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At least if he’s in jail, I know he is safe, I thought, desperately, as I accepted the collect charges from my son. I’m not sure if it was his fourth or fifth incarceration since he’d entered the drug treatment court program—I’ve lost count of the seven to 14 day sentences he has “served” for his disease in the last four months (not to mention the associated fees).
Four months ago (six years into his addiction) my son was arrested on his first felony charge for possessing what amounted to two single doses of heroin for personal use. He was held for seven to 10 days and then seen by a drug court judge who offered to reduce the charges to a misdemeanor if he successfully completed a drug court treatment program.
Naturally, I was ecstatic—Finally! Help! I thought. However, the drug court’s first play at “treatment” was to release my son—a long term, daily heroin user in a chronic state of addiction—to the streets, on his own accord, with instructions to return another day to meet with his probation officer.
My hope crumbled into horror.
What the court failed to consider is that my son struggles with a severe, life threatening disease which hijacks the same parts of his brain that are responsible for motivation and choice—a disease that produces cravings that speak to the same parts of the brain that stimulate him to breathe, or to feel hunger and eat. Who of us, if locked starving in a cage for a week, would not eat the first edible thing we laid eyes on the moment we were released?
It was no startling or unanticipated surprise when he relapsed and missed his probation appointment. Conversely, the most startling occurrence in this sequence of events was that the same court that expects my son to remain abstinent under the threat of a felony conviction, did nothing to assess the severity of his addiction and to provide the treatment it promised.
Within days, my son was apprehended on a warrant for failure to appear, and the near deadly cycle of punitive catch and release began. Rather than sending him to inpatient treatment when he was apprehended for a second and a third time, the drug treatment court, following its standard protocol, repeatedly released my son to the street.
On his third or fourth drug court hearing, after being incarcerated for 10 days for failure to make his probation appointment yet again, the court probation officer inquired of the judge, “Should we roll the dice on this one?”
My son’s life was then reduced to a gamble, and he was placed at an unfair disadvantage to inevitably wind up on the losing end. With a low drug tolerance and a high risk for overdose—brought on by 10 squandered days of detainment with no treatment—my son overdosed on heroin just hours after he was, once again, released from jail.
In the midst of my excitement at a possible solution, and along with the chaotic daily landscape that parents with addicted children often live in, I had obviously neglected to do my homework on drug courts. Within a few short weeks of my son entering drug treatment court, serious questions and concerns arose about this program that my son, with a felony hanging over his head if he fails, is now committed to.
And although it is apparent, as is the case with most forms of treatment, that drug court is very effective for those for whom it works, most of what I’ve discovered about this method of “treatment-meets-punishment” has left me just as anxious about my son’s safety and access to appropriate treatment as I was when he was lost to the streets.
Graduated Sanctions: A Deterrent to Drug Use or a Life-Risking Gamble?
“Flash incarcerations,” or short jail stints such as those sanctioned against my son shortly before he overdosed, are widely used within treatment courts as a method to deter participants from further drug use. The National Association of Drug Court Professionals (NADCP) refers to this practice as “graduated sanctions” and hails it as an “evidence based practice” and one of “10 Key Components” for an effective drug court.
The evidence for the effectiveness of sanctions, as well as drug courts in general, is a hotly debated topic between NADCP and other groups who prefer a health centered approach to the disease of addiction, such as the Drug Policy Alliance and the National Association of Criminal Defense Lawyers. There is limited research on the effectiveness of graduated sanctions within drug courts, and virtually no research on the correlation between overdose and flash incarceration.
No information was found on the overdose risk these sanctions create on either the NADCP website or its sister educational site National Drug Court Institute (NCDI). Also, aside from a link to SAMHSA’s overdose prevention toolkit, I found no mention of overdose prevention assessment or planning within drug courts on the NADCP site.
However, overdose is no stranger to drug treatment courts, even within the courtroom itself. Yet, when a drug court juror overdosed in a Boston courtroom in March, it was a community member, from the community based organization Learn to Cope, who happened to have the naloxone in her purse that saved a life in the courtroom that day.
My son was fortunate to have survived his post-incarceration overdose, unlike others struggling with addiction who have died from overdose shortly after being released from incarceration.
A Lack of Appropriate Treatment Leaves a Family Grieving
On April 2nd, 25-year-old Tasha Riley of Marion, OH overdosed within two weeks of being reassigned from prison to drug treatment court. Riley had written her sister from prison saying, “My judge is wanting to judicial me out in 30 days. He is wanting me to do drug court and I guess that is an 18 month program. I’m better off doing my time and get[ting] out without papers.”
Riley’s mother, Janie Wagers, says her daughter wanted to stay in prison because she knew she was still at risk of relapsing and had not had enough time in a structured environment. Nonetheless, she was enrolled in treatment court and in a period of two weeks, according to her mother, Riley tested positive for drugs twice.
Wagers stated that the drug court took no action to intervene after her daughter tested positive for drugs, such as mandating inpatient treatment or dismissing her from the program and returning her to incarceration. Enrolled for merely two weeks in drug treatment court, and just hours after her 2nd positive drug test, Tasha Riley overdosed on heroin and died, leaving behind three children under the age of eight.
Relapse is a frequently occurring symptom of addiction—and relapse for people addicted to opiates carries a high risk of mortality and morbidity. Even with just a few days of abstinence, an addicted person’s tolerance for opiates is dramatically decreased. Much less of the drug is needed to create the same effects, and resuming drug use at prior levels can flood opiate receptors in the brain’s respiratory center and quickly lead to overdose. It is common knowledge within the drug treatment community that the highest risk of opiate overdose occurs when a person has had a period of abstinence, such as during treatment or incarceration.
The drug court “key component” of graduated sanctions, which shuffles participants in and out of jail, sometimes in a weekly cycle of “catch and release,” can have devastating and deadly consequences from the repeated overdose risk it creates—consequences that Tasha Riley’s three children and the rest of her family and loved ones must now live with on a daily basis.
Why drug treatment courts do not assess and intervene on the overdose risk generated by “flash incarceration” is a perplexing and troubling question—one that deserves to be addressed with the same life and death urgency that this risky practice creates.