10.24.19

Addiction and Public Policy: Creating Reform Through the Lens of Lived Experience

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It was 2018 and I was at the New York State Recovery Conference with T.K. Rabii, a 24-year old peer advocate, public speaker, and person in long-term recovery. I was speaking at the conference on behalf of the Governor of New York for whom I was working at the time and I was about to head to the stage.

I decided that, for the first time, I was going to speak publicly about my own experience as a person in long-term recovery for the past twenty years and how my recovery had shaped my personal and professional life.

Both T.K.’s story and mine, like so many others, feature arrest, addiction treatment, and a slow re-building of a life into one of purpose and a strong sense of community that ultimately led us to advocacy.

I first met T.K. after he had spoken at the National Association for Drug Court Professionals conference in front of a crowd of thousands of judges, treatment providers, peers and professionals. He was there to discuss his personal experience as a drug court participant. Drug courts (or treatment courts) are specialized court dockets for people charged with a drug-related crime. Drug courts were created to divert people with substance use disorders away from incarceration and provide them with treatment.

When I joined the O’Neill Institute to work on addiction policy, my first project was identifying legal and legislative efforts that would increase access to evidence-based treatment in jails and drug courts. 

T.K. was one of the first people I called.

He told me how critical it was for him to have access to medication to treat his opioid use disorder when he was in jail and in drug court, especially in the early stages of his recovery. He also told me that in his current position as a peer advocate, he continues to see the important role medications for opioid use disorder play in his clients’ recovery.

“I think it’s important for people to have access to medication while they are in jail and in drug court because it helps people stay stable in an unstable situation. It’s one tool they can use to help them along in their whole process to get them to a happier point in their life.

“Suboxone helped me, especially when I was in jail, because it was the first time I was in jail and I was going through withdrawals on top of it, and it helped make a terrible situation a little better, so I wasn’t sick and in jail at the same time. In drug court it helped because it was an anchor for me. It was a tool I knew I had that I could utilize to get through the process and maintain my recovery while I went through drug court. 

“Now, I am not on Suboxone any more. I got to the point where I am able to maintain my recovery with the help of my support system and coping skills, but if I didn’t have access to it when I did, I wouldn’t have made it to this point.” 

There are three FDA-approved medications to treat opioid use disorder (M-OUD): methadone, buprenorphine (also known by the brand name Suboxone), and naltrexone. Unfortunately, there remain prohibitions or significant barriers to M-OUD in both drug courts and jails across the country, despite the fact that the reentry population is at heightened risk for overdose. Individuals with opioid use disorder who are treated with medication while incarcerated are as much as 75% less likely to die of any cause and 85% less likely to die of drug poisoning in the first month after release. 

Even in the face of the evidence supporting M-OUD, fewer than 1 percent of the more than 5,000 U.S. prisons and jails, housing more than 2 million people, allow access to these medications, according to a 2018 study by the Pew Charitable Trusts.

In a report being released by the O’Neill Institute this month, we outline legal and policy strategies to increase access to M-OUD in these settings so people can receive evidence-based treatment to reduce overdose death and improve healthier outcomes.

I’ll see T.K. again on October 30 at our convening at Georgetown University, where we will officially release our report and launch an initiative to implement its recommendations over the next year. I’ll be moderating a panel about access to medications for opioid use disorder in drug courts, and T.K. will speak on the panel.

I’m proud to be part of an initiative that elevates the voices of people with lived experience in a meaningful way to inform policy and, ultimately, to help implement reforms that create a more compassionate and just society.

 “All people have the right to flower, to reveal their full potential as human beings, to fulfill their mission in this world…. That is the meaning of human rights.” – Daisaku Ikeda

Shelly R. Weizman is Associate Director of the Addiction & Public Policy Initiative at the O’Neill Institute for National and Global Health Law and Adjunct Professor of Law at Georgetown University Law Center. She is the former Assistant Secretary for Mental Hygiene in the Office of the Governor of New York State and is a person in long-term recovery.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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