"The risk of severe precipitated opioid withdrawal (POW) is amplified when precipitated by a long-acting opioid antagonist. IM [intramuscular] extended release naltrexone (XRNTX; Vivitrol®) is an FDA approved therapy to prevent relapse of opioid and alcohol abuse. Two cases of precipitated opioid withdrawal from XRNTX are presented that illustrate different patient reactions to POW. A 56-year-old woman developed a hypertensive emergency and required continuous intravenous vasodilator, clonidine, and intensive care monitoring after re-initiation of XRNTX following opioid relapse.
Drug Courts & Treatment Alternatives to Incarceration
"As of December 31, 2014, there were 3,057 drug courts in the United States, representing a 24% increase over the previous five years (Tables 3 and 4 and Figure 2). Adult drug courts were by far the most prevalent model, accounting for just over one-half of all drug courts. Other prevalent models included juvenile drug courts (14% of all drug courts), family drug courts (10%), veterans treatment courts (9%), and DUI courts (9%). The remaining models each accounted for less than 3% of drug courts.
"Virtually all drug courts (98%) reported that at least some of their participants were opioid-dependent in 2010. Prescription opioids were more frequently cited as the primary opioid problem than heroin (66% vs. 26%). This trend is particularly apparent in less densely populated areas: prescription versus heroin rates across the three population areas were: rural (76% vs. 12%), suburban (67% vs. 33%), and urban (prescription opioids less likely to be selected than heroin as the primary opioid; 38% vs. 50%); p < .01.
(Causal Links Between Reduced Drug Use And Reduced Recividism Among Drug Court Clients) "However, one counter-explanation for the seemingly powerful linkage between reduced drug use and reduced criminal behavior is that both outcomes are, essentially, measures of compliance with drug court, probation, or other supervision requirements.
(Probability of Re-Offending by Drug Court Clients) "In the first six months of follow up, we found that drug court offenders were significantly less likely than the comparison group to report engaging in any criminal behavior (28 percent vs. 40 percent, p < .05); and drug court offenders averaged significantly fewer total instances of such behavior (12.8 vs. 34.1 criminal acts, p < .001). We detected additional significant differences in the prevalence of drug-related, DWI/DUI, and property-related criminal behavior.
(Reductions In Drug Use Among Drug Court Clients at 18 Months) "As shown in Table 4-3.5, drug court offenders continued to report less drug use than the comparison group in the year prior to the 18-month survey. Drug court offenders had significantly fewer occurrences of any use (56 percent vs. 76 percent, p < .01), serious use (41 percent vs. 58 percent, p < .01), days of use per month (2.1 vs. 4.8, p <.001), and days of serious use per month (1.1 vs. 2.3; p < .001).
(Reductions In Drug Use Among Drug Court Clients At 6 Months) "As shown in Table 4-3.4, offenders in the drug court used drugs significantly less often than did offenders in the comparison group during the initial six-month tracking period. Overall, 40 percent of drug court participants as compared with 55 percent of comparison offenders reported that they had used at least one of the eight measured substances (p < .05). Drug court offenders also averaged fewer days of drug use per month (1.5 vs. 3.7 days; p < .01) and fewer days of serious use per month (1.0 vs.
(What Happens To Participants' Criminal Charges After Graduation From Drug Court) "In addition, and important to criminal justice stakeholders and participants, themselves, is what happens to a person’s criminal charges after s/he successfully graduates from drug court. Recognizing that some courts may have multiple tracks for drug court participants with perhaps varying kinds of criminal justice outcomes, we asked courts what happens to the criminal charges for the majority of their participants after graduation (see Table 2- 3.33).
(Drug Court Sanctions for Positive Drug Tests) "To further investigate how certain and swift consequences are for program requirement infractions, we asked about how courts responded to particular scenarios; first to positive drug test results and second to other types of infractions. The majority of courts (77.3 percent) indicated that every positive drug test results in a sanction. Additionally, 45.3 percent of courts reported that sanctions escalate and are always more severe than the prior sanction when participants have had repeated infractions.
(When and How Clients Entered Drug Court Programs in 2004) "Courts allow participants to enter the program at a variety of points in the criminal justice process (see Table 2-3.1). Most courts reported multiple ways people could get into their drug court. The greatest percent of courts reported the point of entry for participants is 'after a plea is entered, but final disposition is suspended during treatment,' while the least frequent points of entry include 'as a part of parole violation' and 'as a community reentry from jail/prison program.'