Dandridge, Tennessee – Rachel Solomon doesn’t have a good relationship with the judges. Then Judge O. Duane Slone left her “stunned.”
Solomon was 12 years old when a family member gave her her first Percocet with a medicine cabinet full of medication. It made her feel numb, she said. “No injuries.” At 17, she took 80 mg of OxyContin. Ten years later, she was exposed to heroin.
During those years, Solomon got into legal trouble.
Then, five years ago, on the 32nd, she came to Sloan’s courtroom pregnant and fearing the worst. But a state circuit judge sees hope. He ruled that Solomon would serve time in prison for aggravated burglary and then be placed in a drug rehabilitation program for women who are pregnant or parenting. She will retain custody of her son, Brantley, now 4.
Sloan also offered an option that many judges, especially in rural jurisdictions, opposed at the time to be extended: Medication for Opioid Use Disorder, or MOUD.
A study conducted a decade ago found that only half of drug rehab courts offered drug treatment. Those who fail to mention uncertainty about its efficacy and point to political, judicial and administrative opposition. But research over the next few years has convinced many of the most abstinence-only advocates.
According to Monica Christofferson, director of the Therapeutic Courts Program at the Center for Justice Innovation, it’s time for judges, prosecutors, and law enforcement to move away from working with ‘Great shift’ in drug-related stigma. In short, “MOUD works,” asserts Christofferson.
By 2022, more than 90% of drug courts located in communities with high opioid death rates say they will allow the use of buprenorphine and/or methadone, the most commonly used Drugs for the treatment of addiction. The study also found that 65 percent of drug court program staff had training in drug treatment, and a similar proportion had arranged for clients to remain on drug treatment while in prison for program violations. Still, nearly a quarter of projects told researchers they vetoed drug decisions.
Federal legislation lowers the barriers to doing so. The Department of Justice’s assistance funding for courtroom treatment programs now requires medications to treat substance use disorders.
Solomon experienced the transformation in real time in Sloan’s courtroom as the judge allowed her access to medication to treat her opioid addiction.
As a young prosecutor in rural eastern Tennessee in the 1990s, Sloan worked on a drug task force and was well versed in fighting the crisis on the job in the opioid supply. Then, as a circuit court judge, he jailed some of those convicted of drug-related convictions.
As the crisis deepened, he began to wonder if it would be more efficient and effective to address the demand side.
Like many other prosecutors and judges, Sloan believed that abstinence was the only path to recovery. But in 2013, after consulting with substance use disorder experts, he relented and introduced the drug as an alternative to incarceration for pregnant women. By 2016, he had fully embraced the drug in rehab court—though, he said, most judges “still believe it is substituting one drug for another.”
According to Based on evidence-based research, Sloan has initiated projects to show how judges and districts can transform an abstinence-only, abstinence-only approach to one that offers a holistic pathway to recovery.
Earlier Sloan said that after witnessing the effects of drug treatment, he would tell a defendant charged with a drug offense: “This is your second chance. If you violate the conditions of your probation, I will Put you in jail.’”
Typically, they return to his court after six months, charged with low-level crimes and testing positive for drugs. “They’re 19, maybe 20, and I’m serving a five-year sentence. It makes me sick right now.”
Slone is sure there must be a better way.
UP
Subscribe to KFF Health News for a free morning briefing.
He co-founded the Drug Recovery Court in the 4th Judicial District in 2009, a first step. It allows defendants on nonviolent drug-related charges to avoid prison by receiving treatment and counseling. They are closely monitored by a team that includes a judge, case manager, public defender, prosecutor and probation officer. If a participant violates the terms of the agreement, the first step is to reassess treatment needs. Repeated violations may result in imprisonment.
Because this form of drug court is resource intensive, it is able to admit relatively few people. So in 2013, Sloan launched the Tennessee Recovery-Oriented Compliance Strategy (TN-ROCS), an alternative to prison for those who are not considered high-risk for recidivism but are deemed in urgent need of treatment. Many are pregnant women or mothers of young children.
Given the reduced need for supervision, the program can accommodate more participants. To date, more than 1,000 individuals have been listed on the district’s TN-ROCS file.
Both Rehabilitation Court and TN-ROCS offer three drug options: buprenorphine, methadone, and naltrexone.
Sloan said property crime and prison populations in his community have decreased since the introduction of TN-ROCS. In the first five years, all 34 pregnant women who participated in the program gave birth to healthy babies, and 30 of them retained custody of their children. TN-ROCS is now rolling out statewide.
One barrier to wider uptake of drug treatment in rural and urban communities alike is lack of education, Christopherson said.
Corey Williams agrees. He advocated for the education of criminal justice system officials. Williams is a police officer with the Lubbock, Texas Police Department and a consultant to the Law Enforcement Action Partnership, which promotes drug policy and criminal justice reform. He believes that if more criminal justice officials had personal experience using drugs to treat substance use disorders, they would think differently.
Williams’ wife, Brianne Williams, became addicted to opioids while in medical school. She participated in a series of drug rehab programs and spent seven years without drugs before relapsing. She was arrested and placed on probation for prescribing herself opioids.
She was enrolled in a Suboxone treatment program, but her probation officer falsely informed her that she could not continue to take Suboxone while on probation. Williams relapsed, failed a drug test and served 30 months in federal prison. After getting out of prison, she went back on Suboxone (a branded combination of buprenorphine and naloxone) and stayed sober. “It has improved my life tremendously,” she said. She now hopes to regain her license to practice medicine and specialize in addiction treatment.
The relative lack of medication in rural areas is certainly a problem. Kristofferson points out that not only is the shortage a problem in itself, but it is also an obstacle to overcoming stigma. More open jobs, more success stories. More success stories, less stigma. Fewer provider choices also mean that one bad actor — an overprescribing or negligent provider — perpetuates the stigma. Strict supervision is essential.
Dr Stephen Lloyd influenced Sloan’s decision to take medication and is now Sloan in rehab members of the court team. While practicing internal medicine in eastern Tennessee, Loyd developed a dependence on prescription opioids, 100 pills a day. He was the inspiration for the character of Michael Keaton on the Hulu series “Dopesick.” Loyd overcame his addiction and served as the state’s “opioid czar” from 2016 to 2018 under Governor Bill Haslam.
While in state government, Loyd helped plant the seed for TN-ROCS. He told Sloan that the first judge to make such a move would “be on the cover of Time magazine because your success rate is going to skyrocket;”
” He didn’t The cover of Time magazine,” Lloyd admitted, “but he did win the William H. Rehnquist Award.” The William H. Rehnquist Award for Judicial Excellence is one of the highest judicial honors in the country.
Rachel Solomon claims one of the lives saved was hers.
Today, she is with her daughter and son; she has a job. She continues to take Suboxone. She feels fine. She felt lucky when she arrived at Sloan’s court.
“He’s the reason I am today,” she said. “He is.”
