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Scientific seminars equip judges to counter opioid crisis

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Science  26 Jul 2019:
Vol. 365, Issue 6451, pp. 334-335
DOI: 10.1126/science.365.6451.334

Soon after taking the bench in 2004, Yellowstone County District Court Judge Ingrid Gustafson noticed a troubling pattern. Many defendants passing through her criminal court in Billings, Montana, were repeat offenders with a substance use disorder that incarcerations had done little to address.

Six years later, Gustafson founded the Yellowstone County Adult Drug Treatment Court to give offenders a chance to complete an addiction treatment program rather than serving prison time for nonviolent felonies. “They're not really criminals,” Gustafson said. “They're people with a bad disease, and they need help managing that disease.”

One of the drug court's first cases involved a middle-aged woman who had spent 15 years in and out of jail for forgery, drug possession, and other crimes related to her methamphetamine addiction. Gustafson assigned the woman to an intensive outpatient treatment provider and tracked her progress in weekly court sessions.

After two stints in the drug court, with a brief relapse in between, the woman completed the program in 2016. While her struggle is not over, Gustafson said, the program's structure has kept her substance abuse at bay. She is now employed, working full-time as a peer counselor at a drug dependency treatment facility. Last year, she was released from probation for the first time in more than two decades.

Dozens of similar cases convinced Gustafson of the importance of understanding the science behind defendants' actions. In May 2018, she traveled to a 2-day judicial seminar on emerging issues in neuroscience. Organized by the American Association for the Advancement of Science and hosted by the Center for the Neural Basis of Cognition, a joint venture of the University of Pittsburgh and Carnegie Mellon University, the conference covered everything from adolescent brain development and dementia to the neuroscience of pain and violence.

The seminar was one of two that AAAS's Scientific Responsibility, Human Rights and Law Program has convened each year since 2006. The idea for the seminars came in 2005, when the Dana Foundation, a private philanthropic organization that supports brain research, came to AAAS looking for a way to expand its work beyond financing scientific studies. The two organizations forged a partnership to give federal, state, and administrative law court judges an opportunity to learn from researchers how advances in neuroscience can inform courtroom decision-making.

Gustafson was impressed by a lecture on the neuroscience of addiction, particularly as it relates to the ongoing opioid crisis, declared a “nationwide public health emergency” in October 2017 by the U.S. Department of Health and Human Services. Though Montana had not been as hard-hit by opioid addiction as other states, Gustafson was concerned that the highly addictive class of drugs, which the Centers for Disease Control and Prevention found responsible for 68% of all fatal overdoses in the United States in 2017 alone, could intensify in her state. She sought a way to make her judicial colleagues aware of the epidemic's causes, as well as evidence-based interventions to combat it.

Now an associate justice of the Montana Supreme Court and chair of its education committee, Gustafson collaborated with AAAS to bring scientific guidance on the opioid crisis to the state's judicial community. On 9 May, at a scenic resort adjacent to Glacier National Park in Whitefish, 42 of the state's district and supreme court judges attended presentations on the causes, neurological effects, and treatments of opioid addiction. It was the first AAAS judicial seminar dedicated to a single topic within the field of neuroscience. AAAS now plans to transform the pilot conference into three more opioid-focused seminars over the next year.

“There are certainly some judges out there who believe you can incarcerate addiction out of people,” Gustafson said. “The more you educate folks on the science behind why just sitting in a jail cell doesn't work so well, and what kind of incentives you need to build into your system, and what we can reasonably expect people with brain damage to do within 6 months to a year to 2 years—it's bound to help.”

Data support the idea that the traditional criminal justice system is ill-suited to free people with substance use disorders from a cycle of relapse and recidivism. According to a 2010 report by Columbia University's National Center on Addiction and Substance Abuse, 65% of U.S. inmates suffer from addiction. Overdoses at least partly explain why offenders are nearly 13 times more likely to die during their first 2 weeks out of prison than the general population, added the report. Meanwhile, nearly 60% of offenders who are spared prison sentences by drug courts complete their assigned treatment regimens and resume normal lives. By contrast, less than 30% of those with a substance use disorder who serve prison time ever get off probation.

Still, as of 2014, 44% of U.S. counties did not have an adult drug court. Dan Ciccarone, who laid out the neuroscience, demography, and social characteristics of the opioid crisis at both the Pittsburgh and Montana seminars, said that cultural resistance to addiction treatments that include opioid substitution therapy, most commonly using methadone or buprenorphine, is widespread and may be driving the continued lack of drug courts.

At the Montana symposium and at other judicial seminars over the past few years, Ciccarone, a professor at the University of California, San Francisco's School of Medicine who has been studying heroin for 18 years and synthetic opioids since their explosion in 2014, has noticed that most judges do not question the science presented on how to most effectively treat addiction. Rather, they often realize that their hands are tied by the political framework in which they operate. Their states, for example, may only reimburse for social treatments, such as 12-step programs, that have been proven less effective than opioid substitution therapy. Ciccarone hopes that the judges he engages will turn to their mayors and governors, with whom they often have strong relationships, and ask for more funding for buprenorphine and methadone clinics.

“We're not trying to act political; we're just presenting the evidence base,” Ciccarone said. “But when you realize that science is political, and that it requires policies to change in certain places and certain times, you empower change agents. We are in a crisis, and this is what we should be doing.”

By attracting leading researchers to present to legal audiences, the neuroscience seminars have earned favorable reviews. The program, for instance, earned the American Bar Association's Judicial Education Award in 2009, making AAAS the first science organization to win the prize.

“It was the best seminar—head and shoulders above anything I've been to before,” said Robert Wester, a county court judge from Nebraska, after the most recent seminar, held over 2 days beginning 6 June at the University of Miami School of Law in Florida. “The nicest part was the presenters' availability for questions and discussion.”

Craig Stark, a neurobiologist who directs two brain imaging centers at the University of California, Irvine, has presented regularly at the AAAS judicial seminars, usually highlighting research showing how memory, which loses detail over time, can lead to faulty eyewitness testimony or flawed recollections by jurors of court proceedings. In Montana, he focused on drugs' ability to hijack the brain's reward circuit by sending inordinate amounts of dopamine from regions associated with the cognitive processing of motivation to regions critically involved in memory.

Stark has been invited by judges attending the AAAS conferences to present research findings to their state bar associations and other legal groups. He estimates that he has given 70 talks to legal audiences since 2007, in some years delivering more presentations to judges and attorneys than to scientists.

“Our job as researchers is to try to understand the world around us,” Stark said. “In isolation, that's great, but if you actually have something that you can do to try to make society better, you really owe it to yourself and to society to do that. If it can help our system be fairer—punish the people who should be and not punish the people who shouldn't—yeah, I'm going to do it.”

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