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Where Your MD Meets My JD: When the Doctor says yes, but the treatment team says no.

Judge Jodi Debbrecht Switalski

It’s a disease.

It’s not a disease.

Well, it changes the structure of the brain, just like diabetes changes the structure of the pancreas. But it’s a choice. “They” chose to use drugs….

Or did they?

According to the National Institute on Drug Abuse and several published studiesi, 80 percent of heroin users reported using prescription opioids prior to heroin. 60% of opioid related deaths occur in patients who have been given prescriptions according to prescribing guidelines by medical and dental boards and 3.5 million adolescents had their first introduction to opioid medications following a third molar extraction.ii 11% of high school seniors have used an opioid nonmedically before they graduate.iii Physical dependency then addiction can start before we, as judges, even have an opportunity to intervene making the success of recovery much, much more difficult.

Does it really matter?

What really matters, I submit to you, is the process moving forward. We should all be able to agree that recovery is a process. Treatment requires exploring numerous pathways to recovery. For the judge and treatment team, the trick is finding the pathway to recovery for each individual. Sometimes this means setbacks or violations of the terms of probation, but this is not, to me, a failure. If a method of treating cancer does not work, we do not simply incarcerate or give up on the individual. We shift the treatment approach. To this end, treatment courts have an added benefit: the synergy of monitoring and intervention, vulnerability and investment, mentors and recovery coaches and a diverse team whose valued education and experience are crucial to the success of the individual. An individual who for whatever reason is suffering from a disease or a situation that in most cases, began innocently – with a prescription from their doctor.

So what happens when the disparity of the treatment courts with regard to prescription policy precludes recovery success? When philosophy or principal impugn our ability to see the pathway to recovery? And how is recovery defined any more anyway?

While some judges order that a participant in treatment court take no medications, others allow medical “expertise” to influence judicial/treatment decision making. For example, while consulting with a participant in treatment court and the team recently, the participant advised that one of his drugs of choice was Xanax. Ironic then that his drug of abuse is also the drug that his doctor has prescribed for him despite clear disclosure. Does that even make sense? And, what authority do we, the judiciary and/or the treatment team, composed of professionals from every discipline and educated in mental health and substance abuse, many of whom are in long term recovery themselves, have to override the medical order? As medical professionals, you have been taught to treat the symptoms of reported diagnoses… but have you been taught about substance abuse? About screening, assessment, monitoring and accountability in recovery? About informed consent? When do the patient satisfaction surveys, and MACRA reimbursements interfere with your ability to adequately diagnose without the use of behavior therapy? Do we, as educated and invested judges and treatment teams, know more than your MD is willing to learn and invest?

The answer, at times, is yes.

And that then, is when my JD clashes with your MD.

I suggest we get on the same team. Together, we can Be the Change. We can, Do Something.

Judge Jodi Debbrecht Switalski is a former sobriety, drug and veterans treatment court judge in Michigan with a background in interpersonal violence, mental health and substance abuse. She stepped down from the bench to practice law with Lippitt O’Keefe Gornbein, PLLC and started her own consulting firm, Switalski Consulting LLC, where she consults nationally on informed consent and prescription abuse with medical and dental practitioners. She also speaks nationally with The Stutman Switalski Group LLC before hundreds of audiences and performs almost as many consulting engagements on issues surrounding substance abuse and risk evaluation and mitigation strategies for medical and dental practitioners. She is married to a treatment court judge, has two children, three step-children and two grandchildren.