Drug Courts and PDMPs M A Y 1 4, 2 0 1 4

Drug Courts and PDMPs M A Y 1 4, 2 0 1 4

Disclaimer Language of the drug court field can be confusing. Terms Drug court, problem solving court and specialty court are sometimes used interchangeably by practitioners the latter two terms reflecting the growing diversity of the field. In all instances, the term(s) refer to a specialized docket rather than a stand-alone court.

WHY DRUG COURTS?

Why Drug Courts? In 1980 state and local arrests for drug offenses accounted for 5.6% of total estimated arrests. By 2008 state and local arrests for drug offenses had risen to more than 1.7 million 12.2 % of total arrests. 2008 drug arrests: 82.3% were for drug possession, while 17.7% of these arrests were for drug sales or manufacturing violations. FBI, Criminal Justice Information Services Division

Why Drug Courts? In 2011. 1 in 107 adults were incarcerated in prisons or jails across the United States. 1 in 50 adults in the United States were under supervision of probation or parole. The cost of housing a single inmate is more than 20 times as high as supervising that individual in the community. $78.95 per day vs. $3.42

Why Drug Courts? More than half of the individuals entering the criminal justice system, regardless of their offense, have substance-abuse problems. About 32% of state inmates reported drug use at the time of their offense. Bureau of Justice Statistics

Prevalence of Substance Use and Mental Health Disorders in State Prisons and Local Jails Bureau of Justice Statistics

Costs of Addiction Federal, state and local governments spent $467.7 billion in 2005 on substance abuse treatment (10.7% of total spending). 95.6% of federal and state spending is on the burden to public programs (Health Care, Adult Corrections, Juvenile Justice, Courts, Child Welfare, Public Safety, Mental Health, etc.) 4.4% of Federal and State Substance-Related Spending goes to prevention, treatment, research, interdiction, regulation and compliance. Source: CASA Columbia

THE GROWTH OF DRUG COURTS

25 Years of Drug Court First drug court began in Miami-Dade, Florida in 1989. There are now approximately 2,840 drug courts found in all 50 states. 23 countries have drug courts.

Expansion of the Model 1989: First Drug Court 1995: First DUI Court and Family Dependency Treatment Court 1997: First Mental Health Court and Tribal Drug Court 2008: First Veteran s Treatment Court There are numerous other types of problem solving courts as well.

THE DRUG COURT MODEL

Three Primary Goals of Drug Court Reduce recidivism among participants. Reduce substance abuse among participants. Rehabilitate participants to improve their chances of successful reintegration into society by providing support services such as employment, job training, education and housing assistance.

Eligibility for Drug Court Varies by court although most drug courts target felony drug offenders with drug possession charges or non-violent, drug related charges. Emphasis is on serving high risk/high need offender at risk of re-incarceration. Programs operate at all phases of the criminal justice system pre-adjudication, post-plea, and re-entry. Participation in drug court is voluntary although most courts incentivize participation - offer a dismissal of charges or avoid incarceration/reduced sentence

Traditional Court vs. Drug Court Adversarial Proceedings Traditional System Limited judicial supervision or knowledge of defendant s progress after adjudication and disposition Punishment is the primary tool for deterring further drug offenses Treatment varies in availability, cost, intensity Supervision/drug testing is intermittent Drug relapse is treated as a new crime or a probation violation Drug Court System Collaborative, multi-disciplinary team The court is active in monitoring progress and applying immediate sanctions Treatment is an effective tool for reducing the demand for drugs While uniform in structure, treatment is individualized Frequent drug testing and probation monitoring While relapse and program non-compliance results in graduated and immediate sanctions, relapse is viewed as part of the recovery process rather than a new offense

Drug Court Team Judge Coordinator (in most localities) Prosecutor Defense attorney (in most localities) Treatment Probation Law enforcement (in some localities)

Drug Court Evaluations Drug courts have been extensively studied. Findings of note: Drug courts reduce crime as much as 45% more than other sentencing options. For every $1.00 invested in drug courts, taxpayers save as much as $3.36 in avoided criminal justice costs. Family re-unification rates are 50% higher for family drug court participants. Drug courts are six times more likely to keep participants in treatment long enough for them to get better.

Adult Drug Court Standards Many of the findings from drug court evaluations are now being incorporated into national standards for adult drug courts. The first five standards were released in June 2013. The next five will be released in May 2014.

