Judges Behaving Badly

aaaaaaaaaaaaStepping Stone memo from Judge Ginn (2)

 

Methadone and buprenorphine treatment for opioid use disorders saves lives. Over five decades, we’ve accumulated more studies to support this treatment than any other medication, device, or intervention that I can think of. And yet, opioid use disorder appears to be the only disease where medically untrained people dictate medical treatment. The above memo from a judge of the 24th District Court in North Carolina illustrates this all too well.

Let’s change that sentence in the middle of Judge Ginn’s memo: “Therefore, effective immediately, the use of insulin as a treatment for diabetes will no longer be allowed as a part of any probationary sentence in the 24th Judicial District.”

It wouldn’t make any sense, would it? People would wonder why a judge was involved in a patient’s medical care. They might even be tempted to believe a judge had no authority to dictate medical care.

I worked in Boone, North Carolina, when this memo was issued, and it caused a great deal of suffering for patients. These patients, contrary to the judge’s beliefs, were doing well on medication-assisted treatments. They were no longer injecting drugs or committing crimes to support their active addiction. Their involvement with criminal justice system almost always pre-dated their entry into treatment. Yet the judge proclaimed they must stop the very medications that were helping them become productive members of society again!

I wrote letters of advocacy and information, citing studies that support MAT. I encouraged patients, and told them to expect their lawyer to advocate for them on this issue. The patients said their lawyers often advised them just to do what would make the judge happy. Patients, understandably, were timid about pushing against a judge with so much power over their lives.

Ironically, many of the people Judge Ginn thought were doing well in his court were also our patients. It was widely known that probation officers’ drug tests didn’t detect methadone or buprenorphine at that time. Unless the offender told the truth about being in treatment on buprenorphine or methadone, the court never knew. I’d estimate that dozens of people successfully passed through Judge Ginn’s court while being treated with buprenorphine or methadone, without him ever knowing about it, due to inadequate drug testing. The people who told the truth were penalized by being told to quit life-saving medication.

I know Judge Ginn is now retired, but I suspect attitudes and beliefs of the judiciary in that area haven’t changed much.

One of the opioid treatment programs in the area tried to advocate for their patients, by seeking some sort of censure against Judge Ginn, but I don’t know what came from that.

The National Institute on Drug Abuse (NIDA) and Substance Abuse and Mental Health Services Administration (SAMHSA) both strongly recommend expanding opioid addiction treatment with medications to criminal justice participants. Congress just passed a bill that recommends spending money to treat opioid addiction in jails and prisons That bill pushes for people with opioid use disorder to get treatment instead of jail sentences. Experts everywhere advocate for expanding medication-assisted treatments to patients involved with the legal system, whether in jail, on parole, or on probation.

All of these actions are great. But Judge Ginn is an example of the many obstacles to implementation of the evidence-based treatments that experts recommend. Particularly in rural Appalachian areas, people in positions of power actively thwart life-saving medical treatments.

I don’t understand how judges can get away with such irresponsible actions. To me, it appears Judge Ginn practiced medicine without a license. If I somehow lost my medical license but continued to practice, I’d be committing a felony.

What if Judge Ginn commanded a patient stop buprenorphine or methadone, and the patient died in a relapse? Would Judge Ginn have any liability, civil or criminal?

I don’t know what can be done about judges like him, but don’t they have to answer to someone? Are they appointed, or elected? If elected, perhaps we need to start understanding judges’ positions on medical treatments before we vote for them.

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16 responses to this post.

  1. Your trilogy, on the bias, stigma and ignorance, regarding the manner of operation of MAT, coupled with the limits of judges to become, self appointed physicians, is well described. I believe that your point, relative to civil liability of all aspects of the court systems, as well as, the treatment industry, is well taken. Whether the ability to influence another’s life, emanates from a court system or a treatment system, the individual, who is being affected, has every right to be given all options that are best proven to help them recovery from their situation and to establish a new life. The day may soon be coming, when we see ads, from law firms, that ask the question “Have you or a loved one ever been denied access to Medications, during your stay in a treatment facility or while incarcerated” after another death.
    There is, way too much evidence, that MAT works, for an attorney to lack the capacity to convince a jury, that a family’s child’s death may have been prevented, had they been offered the option to utilize buprenorphine or methadone. Closed minds, begin to open when they receive multi-million dollar judgments from well informed juries, who can put themselves in the vulnerable place, that most addicts and families find themselves. Our systems of change, should be focused on identifying the best practice for achieving this change not on the stigma, bias and refusal to educate themselves, that is far too prevalent in the treatment and court systems. Well done. It is becoming very old, but dead people, don’t get sober, they just create lakes of tears in their wake.
    Thanks, Jana for maintaining your focus on MAT and providing insight into the truth of how poorly we treat our most vulnerable sons, daughters, brothers and parents.
    Perhaps, Judge Ginn, will choose to educate himself about MAT, through NiDA, SAMSHA and many other federal agencies that strongly support this methadology.

    Reply

    • I love this idea!!!
      I think we have more than enough science to back a claim of negligence against a doctor or treatment center who fails to recommend or even to mention the most evidence-based form of treatment for opioid use disorder: medication-assisted treatment.

