It’s a disease.
It’s not a disease.
Well, it changes the structure of the brain, just like diabetes changes the structure of the pancreas.
But it’s a choice. ’They chose to use drugs….
Or did they?
According to the National Institute on Drug Abuse and several published studies1, 80 percent of heroin users reported using prescription opioids prior to heroin. 60% of opioid-related deaths occur in patients who have been given prescriptions according to prescribing guidelines by medical and dental boards and 3.5 million adolescents had their first introduction to opioid medications following a third molar extraction.2 11% of high school seniors have used an opioid nonmedically before they graduate.3 Physical dependency then addiction can start before we, as judges, even have an opportunity to intervene making the success of recovery much, much more difficult.
Does it really matter?
What really matters, I submit to you, is the process moving forward. We should all be able to agree that recovery is a process. Treatment requires exploring numerous pathways to recovery. For the judge and treatment team, the trick is finding the pathway to recovery for each individual. Sometimes this means setbacks or violations of the terms of probation, but this is not, to me, a failure. If a method of treating cancer does not work, we do not simply incarcerate or give up on the individual. We shift the treatment approach. To this end, treatment courts have an added benefit: the synergy of monitoring and intervention, vulnerability and investment, mentors and recovery coaches, and a diverse team whose valued education and experience are crucial to the success of the individual. An individual who for whatever reason is suffering from a disease or a situation that in most cases, began innocently – with a prescription from their doctor. So what happens when the disparity of the treatment courts with regard to prescription policy precludes recovery success? When philosophy or principle impugn our ability to see the pathway to recovery? And how is recovery defined anymore anyway?
While some judges order that a participant in treatment court take no medications, others allow medical “expertise” to influence judicial/ treatment decision making. For example, while consulting with a participant in treatment court and the team recently, the participant advised that one of his drugs of choice was Xanax. Ironic then that his drug of abuse is also the drug that his doctor has prescribed for him despite clear disclosure. Does that even make sense? And, what authority do we, the judiciary and/or the treatment team, composed of professionals from every discipline and educated in mental health and substance abuse, many of whom are in long-term recovery themselves, have to override the medical order? As medical professionals, you have been taught to treat the symptoms of reported diagnoses… but have you been taught about substance abuse? About screening, assessment, monitoring, and accountability in recovery? About informed consent?
When do the patient satisfaction surveys, and MACRA reimbursements interfere with your ability to adequately diagnose without the use of behavior therapy? Do we, as educated and invested judges and treatment teams, know more than your MD is willing to learn and invest? The answer, at times, is yes. And that then is when my JD clashes with your MD.
I suggest we get on the same team. Together, we can Be the Change. We can Do Something.
1. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of
prescription opioid pain relievers – the United States, 2002-2004 and 2008-2010. Drug
Alcohol Depend. 2013;132(1-2):95-100.
Lankenau SE, Teti M, Silva K, Jackson Bloom J, Harocopos A, Treese M. Initiation into
prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012;
23(1):37-44.
Muhuri PK, Gfroerer JC, Dvies MC; SAMHSA. Associations of nonmedical pain reliever
use and initiation of heroin use in the United States. CBHSQ Data Review. http://www.
samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.pdf
Published August 2013. Accessed October 8, 2015.
2. Manchikanti L, Helm S 2nd, Fellows B, et al. Opioid epidemic in the United States. Pain
Physician. 2012; 15(3 Suppl):9-38.
Further, Wisdom teeth removal is reportedly inflammatory in nature alone and therefore
should not require an opioid but rather an NSAID, acetaminophen, ibuprofen or something
much less addictive. Despite this, dentists rank number 5 in the country for writing
prescription opioids behind internal medicine, primary care, nurse practitioners, and
orthopedic doctors.
3. https://www.drugabuse.gov/news-events/nida-notes/2017/04/nonmedical-opioidheroin-
use-among-high-school-seniors#.WPPThJE7ttU.gmail. Published April 14, 2017.
Retrieved April 15, 2017.
4. 259 million prescriptions for opioids were written in 2012 (CDC). Despite this, medical
practitioners and students receive little to no education on addiction, substance abuse,
behavioral therapy, mental health, etc. Only recently have some medical and pharmacy
schools added an elective class to their curriculum and continuing medical education
credits have been highly recommended but gaining little traction
Judge Jodi Debbrecht Switalski is a former sobriety, drug and veterans
treatment court judge in Michigan with a background in interpersonal
violence, mental health and substance abuse. She stepped down from
the bench to practice law with Lippitt O’Keefe Gornbein, PLLC and started
her own consulting firm, Switalski Consulting LLC, where she consults
nationally on informed consent and prescription abuse with medical
and dental practitioners. She also speaks nationally with The Stutman
Switalski Group LLC before hundreds of audiences and performs almost
as many consulting engagements on issues surrounding substance
abuse and risk evaluation and mitigation strategies for medical and dental
practitioners. She is married to a treatment court judge, has two children,
three step-children and two grandchildren.
(end Notes)
1. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of
prescription opioid pain relievers – United States, 2002-2004 and 2008-2010. Drug
Alcohol Depend. 2013;132(1-2):95-100.
Lankenau SE, Teti M, Silva K, Jackson Bloom J, Harocopos A, Treese M. Initiation into
prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012;
23(1):37-44.
Muhuri PK, Gfroerer JC, Dvies MC; SAMHSA. Associations of nonmedical pain reliever
use and initiation of heroin use in the United States. CBHSQ Data Review. http://www.
samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.pdf.
Published August 2013. Accessed October 8, 2015.
2. Manchikanti L, Helm S 2nd, Fellows B, et al. Opioid epidemic in the United States. Pain
Physician. 2012; 15(3 Suppl):9-38.
Further, Wisdom teeth removal is reportedly inflammatory in nature alone and therefore
should not require an opioid but rather an NSAID, acetaminophen, ibuprofen or something
much less addictive. Despite this, dentists rank number 5 in the country for writing
prescription opioids behind internal medicine, primary care, nurse practitioners, and
orthopedic doctors.
3. https://www.drugabuse.gov/news-events/nida-notes/2017/04/nonmedical-opioidheroin-
use-among-high-school-seniors#.WPPThJE7ttU.gmail. Published April 14, 2017.
Retrieved April 15, 2017.
4. 259 million prescriptions for opioids were written in 2012 (CDC). Despite this, medical
practitioners and students receive little to no education on addiction, substance abuse,
behavioral therapy, mental health, etc. Only recently have some medical and pharmacy
schools added an elective class to their curriculum and continuing medical education
credits have been highly recommended but gaining little traction.