PRESCRIPTION DRUG ABUSE IN DRUG COURT

Profiles of Prescription Drug Abusers who Enter Drug Court Defendant with medical background (e.g. nurses, dental assistant, receptionist at medical office, home health care workers, etc.) Specific challenges with this population: Continued access to medication and a more sophisticated understanding of how to successfully divert without being detected. Vast knowledge of prescription drugs including what can be detected through traditional drug testing means and what cannot.

Profiles of Prescription Drug Abusers who Enter Drug Court Traditional doctor shopper Specific challenges with this population: Have an understanding of where to access medication in their community and what to say in order to narrow the prescribing options to desirable medications. Access to PDMP data can be highly effective with this population.

Profiles of Prescription Drug Abusers who Enter Drug Court Defendant with legitimate chronic pain issues or other medical issues who also misuses or abuses prescription medications Specific challenges with this population: Extraordinarily complicated cases requiring significant coordination among all providers to manage the case successfully.

Profiles of Prescription Drug Abusers who Enter Drug Court Opportunistic prescription drug abusers Specific challenges with this population: Primary drug of choice is often something other than prescription medications prior to entering drug court but the defendant switches to prescription medication because it s easier to avoid detection or because court policies may permit the use of prescription medication.

Specific Challenges Drug testing expenses are significantly higher for this population. Requires laboratory testing to be thorough average $25/prescription drug panel versus $4-5 for a 10 panel onsite test. The window of detection for drug testing can be more narrow than the detection window for illicit drugs.

Specific Challenges HIPAA regulations create a confusing process for drug court practitioners who want to coordinate case planning with physicians. Medical community is not always receptive to case coordination with substance abuse treatment providers and it can be challenging (e.g. ER physicians). Fear of liability (particularly for those defendants working in the medical fields) and the importance of protecting the safety of patients, client and children (family drug courts). Concerns about any appearance of interfering with medical care. Defendants perceive themselves as different.

Monitoring Efforts Treatment staff focus heavily on treatment engagement and relapse prevention skills. Probation often orders drug court participants to report emergency room visits and any new prescriptions for potentially addictive medication to their PO within 24 hours. May count pills and/or monitor access to medications during home visits. PDMP monitoring where legally permitted. Goal of monitoring is to promote therapeutic engagement, not to nail them and jail them as is often the perception.

Drug Courts and PDMP Monitoring Drug courts can directly access PDMP data in some states. Access through law enforcement or prosecutors on the drug court team particularly in pre-plea cases where the criminal case remains open. Access through probation and parole officers. Access through treatment providers. Participant agreement. Example of states that fall into one or more of the above options: AK, ID, IL, IN, KY, MS, UT, WY

Drug Courts and PDMP Monitoring Enabling access by drug courts to PDMP reports was identified as a PDMP best practice by the PDMP Center of Excellence.

How Can PDMP Administrators Become More Familiar with their State Problem Solving Courts? Most states have a state-level problem solving court coordinator. A list of current state level drug court coordinators can be found here: http://www.nadcp.org/learn/state-leaders/state-drug-courtcoordinators Most states host annual training conferences for state problem solving court teams they would likely welcome a presentation from you or your staff about PDMPs. Take time to visit a problem solving court professional visitors are usually welcome.

Conclusion The hard work you do with limited budgets and staffing does not go unnoticed. The thoughtfulness with which you approach very complex issues is appreciated. Thank you.

Contact Information Tara Kunkel Principal Court Management Consultant National Center for State Courts tkunkel@ncsc.org (757) 259-1575

Kentucky Drug Court Use of the Kentucky All Schedule Prescription Electronic Reporting System Charles R. Hickman Vice-Chief Regional Circuit Judge Chief Circuit Judge Kentucky Court of Justice Prescription Drug Monitoring Program Training and Technical Assistance Center May 14, 2014

Drug Court Access to PDMPs

Kentucky Drug Courts

What is KASPER? KASPER is Kentucky s Prescription Drug Monitoring Program (PMP). KASPER tracks Schedule II V controlled substance prescriptions dispensed within the state as reported by pharmacies and other dispensers. Enhanced KASPER (ekasper) is the real-time web accessed database that provides a tool to help address the misuse, abuse and diversion of controlled pharmaceutical substances.

KASPER Operation KASPER tracks most Schedule II V substances dispensed in KY Over 10 million controlled substance prescriptions reported to the system each year KASPER data is 1 to 3 days old Dispensers have 1 business day to report Reports available to authorized individuals Available via web typically within 15 seconds (97% of requests) Available 24/7 from any PC with Web access

Goals of KASPER KASPER was designed as a tool to help address the problem with prescription drug abuse and diversion by providing: A source of information for health care professionals. An investigative tool for law enforcement and regulatory agencies. KASPER was not designed to: Prevent people from getting prescription drugs for legitimate medical conditions.

