
potentially no out-of-pocket costs*,†
For more information, call toll-free
1-800-VIVITROL (1-800-848-4876, ext. 2).
*Eligibility for FREE first dose: Product sample provided at discretion of healthcare provider. Eligible patients are
those starting VIVITROL therapy. Limit one free dose per patient. Alkermes, Inc. reserves the right to rescind,
revoke or amend these offers without notice.
†
Eligibility for co-pay assistance: Offer not valid for prescriptions purchased under Medicaid, Medicare, or any federal
or state healthcare programs, including any state medical or pharmaceutical assistance program. Offer not valid in
Massachusetts. Void where prohibited by law, taxed or restricted. Alkermes, Inc. reserves the right to rescind, revoke
or amend these offers without notice.
indicaTion
1
VIVITROL® is indicated for the treatment of alcohol dependence in patients who are able to abstain
from alcohol in an outpatient setting prior to initiation of treatment with VIVITROL.
Patients should not be actively drinking at the time of initial VIVITROL administration.
Treatment with VIVITROL should be part of a comprehensive management program that includes
psychosocial support.
imPorTanT safeTy informaTion for ViViTrol1
VIVITROL is contraindicated in patients receiving opioid analgesics or with current physiologic
opioid dependence, patients in acute opiate withdrawal, any individual who has failed the naloxone
challenge test or has a positive urine screen for opioids, or in patients who have previously exhibited
hypersensitivity to naltrexone, PLG, carboxymethylcellulose or any other components of the diluent.
VIVITROL patients must be opioid free for a minimum of 7-10 days before treatment. Attempts to
overcome opioid blockade due to VIVITROL may result in a fatal overdose. In prior opioid users,
use of opioids after discontinuing VIVITROL may result in a fatal overdose because patients may be
more sensitive to lower doses of opioids. Patients requiring reversal of the VIVITROL blockade for
pain management should be monitored by appropriately trained personnel in a setting equipped for
cardiopulmonary resuscitation.
Please see brief summary of ViViTrol Prescribing informaTion,
including boxed warning, on The nexT Page.
Naltrexone has the capacity to cause hepatocellular injury when given in excessive doses.
Naltrexone is contraindicated in acute hepatitis or liver failure, and its use in patients with active liver
disease must be carefully considered in light of its hepatotoxic effects.
The margin of separation between the apparently safe dose of naltrexone and the dose causing
hepatic injury appears to be only five-fold or less. VIVITROL does not appear to be a hepatotoxin at the
recommended doses.
Patients should be warned of the risk of hepatic injury and advised to seek medical attention if they
experience symptoms of acute hepatitis. Use of VIVITROL should be discontinued in the event of symptoms
and/or signs of acute hepatitis.
VIVITROL is administered as a gluteal intramuscular injection. Inadvertent subcutaneous injection of
VIVITROL may increase the likelihood of severe injection site reactions. VIVITROL must be injected using
the customized needle provided in the carton. Because needle length may not be adequate due to body
habitus, each patient should be assessed prior to each injection to assure that needle length is adequate
for intramuscular administration. VIVITROL injection site reactions may be followed by pain, tenderness,
induration, swelling, erythema, bruising or pruritus; however, in some cases injection site reactions may be
very severe. Injection site reactions not improving may require prompt medical attention, including in some
cases surgical intervention.
Consider the diagnosis of eosinophilic pneumonia if patients develop progressive dyspnea and hypoxemia.
In an emergency situation in patients receiving VIVITROL, suggestions for pain management include regional
analgesia or use of non-opioid analgesics. Alcohol dependent patients, including those taking VIVITROL,
should be monitored for the development of depression or suicidal thoughts. Caution is recommended in
administering VIVITROL to patients with moderate to severe renal impairment.
The most common adverse events associated with VIVITROL in clinical trials were nausea, vomiting,
headache, dizziness, asthenic conditions and injection site reactions.
1. VIVITROL [full prescribing information]. Cambridge, MA: Alkermes, Inc; May 2009.
VIVITROL is a registered trademark of Alkermes, Inc.
©2009 Alkermes, Inc.
All rights reserved VIV 889C August 2009 Printed in U.S.A.
www.vivitrol.com
3788 TP NADCP_single_L1.indd 1
7/31/09 2:47:24 PM
BRIEF SUMMARY See package insert for full Prescribing Information.
