Continuing the Conversation about Drug Addiction and Treatment



Drug-related convictions place a substantial burden on the criminal justice system and on society. The MD Magazine Peer Exchange “Medication-Assisted Treatment in Drug Abuse Cases: A Path to Success” features a panel of experts in the criminal justice field who provide insight on medication-assisted re-entry programs.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons, and an associate director of Surgical Intensive Care at New York-Presbyterian Hospital.

The panelists are:

  • Phillip Barbour, master trainer with the Center for Health and Justice at Treatment Alternatives for Safe Communities, in Chicago, IL
  • Jac Charlier, director for consulting and training, also with the Center for Health and Justice at Treatment Alternatives for Safe Communities, in Chicago, IL
  • Jonathan Grand, MSW, LICSW, senior program associate at the Advocates for Human Potential in Sudbury, MA
  • Joshua Lee, MD, MSc, associate professor in the Department of Population Health, and a research clinician at Bellevue Hospital Center, NYU Langone Medical Center, and the New York City jails

Peter L. Salgo, MD: I don’t want to leave today without giving each of you an opportunity to have one final word. One last, uninterruptable, statement. Why don’t you start, Phil?

Phillip Barbour: First, Peter, I want to thank you for having us here because this is a group that doesn’t normally get together in this kind of a conversation. Having a medical doctor and behavioral health specialists in the same room talking about the same thing, I think, is very, very important. It’s progressive, and more of this needs to happen. So, I just want to thank you for inviting us and having us at this forum.

Peter L. Salgo, MD: You’re up.

Joshua D. Lee, MD, PhD: I would say to the largely medical practitioner audience, the medications for opiate-use disorders are simple, safe, and exquisitely effective. If you are tired of prescribing Prozac and not getting much out of it, or other things we use for chronic disorders where you just don’t see a ton of treatment effect per individual patient, these are totally different. People that are on these and staying on them—thinking of Vivitrol, extended-release naltrexone, or buprenorphine, or Suboxone, in particular—they do amazingly well, right off the bat. It’s a challenge to get them all to do well over the next year, for instance, and that’s why these disorders are tough. But, really we want to encourage more people to think about doing it, and emphasize how safe and effective the medications are, and, essentially, easy to use.

Peter L. Salgo, MD: You’re up.

Jac A. Charlier, MPA: First of all, I’m going to echo what Phil said. It’s very cool, as a guy who worked with a badge and vest for many years, to be here speaking with the medical community. So, I want to just commend you for that. On a very practical level, then, there are three things. One, ask doctors out there to be part of the solution. Not only of addiction in the United States, but specifically the opiate epidemic. Educate yourself in your practice on addiction and for the well-being of your patients. Think about that as you are prescribing, and as you’re interacting with them, that addiction might be at play. Two, as I’ve said earlier, reach out to the criminal justice world through organizations like AHP, like TASC, and help us understand better medications and medication-assisted treatment. And, three, when those people present to you from the justice system, they might not be the patients you ideally want sitting in your waiting room. Be hopeful that you are going to be part of the solution through MAT to restore lives and to reduce crime. Being part of this, it’s a big, big deal for a population that generally does not access primary care, but goes to the emergency room instead. Very hopeful message on that last point.

Peter L. Salgo, MD: Last word.

Jonathan Grand: My company’s grant has us speaking with state officials, almost on a daily basis, and I can tell you, based on our conversations, that addiction services are expanding dramatically, almost daily. Right now we have 12 states that are doing MAT prison reentry programs, but we know for a fact that states are talking to other states that already have it and are starting to implement it themselves. And, right now, we have 88 jails in the country that are doing reentry. But, it’s probably going to be 95 when I get back to Massachusetts cause it’s increasing that fast. So, the message is: help is on the way. It’s going to be more services, not only in the criminal justice programs, but out in the community, as well. And, we just have to hold on and start working on it, and we’re going to start really addressing this, effectively, real soon.

Jac A. Charlier, MPA: There are over 3000 jails, though, in the United States, so I want to be clear.

Jonathan Grand: It’s a start.

Peter L. Salgo, MD: I just want to thank all of you for being here. It’s been a tremendous discussion. I think, I hope, it’s been eye opening for a lot of clinicians out there. And, I almost never give my opinion, but I’m going talk just for one second, too. I went to medical school to make a difference, and I’ll bet you did, too. I know my classmates did. This is an epidemic. And, if you choose to engage it, you can make a difference. That’s something at the end of your career you might want to look back on and be proud of. With that, I want to thank you for watching. I’m Dr. Peter Salgo, and I’ll see you next time.

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