DANDRIDGE, Tenn. 鈥 Rachel Solomon and judges hadn鈥檛 been on the best of terms. Then Judge O. Duane Slone 鈥渄umbfounded鈥 her.
Solomon was given her first Percocet at age 12 by a family member with a medicine cabinet full. It made her feel numb, she said. 鈥淣othing hurt.鈥 By 17, she was taking 80-milligram OxyContins. A decade later, she was introduced to heroin.
During those years, Solomon was in and out of trouble with the law.
Then, five years ago, at 32, she arrived in Slone鈥檚 courtroom, pregnant, fearing the worst. But the state circuit court judge saw promise. He ruled that Solomon would serve jail time for an outstanding warrant for aggravated burglary and then would be placed in a program for pregnant or parenting women recovering from addiction. She would retain custody of her son, Brantley, now 4.
Slone also offered an option that many judges, particularly in rural jurisdictions, at that time were averse to extending: , or MOUD.
A study conducted a decade ago found that offered medication treatment. Those that didn鈥檛 cited uncertainty about its efficacy and noted political, judicial, and administrative opposition. But research in the years since has persuaded many of the most insistent abstinence-only advocates.
According to Monica Christofferson, director of treatment court programs at the , amid an accelerating opioid crisis there has been a 鈥溾 among judges, prosecutors, and law enforcement agencies away from the stigma associated with medication treatment. Simply put, 鈥,鈥 Christofferson asserted.
By 2022, more than 90% of drug courts located in communities with high opioid mortality rates that responded to a survey said they allow buprenorphine and/or methadone, the medications most commonly used to treat addiction. The study also found that 65% of drug court program staffers have received training in medication for treatment, and a similar share have arranged for clients to continue receiving medications while serving jail time for program violations. Still, almost 1 in 4 programs told researchers they overrule medication decisions.
Federal legislation has to it. And Bureau of Justice Assistance funding for treatment-court programs now mandates that medication for substance use disorder be provided.
Solomon experienced that shift in real time in Slone鈥檚 courtroom as the judge allowed her access to medication to treat her addiction to opioids.
As a young prosecutor in the 1990s in mostly rural eastern Tennessee, Slone was embedded with a drug task force and was well versed in efforts to counteract the supply side of the opioid crisis. Then, as a circuit court judge, he鈥檇 put his share of people behind bars on drug-related convictions.
As the crisis deepened, he started to wonder if addressing the demand side would be more effective.
Like so many other prosecutors and judges, Slone believed abstinence was the only path to recovery. But in 2013, after consulting with substance use disorder experts, he relented, introducing medication as an alternative to incarceration for pregnant women. By 2016, he had fully embraced it throughout his recovery courts 鈥 even as most judges, he said, 鈥渟till believed that it was substituting one drug for another.鈥
Building from evidence-based research, Slone has launched programs that show how a judge, and a region, can trade an abstinence-only, lock-鈥檈m-up approach for one that offers a full range of paths to recovery.
Before witnessing medication treatment鈥檚 efficacy, Slone said, he would tell a defendant charged with a drug offense, 鈥溾楾his is your second chance. If you violate the conditions of your probation, I鈥檓 going to put you in jail.鈥欌
Often, six months later they鈥檇 be back in his courtroom, charged with a low-level crime and having tested positive for drugs. 鈥淭hey鈥檙e 19, maybe 20 years old, and I鈥檓 executing a five-year sentence. It makes me sick to my stomach now.鈥
Slone was sure there must be a better way.
A drug recovery court, which he co-founded in his 4th Judicial District in 2009, was a first step. It allows defendants with nonviolent drug-related charges to avoid jail time by entering treatment and counseling. They鈥檙e closely monitored by a team that includes a judge, case manager, public defender, prosecutor, and probation officer. If the participant violates the terms of the agreement, the first step is a reassessment of treatment needs. Multiple violations may result in incarceration.
Because this form of drug court is resource-intensive, relatively few people can be enrolled. So in 2013, Slone introduced the , or TN-ROCS, an alternative to jail for those who aren鈥檛 considered at high risk of recidivism but are deemed in urgent need of treatment. Many are pregnant women or mothers of young children.
Given the reduced need for supervision, the program can accommodate more participants. So far, more than 1,000 people have been on the district鈥檚 TN-ROCS docket.
Both the recovery court and TN-ROCS offer three medication options: buprenorphine, methadone, and naltrexone.
Since TN-ROCS鈥 launch, Slone said, his community has seen a decrease in property crimes and its jail population. Over its first five years, all 34 pregnant women in the program gave birth to healthy babies and 30 kept custody of their children. TN-ROCS is now being replicated across the state.
One barrier to broader acceptance of medication treatment in both rural and urban communities, Christofferson said, is a lack of education.
Corey Williams agrees. He advocates for educating criminal justice system officials. Williams is an officer with the Lubbock, Texas, Police Department and is a consultant with the , which promotes drug policy and criminal justice reform. He believes that if more criminal justice officials had personal experience with medication to treat substance use disorder, they鈥檇 view it differently.
Williams鈥 wife, Brianne Williams, became addicted to opioids in medical school. She participated in a series of abstinence-only programs and was free of the drugs for seven years, then relapsed. She was arrested for writing herself a prescription for opioids and placed on probation.
She had entered a Suboxone treatment program, but her probation officer incorrectly informed her she couldn鈥檛 remain on Suboxone on probation. Williams relapsed, failed a drug test, and served 30 months in federal prison. After her release, she went back on Suboxone 鈥 a brand-name combination of buprenorphine and naloxone 鈥 and has maintained her sobriety. 鈥淚t improved my life drastically,鈥 she said. She now hopes to regain her medical license and specialize in addiction treatment.
The relative is certainly a problem. A shortage, Christofferson noted, is not only an issue in itself, but also a barrier to overcoming stigma. More openings available, more success stories. More success stories, less stigma. Fewer provider options also means one bad actor 鈥 a provider who overprescribes or is otherwise negligent 鈥 perpetuates the stigma. Strict oversight is essential.
Physician Stephen Loyd influenced Slone鈥檚 decision to embrace medication treatment and is now a member of Slone鈥檚 recovery court team. Loyd was practicing internal medicine in eastern Tennessee when he developed a 100-pill-a-day addiction to prescription opioids. He was the inspiration for the character Michael Keaton portrayed in the Hulu series 鈥淒opesick.鈥 Loyd overcame his addiction and served as the state鈥檚 鈥渙pioid czar鈥 under Gov. Bill Haslam from 2016 to 2018.
While in state government, Loyd helped plant the seed for TN-ROCS. He told Slone the first judge to take such an initiative would 鈥渂e on the cover of Time magazine, because your success rates are gonna go up dramatically; you鈥檙e gonna save a bunch of lives.鈥
鈥淗e didn鈥檛 get on the cover of Time,鈥 Loyd allowed, 鈥渂ut he did win the William H. Rehnquist Award.鈥 The is among the country鈥檚 highest judicial honors.
Rachel Solomon contends one of those lives saved was hers.
Today she and her son are together; she鈥檚 employed. She remains on Suboxone. She feels good. And she feels fortunate she arrived in Slone鈥檚 courtroom when she did.
鈥淗e鈥檚 the reason I am where I am today,鈥 she said. 鈥淗e really is.鈥