Open Society Foundation, 21-24 Millbank, SW1P 4QP London, UK.
Harm Reduct J. 2013 Dec 5;10:35. doi: 10.1186/1477-7517-10-35.
Specialized drug treatment courts are a central part of drug-related policy and programs in the United States and increasingly outside the U.S. While in theory they offer treatment as a humane and pragmatic alternative to arrest and incarceration for certain categories of drug offenses, they may exclude some forms of treatment-notably methadone maintenance treatment (MMT). We sought to understand from the perspective of treatment providers whether this exclusion existed and was of public health importance in New York State as a case example of a state heavily committed to drug courts and with varying court-level policies on MMT. Drug courts have been extensively evaluated but not with respect to exclusion of MMT and not from the perspective of treatment providers.
Qualitative structured interviews of 15 providers of MMT and 4 NGO advocates in counties with diverse court policies on MMT, with content analysis.
Courts in some counties require MMT patients to "taper off" methadone in an arbitrary period or require that methadone be a "bridge to abstinence". Treatment providers repeatedly noted that methadone treatment is stigmatized and poorly understood by some drug court personnel. Some MMT providers feared court practices were fueling non-medical use of prescription opiates.
Drug court practices in some jurisdictions are a barrier to access to MMT and may constitute discrimination against persons in need of MMT. These practices should be changed, and drug courts should give high priority to ensuring that treatment decisions are made by or in close consultation with qualified health professionals.
专门的药物治疗法庭是美国和美国以外地区与毒品相关政策和项目的核心部分。虽然从理论上讲，它们为某些类别的毒品犯罪提供了一种人性化和务实的替代逮捕和监禁的选择，但它们可能会排除某些形式的治疗，特别是美沙酮维持治疗（MMT）。我们试图从治疗提供者的角度了解这种排除是否存在，以及在纽约州是否存在公共卫生重要性，因为纽约州是一个大力推行药物法庭的州，而且在法庭层面上对 MMT 的政策也存在差异。药物法庭已经得到了广泛的评估，但没有涉及到 MMT 的排除，也没有从治疗提供者的角度进行评估。
对在 MMT 政策差异较大的县的 15 名 MMT 提供者和 4 名非政府组织倡导者进行了定性结构访谈，采用内容分析法。
一些县的法庭要求 MMT 患者在任意时间段内“逐渐减少”美沙酮的用量，或者要求美沙酮成为“戒除毒瘾的桥梁”。治疗提供者反复指出，美沙酮治疗受到一些药物法庭工作人员的歧视和误解。一些 MMT 提供者担心法庭的做法正在助长非医疗用途的处方类阿片类药物的使用。
在某些司法管辖区，药物法庭的做法是获得 MMT 的障碍，可能构成对需要 MMT 的人的歧视。这些做法应该改变，药物法庭应该高度优先确保治疗决策是由合格的卫生专业人员做出的，或在他们的密切协商下做出的。