INDICATIONS AND USAGE: VIVITROL is indicated for the treatment of alcohol dependence
in patients who are able to abstain from alcohol in an outpatient setting prior to initiation
of treatment with VIVITROL. Patients should not be actively drinking at the time of initial
VIVITROL administration. Treatment with VIVITROL should be part of a comprehensive
management program that includes psychosocial support. CONTRAINDICATIONS: VIVITROL is
contraindicated in: • Patients receiving opioid analgesics (see PRECAUTIONS). • Patients with
current physiologic opioid dependence (see WARNINGS). • Patients in acute opiate withdrawal
(see WARNINGS). • Any individual who has failed the naloxone challenge test or has a positive
urine screen for opioids. • Patients who have previously exhibited hypersensitivity to naltrexone,
PLG, carboxymethylcellulose, or any other components of the diluent.
WARNINGS: Hepatotoxicity
Naltrexone has the capacity to cause hepatocellular injury when given in excessive doses.
Naltrexone is contraindicated in acute hepatitis or liver failure, and its use in patients with active
liver disease must be carefully considered in light of its hepatotoxic effects.
The margin of separation between the apparently safe dose of naltrexone and the dose causing
hepatic injury appears to be only five-fold or less. VIVITROL does not appear to be a hepatotoxin at
the recommended doses.
Patients should be warned of the risk of hepatic injury and advised to seek medical attention if
they experience symptoms of acute hepatitis. Use of VIVITROL should be discontinued in the event
of symptoms and/or signs of acute hepatitis.
Eosinophilic pneumonia In clinical trials with VIVITROL, there was one diagnosed case and one
suspected case of eosinophilic pneumonia. Both cases required hospitalization, and resolved after
treatment with antibiotics and corticosteroids. Should a person receiving VIVITROL develop
progressive dyspnea and hypoxemia, the diagnosis of eosinophilic pneumonia should be
considered (see ADVERSE REACTIONS). Patients should be warned of the risk of eosinophilic
pneumonia, and advised to seek medical attention should they develop symptoms of pneumonia.
Clinicians should consider the possibility of eosinophilic pneumonia in patients who do not respond
to antibiotics. Unintended Precipitation of Opioid Withdrawal—To prevent occurrence of an
acute abstinence syndrome (withdrawal) in patients dependent on opioids, or exacerbation
of a pre-existing subclinical abstinence syndrome, patients must be opioid-free for a
minimum of 7-10 days before starting VIVITROL treatment. Since the absence of an opioid
drug in the urine is often not sufficient proof that a patient is opioid-free, a naloxone
challenge test should be employed if the prescribing physician feels there is a risk of
precipitating a withdrawal reaction following administration of VIVITROL. Opioid Overdose
Following an Attempt to Overcome Opiate Blockade VIVITROL is not indicated for the purpose
of opioid blockade or the treatment of opiate dependence. Although VIVITROL is a potent antagonist
with a prolonged pharmacological effect, the blockade produced by VIVITROL is surmountable. This
poses a potential risk to individuals who attempt, on their own, to overcome the blockade by
administering large amounts of exogenous opioids. Indeed, any attempt by a patient to overcome
the antagonism by taking opioids is very dangerous and may lead to fatal overdose. Injury may
arise because the plasma concentration of exogenous opioids attained immediately following their
acute administration may be sufficient to overcome the competitive receptor blockade. As a
consequence, the patient may be in immediate danger of suffering life-endangering opioid
intoxication (e.g., respiratory arrest, circulatory collapse). Patients should be told of the serious
consequences of trying to overcome the opioid blockade (see INFORMATION FOR PATIENTS).There
is also the possibility that a patient who had been treated with VIVITROL will respond to lower doses
of opioids than previously used. This could result in potentially life-threatening opioid intoxication
(respiratory compromise or arrest, circulatory collapse, etc.). Patients should be aware that they
may be more sensitive to lower doses of opioids after VIVITROL treatment is discontinued (see
INFORMATION FOR PATIENTS). PRECAUTIONS: General—When Reversal of VIVITROL Blockade
is Required for Pain Management In an emergency situation in patients receiving VIVITROL,
suggestions for pain management include regional analgesia or use of non-opioid analgesics. If
opioid therapy is required as part of anesthesia or analgesia, patients should be continuously
monitored in an anesthesia care setting, by a person not involved in the conduct of the surgical or
diagnostic procedure. The opioid therapy must be provided by an individual specifically trained in
the use of anesthetic drugs and the management of the respiratory effects of potent opioids,
specifically the establishment and maintenance of a patent airway and assisted ventilator.