Access by Law Enforcement Officers KRS 218A.202(6): The Cabinet for Health and Family Services shall be authorized to provide data to: a Kentucky peace officer; Commonwealth s attorneys and county attorneys; a certified or full-time peace officer of another state; a federal peace officer whose duty is to enforce the laws of this Commonwealth, of another state, or of the United States relating to drugs; and who is engaged in a bona fide specific investigation involving a designated person

Access by Drug Court Judges KRS 218A.202(6): The Cabinet for Health and Family Services shall be authorized to provide data to: a judge or probation or parole officer administering a diversion or probation program of a criminal defendant arising out of a violation of this chapter or of a criminal defendant who is documented by the court as a substance abuser who is eligible to participate in a court-ordered drug diversion or probation program.

Law Enforcement/Judge Report Request

Sample KASPER Patient History Report

Access by Drug Court Judges (cont d) Management of Reports A judge may discuss the information in a KASPER report with the Drug Court participant, but does not provide a copy of the report to anyone including the Drug Court participant. After review the judge may shred the report. Each report has a number that will allow reproduction of the report at any time.

Do You Discuss KASPER with the Participant? 49% 27% 24% Yes No Other (inc. Only if there is an issue, If they lied about an Rx, Judge may if it has new information, We try to keep it under wraps)

Drug Court use of KASPER Data Used to track a participant s non-medical use or diversion of controlled substances. Rise in prescription drug diversion, abuse and addiction means that an increasing number of drug court participants are enrolled due to involvement with controlled prescription drugs. Information on a participant s prescription history for controlled substances can play a valuable role in monitoring and changing the participant s behavior. Approximately half of Kentucky Drug Courts currently make use of KASPER data in a variety of situations.

How Drug Courts use KASPER Reports 35% 23% 15% 12% 15% Suspicion of new drug use Regular checks of all participants To determine whether a specific drug has been prescribed For verification Other (inc. of a random checks, prescription, ER determine visit or doctor's doctor visit shopping, verify participant honesty)

Who Requests if Other than the Judge? 37% 33% 27% 3% Probation or Parole Officer Law Enforcement Commonwealth Attorney Other (inc. DC program supervisor, team member, Judicial Secretary, Judge's Designee)

Frequency of KASPER Use 31% 17% 20% 9% 11% 3% 3% 6% A few times Once a year or less Every 6-12 months Every 3-6 months Every 1-3 months Once a month or more Weekly or more often Other (inc. didn't know it was available, not using it yet, infrequently, as needed)

Drug Court Use of KASPER Data (cont d) Periodic and random drug tests (drug screens) that analyze hair, blood or urine samples are routinely used to detect illicit and non-medical drug use. However, these tests aren t completely reliable in detecting the presence of all prohibited substances, and are subject to evasion by resourceful and determined drug users. Drug Courts must take other steps to monitor participant behavior to ensure they uphold agreements to remain drug free, or in the case of prescription drugs, use them only as medically indicated.

Drug Court Use of KASPER Data (cont d) A typical Drug Court program in Kentucky consists of 3 phases that gradually give participants more autonomy, plus a postgraduation aftercare phase In the drug court supervised by Vice-Chief Regional Circuit Judge Charles Hickman, KASPER reports are run on participants when they move from one phase of the program to another to help confirm that their purchases of controlled substances, if any, are consistent with good clinical care. KASPER data can reveal patterns of prescribing that indicate a participant might be using controlled medications nonmedically or diverting them to friends, family or paying customers.

Drug Court Use of KASPER Data (cont d) KASPER reports are also run if, at any point in the program, a participant seems to be having unexpected or unexplained setbacks, or if evidence comes to light suggesting illicit drug use (e.g., a positive drug screen) or diversion activity (e.g., unexplained cash in hand). A participant can move on to the next phase only if their behavior as monitored by the court, including the prescription purchases listed in KASPER reports, passes muster.

Drug Court Use of KASPER Data (cont d) While a drug screen can t detect drug diversion, only drug use, KASPER data showing medically unnecessary prescriptions are a prima facie indicator of possible diversion. KASPER reports are only indicators, not proof, of diversion or misuse. The pharmacies and doctors listed are contacted and records reviewed to confirm that the individual in question actually received the prescriptions dispensed.

Charles R. Hickman Vice-Chief Regional Circuit Judge Chief Circuit Judge 501 Main Street Shelbyville, KY 40065 (502) 647-5234 KASPER Web Site: www.chfs.ky.gov/kasper