Comment by zkms | Hacker News Reader

Comment by zkms | Hacker News Reader

Parent Full thread

"Drug courts" don't help addicted people (nor the people around them) -- they're mostly a way for the criminal legal system to whitewash itself and pretend that it cares about drug users in a "medical" way (and not just by slamming them in the clink), and there's a decent article about this: https://psmag.com/news/how-america-overdosed-on-drug-courts

Besides the inherent issue of non medically-trained people coercively prescribing medication for behavioural modification, there's the fact that drug court judges tend to disfavour opioid maintenance therapy and value abstinence from drug use over everything else; which severely increases the risk of fatal overdoses and other bad outcomes. Abstinence-only treatment does not work well for opioid addiction (http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...), and coercive abstinence-only treatment doesn't work well either.

Drug rehab in US is a fucked up industry where degradation, isolation, and humiliation are commonplace and are seen as best practice, and this is the case because, well, their "patients" are literally captive -- it's either that or literal jail.

It seems insane having a Judge prescribe treatment options. Addicts who wish to give up are definitely a medical case and should be treated likewise. Tapering off Opiates does work. Let's not forget that it was prescription meds being pulled away (without support) that caused the huge rise in people turning to heroine. I have quite a strong view that prescribing pain medication should be referred to specialists after six months and/ or stronger medication than co-codamol is needed.

I suffer from Chronic pain and have been prescribed Buprenorphine in the past (Butrans, which don't have the same counter-measures as Subutex), unfortunately they are no longer adequate for me (the patches get pretty big in higher doses).

Interesting fact: the counter measure (naloxone) in subutex is useless. Bupe binds infinitely more than naloxone does to your opiate receptors, and the dose of naloxone is so low that it can't compete anyway.

Even the claims that the naloxone is to deter injection of the drug is suspect at best. It's most likely that this new combination was simply an easy way to get approval and obtain a patent.

This system also invites and funds quack medicine, like "treatment" for non-addictive drug use and non-addicts, while real addicts find a shortage of treatment resources.

This. A non-alcoholic friend of mine got popped for drunk driving, and part of his sentence was counseling for alcoholism. At one point they asked him if he'd ever done cocaine, he foolishly answered yes, and they sent him to a similar program for coke.

On the other hand, since he had to pay the cost it's not like anybody who needed treatment got shorted as a result.

It also educates him about addiction which helps disseminate correct information back to the public (hopefully).

Your black and white thinking does not reflect the truth. I personally know dozens of people who have turned their lives around as a result of drug court. True, the success rate isn't very high, which is the direct result of the variability of whether each individual possesses the tiny bit of willingness to change, which is essential to the recovery process.

> True, the success rate isn't very high, which is the direct result of the variability of whether each individual possesses the tiny bit of willingness to change, which is essential to the recovery process.

"If our process hasn't worked for you, you didn't want it to work enough" is unfalsifiable and can be used to defend any sort of quackery. Indeed, there's no way to generate a counterexample -- of someone who had "willingness to change" but for whom the drug court didn't work -- because the defender of the drug court can always claim that they "didn't want to change enough".

Pseudoscience of this sort has no role in anything as fraught and complex as drug use/addiction.

> "If our process hasn't worked for you, you didn't want it to work enough" is unfalsifiable and can be used to defend any sort of quackery.

Notably, it is routinely used to defend 12-step programs. The standard set of slogans includes the phrase "it works if you work it" (which I've more recently seen applied to cognitive-behavioral therapy).

So by your definition, "science" means curing addiction by giving the addict more drugs.

As bad as drug court sounds, it still sounds more rehabilitative than prison.

It replaces a bigger problem with a smaller problem.

Can better be done? Yes.

Sure, some folks get clean using a variety of methods, many with little research. So what? If the success rate isn't very high, it probably isn't the best program.

We could research this stuff and then listen to the research. Use the methods with the best general outcome for the patient, based on medical proceedings. And perhaps use these things with iffy outcomes - AA, for example - as add-ons or options for patients to choose from, with a medical doctor's blessing.

Reply on news.ycombinator.com