Depression and Suicidality In controlled clinical trials of VIVITROL, adverse events of a suicidal
nature (suicidal ideation, suicide attempts, completed suicides) were infrequent overall, but were
more common in patients treated with VIVITROL than in patients treated with placebo (1% vs. 0).
In some cases, the suicidal thoughts or behavior occurred after study discontinuation, but were in
the context of an episode of depression which began while the patient was on study drug. Two
completed suicides occurred, both involving patients treated with VIVITROL. Depression-related
events associated with premature discontinuation of study drug were also more common in
patients treated with VIVITROL (~1%) than in placebo-treated patients (0). In the 24-week,
placebo-controlled pivotal trial, adverse events involving depressed mood were reported by 10%
of patients treated with VIVITROL 380 mg, as compared to 5% of patients treated with placebo
injections. Alcohol dependent patients, including those taking VIVITROL, should be monitored for
the development of depression or suicidal thinking. Families and caregivers of patients being
treated with VIVITROL should be alerted to the need to monitor patients for the emergence of
symptoms of depression or suicidality, and to report such symptoms to the patient’s healthcare
provider. Injection Site Reactions VIVITROL injections may be followed by pain, tenderness,
induration, swelling, erythema, bruising or pruritus; however in some cases injection site reactions
may be very severe. In the clinical trials, one patient developed an area of induration that continued
to enlarge after 4 weeks with subsequent development of necrotic tissue that required surgical
excision. In the postmarketing period, additional cases of injection site reaction with features
including induration, cellulitis, hematoma, abscess, sterile abscess and necrosis have been
reported. Some cases required surgical intervention. VIVITROL is administered as a gluteal
intramuscular injection. An inadvertent subcutaneous injection of VIVITROL may increase likelihood
of severe injection site reactions. VIVITROL must be injected by the customized needle provided in
the carton. Alternate treatment should be considered for those patients whose body habitus
precludes a gluteal intramuscular injection with the provided needle. Patients should be informed
that any injection site reactions should be brought to the attention of the healthcare provider (see
INFORMATION FOR PATIENTS). Patients exhibiting signs of abscess, cellulitis, necrosis or extensive
swelling should be evaluated by a physician. Renal Impairment VIVITROL pharmacokinetics have
not been evaluated in subjects with moderate and severe renal insufficiency. Because naltrexone
and its primary metabolite are excreted primarily in the urine, caution is recommended in
administering VIVITROL to patients with moderate to severe renal impairment. Alcohol Withdrawal
Use of VIVITROL does not eliminate nor diminish alcohol withdrawal symptoms. Intramuscular
injections As with any intramuscular injection, VIVITROL should be administered with caution to
patients with thrombocytopenia or any coagulation disorder (e.g., hemophilia and severe hepatic
failure). Information for Patients Physicians are advised to consult Full Prescribing Information for
information to be discussed with patients for whom they have prescribed VIVITROL. Drug
Interactions Patients taking VIVITROL may not benefit from opioid-containing medicines
(see PRECAUTIONS, Pain Management). Because naltrexone is not a substrate for CYP drug
metabolizing enzymes, inducers or inhibitors of these enzymes are unlikely to change the
clearance of VIVITROL. No clinical drug interaction studies have been performed with VIVITROL to
evaluate drug interactions, therefore prescribers should weigh the risks and benefits of
concomitant drug use. The safety profile of patients treated with VIVITROL concomitantly with
antidepressants was similar to that of patients taking VIVITROL without antidepressants.
Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies have not been
conducted with VIVITROL. Carcinogenicity studies of oral naltrexone hydrochloride (administered
via the diet) have been conducted in rats and mice. In rats, there were small increases in the
numbers of testicular mesotheliomas in males and tumors of vascular origin in males and females.
The clinical significance of these findings is not known. Naltrexone was negative in the following
in vitro genotoxicity studies: bacterial reverse mutation assay (Ames test), the heritable
translocation assay, CHO cell sister chromatid exchange assay, and the mouse lymphoma gene
mutation assay. Naltrexone was also negative in an in vivo mouse micronucleus assay. In contrast,
naltrexone tested positive in the following assays: Drosophila recessive lethal frequency assay,
non-specific DNA damage in repair tests with E. coli and WI-38 cells, and urinalysis for methylated
histidine residues. Naltrexone given orally caused a significant increase in pseudopregnancy and
a decrease in pregnancy rates in rats at 100 mg/kg/day (600 mg/m2/day). There was no effect on
male fertility at this dose level. The relevance of these observations to human fertility is not known.
