Family Treatment Drug Courts (FTDC) have shown such promise in the US, that they are utilized at an international level.  In England, Family Drug and Alcohol Courts (FDAC) use an integrated approach similar to FTDCs in the US, where the same judge oversees both the care proceedings and the treatment intervention. In contrast to some American FTDCs, if parents don’t follow their FPAC plan, the case goes back to being public law care proceedings where authorities still must prove the child is at risk and the FDAC has no further involvement.

The London FDAC was evaluated for long-term outcomes before FDAC was implemented in other regions in England. All London FDAC cases from January 2008 to  August 2012 were tracked for up to five years after the intervention. The cohort was compared to cases that weren’t provided FDAC. Thirty-six percent of FDAC mothers had previously removed children,  37% had mental health problems, and 71% had experienced domestic violence. The majority of children (87%) of the cases were brought because of neglect, 25% had emotional and behavioral difficulties, and 41% had physical health problems.

Overall, FDAC mothers had better outcomes than comparison mothers. Forty-six percent of FDAC mothers stopped misusing substances, compared to only 30% of the comparison mothers ceased. Thirty-seven percent of FDAC families either continued to live together or were reunited vs. 25% of comparison familiesFifty-eight percent of FDAC mothers sustained the reunification compared to only 24% of the comparison mothers. However, there was no difference in the amount of time it took for the child to be permanently placed. The study also found that the first two years after the reunification was especially risky for mothers. However, about a fifth of all children (both FDAC and comparison) were estimated to change placements after they had received their permanent placement. This study shows evidence of positive, long-lasting effects from FDAC. Additional support for the first two years following FDAC may need to be offered, as this study showed that it is a vulnerable time for families.

Harwin J, Alrouh B, Broadhurst K, McQuarrie T, Golding L, Ryan M. 2018. Child and parent outcomes in the London Family Drug and Alcohol Court five years on: building on international evidence. International Journal of Law, Policy and the Family 32(2): 140–169. https://doi.org/10.1093/lawfam/eby006.

Individuals who have a criminal history have high rates of opioid dependence and mortality risk. The fatality risk from substances such as heroin, for example, is much higher in the weeks following release from prison. Despite this risk, Medications for Opioid Use Disorder (MOUD) are critically underused among inmates. The objective of this study was to examine the association between adherence to methadone maintenance treatment (MMT) and fatal overdoses among individuals with criminal histories.

This study analyzed 14,530 administrative records of individuals in British Columbia with conviction histories who filled a methadone prescription between January 1st, 1998 and March 31st, 2015. Participants were followed from the date methadone was first dispensed, until a death certificate was issued and registered, or until March 31st, 2015. The average age of participants was 34.5, and 71.4% were male. The median follow-up time was 6.9 years, and 1,275 individuals died during that time. The overall all-cause mortality rate was 11.2 per 1,000 Person-Years (or 11.2 deaths per 1000 persons observed for one year). Looking at non-MMT compared to MMT periods, the all-cause mortality rate was significantly higher at 15 per 1,000 person-years compared to 5.9 per 1,000 PYs during MMT periods.

Methadone use was associated with a lower mortality rate among individuals with a criminal history and opioid dependence. It is worth considering that individuals adhering to MMT exhibit lifestyle changes that influence mortality. Despite the known benefits of MOUD, such as methadone, they are not routinely offered in prisons. Barriers to providing treatment include stigma, lack of knowledge, concerns about medication diversion, and lack of linkages between providers and correctional facilities. Inmates and those recently released would benefit from ongoing treatment, following detox while incarcerated.

Russolillo, A., Moniruzzaman, A., & Somers, J. M. (January 01, 2018). Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada. Plos Medicine, 15, 7.)

Previous studies have shown consistently that Medications for Opioid use Disorder (MOUD) formally known as Medication-Assisted Treatment], including methadone maintenance treatment (MMT), buprenorphine, and naltrexone are beneficial across outcomes. Findings are mixed when it comes to MOUD following an overdose. Because a major risk factor for fatal opioid overdose is prior to nonfatal overdoses, this study investigates whether MOUD after opioid overdoses decreases mortality rates – both related and unrelated to opioid use. This study used retrospective data from 17,568 adults in Massachusetts who survived an opioid overdose between 2012 and 2014. Individuals who died within 30 days of the nonfatal overdose were excluded from the study, as were individuals with evidence of cancer.

Sixty-two percent of participants were male and 69% were under the age of 45. In the previous  12 months before the nonfatal overdose, 26% received 1 or more kinds of MOUD, 41% received prescriptions for opioids, and 28% received prescriptions for benzodiazepines. See the chart below for the results of the study.

Approximately a third of the individuals in this sample received MOUD. MMT and Buprenorphine treatment were associated with reduced all-cause mortality and opioid-related mortality. Considering the greater mortality risk that the non-MOUD group face, this study supports engaging individuals in MOUD treatment following a non-fatal overdose.

Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., … Walley, A. Y. (January 01, 2018). Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Annals of Internal Medicine, 169, 3, 137-145.

Poorly managed persistent pain is a risk factor for opioid use disorders (OUD). An estimated 62% of patients using medication-assisted treatment (MAT) have persistent pain. Individuals receiving MAT while coping with persistent pain face unique challenges such as heightened sensitivity to pain and high opioid tolerance. Complicating these barriers further, many MAT patients with persistent pain don’t have health insurance that covers other pain therapies such as acupuncture or cognitive behavioral therapy. Additionally, many OUD treatment providers don’t offer on-site support for pain management. This study piloted an online pain management program, Goalistics Chronic Pain Management Program (CPMP), among adults with persistent pain who receive MAT at an outpatient clinic in Washington State.

CPMP is a self-directed, Internet-based program for patients with persistent pain. CPMP is made up of modules to be completed over the course of eight weeks. The modules target four areas of pain management: cognitive, emotional, behavioral, and social. The program includes written information, interactive activities, homework exercises, and self-monitoring activities. The goal is to decrease pain symptoms, improve mood, and reduce opioid misuse.

A total of 31 individuals participated in CPMP, with 29 individuals in the control group. Sixty-five percent of CPMP participants engaged with the online program, by completing some or all of the modules. CPMP participants showed improvement of pain severity, pain interference, opioid misuse, and depressive symptoms, compared to the control group. The CPMP group did not show changes in self-efficacy, anxiety, or withdrawal symptoms after the course of the program. One possible explanation is that the chronic pain symptoms of the participants exacerbated their withdrawal and anxiety symptoms. These results are promising and show that online self-management programs may be effective among adults receiving MAT while coping with persistent pain in managing physical and emotional symptoms of pain. Going forward, treatment clinics should place more emphasis on the specialized needs of individuals with persistent pain.

Wilson, M., Finlay, M., Orr, M., Barbosa-Leiker, C., Sherazi, N., Roberts, M. L. A., Layton, M., … Roll, J. M. (November 01, 2018). Engagement in online pain self-management improves pain in adults on medication-assisted behavioral treatment for opioid use disorders. Addictive Behaviors, 86, 130-137.