      Reply

  2. Posted by Alan Wartenberg MD on August 14, 2016 at 7:46 pm

    Over 20 years ago I had a District Court judge ORDER that one of my patients, who was 8 months pregnant, IMMEDIATELY stop taking methadone or be incarcerated. I fortunately knew someone in the US Attorney’s Office and he assisted me in getting a Federal injunction which helped save this woman and her unborn baby. The recent decision by the Obama administration to withhold Federal funds from any drug court may end up moving the needle (pardon the expression) in this struggle. There are all too many judges, cops, correctional officers, probation officers and many others practicing medicine. Unfortunately, there are also a large number of our colleagues, both in medicine, psychology and social work, who are either ignorant or believe in the “bibilical inerrancy” of 12 step doctrine as outlined in bulletin 29 of Narcotics Anonymous, and these folks influence the public, politicians and regulators.

    Reply

    • Posted by Kayce Victoria on June 29, 2017 at 3:29 pm

      “”who are either ignorant or believe in the “bibilical inerrancy” of 12 step doctrine as outlined in bulletin 29 of Narcotics Anonymous””

      Oh thank you, I needed to hear someone else say this besides me! I’m on methadone. I thought i would attend NA meetings locally but had bad experiences. As I’m reading the literature, the papers, pamphlets, etc. On how NA feels about MAT, I got so frustrated! Hypocritical. They claim to have no opinion on it or any outside issues yet NA allows groups to treat MAT patients like they are inferior to those who chose complete abstinence. Some groups don’t allow “us” to share, lead, or have any sort of role within the group. Yet they preach open mindedness and compassion. They made me feel like I was wrong for feeling the Way I do. So it just felt good to read your comment! Thanks!

      Reply

  3. I would love to see a judge or probation officer reported to the state medical board for practicing medicine without a license. Unfortunately when this occurs it is not the judge or probation officer that makes the request – it is the patient under threat of incarceration.

    Nearly every dealing that I have had with the criminal justice system they have been rude and obviously have no knowledge about addiction and can not answer any simple questions put to them. I am trying to say nicely that they are stupid.

    When the former patient relapses they suffer the consequences setting back their recovery years – and some pay with their lives.

    While President Obama has set new policy on the federal level because all new SAMHSA grants have new wording that individuals with opiate addiction need to have medication as an option and grantees will lose funding if they remove patients from their medication. The problem is that most of these drug courts and probation and parole officers receive state funding and this has nothing to do with them. But times are changing and some states have begun to pass laws like New York and New Jersey.

    Judges that are elected can often be handled because the number of patients at a program or often several programs are enough to change an election. A group of patients did it in New York City with a Council Member who believed it was his goal in life to close methadone programs. The next election he was out and no one ever heard of him again.

    So changes are possible.

    Reply

  4. Posted by lisa wheeler on August 15, 2016 at 9:49 pm

    Hi Dr. Burson, just was talking to a colleague and shared your blog. Her response was that this would be a direct violation of ADA. Upon some review of ADA regulations/law, I am inclined to agree with her. A little ammo for the next time this comes up.

    Reply

  5. Posted by kevin on August 18, 2016 at 5:39 pm

    Surprised he isn’t a judge in Tennessee

    Reply

  6. Posted by David Ames MD on August 18, 2016 at 10:29 pm

    very interesting Jana; I had not heard of this type of judicial ruling. Thanks for publicizing.

    Reply

  7. Posted by shannon mchenry on October 8, 2016 at 9:47 pm

    I have a nephew who had a spinal cord injury at age 12 and is on methadone. He is disabled. He got into some legal trouble, and community corrections in Indiana will not allow him to be on methadone MAT to be on house arrest. He also has no control over his bowels and I fear he will die if he tries to come off methadone immediately. He has been on it 8 years! What can I do to help him??

    Reply

    • Posted by shifter9A on October 9, 2016 at 7:24 pm

      Who knows how maladjusted his neurochemistry is at this point, and the devil is in the details. Does Indiana allow Buprenorphine (Suboxone)? If so, there is your answer, though he won’t like it nearly as much as Methadone, it will keep him from dying. In fact, that’s the big difference, you really don’t ‘like’ Buprenorphine, which is why it is so effective. Methadone, on the other hand, is a full agonist like Heroin.

      Reply

    • Sounds like you need to get his lawyer and his doctor to advocate for him.

      Reply

  8. Posted by shannon mchenry on October 8, 2016 at 9:48 pm

    I do not understand what him being on house arrest has to do with methadone?

    Reply

  9. Posted by Kayce Victoria on June 29, 2017 at 3:20 pm

    A judge here in Bonham, TX has a reputation for not supporting MAT patients. Unfortunately I experienced that first hand. She told me I should be “embarassed” for being on methadone to treat substance abuse. EMBARASSED! I was livid! Ofcourse, too afraid to stand up for myself since she does hold so much power over my life right now. As a part of my probation requirement I’m to decrease my dose. She told me that my clinic didn’t want to help me, they just want money and will never taper me off. So I decided to mail her a methadone education packet, anonymously ofcourse! I included your blog and just wanted to say how grateful I am for you & your passion to educate on MAT! Thank you from the bottom of my heart! If you don’t already know, you’ve made a positive difference in atleast one person’s life today, mine!

    Reply

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