Pregnancy Category C Reproduction and developmental studies have not been conducted for
VIVITROL. Studies with naltrexone administered via the oral route have been conducted in pregnant
rats and rabbits. Teratogenic Effects Oral naltrexone has been shown to increase the incidence
of early fetal loss in rats administered ≥30 mg/kg/day (180 mg/m2/day) and rabbits administered
≥60 mg/kg/day (720 mg/m2/day). There are no adequate and well-controlled studies of either
naltrexone or VIVITROL in pregnant women. VIVITROL should be used during pregnancy only if the
potential benefit justifies the potential risk to the fetus. Labor and Delivery The potential effect of
VIVITROL on duration of labor and delivery in humans is unknown. Nursing Mothers Transfer of
naltrexone and 6β-naltrexol into human milk has been reported with oral naltrexone. Because of
the potential for tumorigenicity shown for naltrexone in animal studies, and because of the
potential for serious adverse reactions in nursing infants from VIVITROL, a decision should be made
whether to discontinue nursing or to discontinue the drug, taking into account the importance of
the drug to the mother. Pediatric Use The safety and efficacy of VIVITROL have not been
established in the pediatric population. Geriatric Use In trials of alcohol dependent subjects, 2.6%
(n=26) of subjects were >65 years of age, and one patient was >75 years of age. Clinical studies
of VIVITROL did not include sufficient numbers of subjects age 65 and over to determine whether
they respond differently from younger subjects. ADVERSE REACTIONS: In all controlled and
uncontrolled trials during the premarketing development of VIVITROL, more than 900 patients with
alcohol and/or opioid dependence have been treated with VIVITROL. Approximately 400 patients
have been treated for 6 months or more, and 230 for 1 year or longer. Adverse Events Leading
to Discontinuation of Treatment In controlled trials of 6 months or less, 9% of patients treated
with VIVITROL discontinued treatment due to an adverse event, as compared to 7% of the patients
treated with placebo. Adverse events in the VIVITROL 380-mg group that led to more dropouts were
injection site reactions (3%), nausea (2%), pregnancy (1%), headache (1%), and suicide-related
events (0.3%). In the placebo group, 1% of patients withdrew due to injection site reactions, and
0% of patients withdrew due to the other adverse events. Common Adverse Events The most
common adverse events associated with VIVITROL in clinical trials were nausea, vomiting, headache,
dizziness, fatigue, and injection site reactions. For a complete list of adverse events, please refer to
the VIVITROL package insert for full Prescribing Information. A majority of patients treated with
VIVITROL in clinical studies had adverse events with a maximum intensity of “mild” or “moderate.”
Post-marketing Reports—Reports From Other Intramuscular Drug Products Containing
Polylactide-co-glycolide (PLG) Microspheres – Not With VIVITROL. Retinal Artery
Occlusion Retinal artery occlusion after injection with another drug product containing
polylactide-co-glycolide (PLG) microspheres has been reported very rarely during postmarketing surveillance. This event has been reported in the presence of abnormal
arteriovenous anastomosis. No cases of retinal artery occlusion have been reported during
VIVITROL clinical trials or post-marketing surveillance. VIVITROL should be administered
by intramuscular (IM) injection into the gluteal muscle, and care must be taken to avoid
inadvertent injection into a blood vessel (see DOSAGE AND ADMINISTRATION).
OVERDOSAGE: There is limited experience with overdose of VIVITROL. Single doses up to 784 mg
were administered to 5 healthy subjects. There were no serious or severe adverse events. The most
common effects were injection site reactions, nausea, abdominal pain, somnolence, and dizziness.
There were no significant increases in hepatic enzymes. In the event of an overdose, appropriate
supportive treatment should be initiated. This brief summary is based on VIVITROL Prescribing
Information (VIV 566C May 2009).
Alkermes® and VIVITROL® are registered trademarks of Alkermes, Inc.
Manufactured and marketed by Alkermes, Inc.
©2009 Alkermes, Inc. VIV 107B August 2009 Printed in U.S.A. All rights reserved.
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