Spring 2012 A Publication of The National Association of Drug Court Professionals Drug Courts WWherehere AAccountabilityccountability MMeetseets CompassionCompassion 18th Annual Training Conference May 30 - June 2 Nashville, TN

2012 National Drug Court Month page 7

GAO Validates Drug Court Effectiveness page 11 Buprenorphine Misuse and Its Effect on M.A.T. in Drug Courts page 13 Board of Directors Staff

Hon. Jeff Bagley Hon. Melanie May (Emeritus) Percy Brooks Brie Johnson Cumming, GA West Palm Beach, FL Registrar Training Coordinator Hon. Michael Barrasse General Barry R. McCaffrey Laquetta Butler Jennifer Lubold Scranton, PA Alexandria, VA Administrative Coordinator Director of Meetings Louis Baxter, MD Connie Payne Brian Clubb Douglas Marlowe, Ph.D., J.D. Princeton, NJ Frankfort, KY DCPI Project Director Chief of Science, Law and Policy Hon. Rogelio Flores Hon. Louis Presenza (Emeritus) Jennifer Columbel Lynda Morgan Santa Maria, CA Philadelphia, PA Senior Director, Public Policy Accounting Technician Evert Fowle Hon. William Ray Price, Jr. Anna Cooper Nejla Routsong Augusta, ME Jefferson City, MO Special Assistant to the CEO Web & Social Media Specialist Hon. Richard Gebelein Hon. Robert Rancourt (Chair) Vanessa Cunningham Matt Stiner Wilmington, DE Center City, MN Research Coordinator Director of Development and Outreach Buddy Gilmore Hon. Ruben Reyes Janet Davis Colorado Springs, CO Lubbock, TX Chief Financial Offi cer Tonya Voelker Assoc. Director of Hon. Pamela Gray Hon. Robert Russell (Emeritus) Kristen Daugherty Legislative Affairs Washington, DC Buffalo, NY Director of Development David Wallace Hon. Bob Helfrich Hon. John R. Schwartz (Emeritus) Chris Deutsch Senior Director, Hattiesburg, MS Rochester, NY Director of Communications National Center for DWI Courts (NCDC) Scott Henggeler, Ph.D. Hon. Chuck Simmons Leonora Fleming Charleston, SC Greenville, SC Training Coordinator Resource Consultants Hon. Jamey H. Hueston Hon. Keith Starrett Robert Foster Baltimore, MD U.S. District Court, MS Director of Membership Hon. Jeri Beth Cohen Senior Judicial Fellow Norma Jaeger Hon. Jeff Tauber (Emeritus) Carson Fox Boise, ID Berkeley, CA NADCP Senior Director Hon. Peggy Hora (ret.) of Operations Senior Judicial Fellow Chief Russell B. Laine Hon. Korey Wahwassuck Algonquin, IL Cass Lake, MN Ingrid Gutierrez Hon. William G. Meyer (ret.) Training Coordinator Senior Judicial Fellow Hon. Leonia J. Lloyd Rev. Dr. James White Detroit, MI Washington, DC Carolyn Hardin Former Congressman Senior Director, National Drug Jim Ramstad Hon. Stephen Manley Court Institute (NDCI) Senior Policy Analyst San Jose, CA West Huddleston Hon. Jeff Tauber (ret.) Chief Executive Offi cer President Emeritus for Life Senior Judicial Fellow Clifford Jacobs Training Coordinator Dana Jenkins Statewide Program Director

NADCP PROMISE STATEMENT: To champion proven strategies within the judicial 1029 N. Royal Street, Suite 201 system that empower drug-using offenders to Alexandria, VA 22314 change their lives. 703.575.9400 phone 703.575.9402 fax NADCP MISSION STATEMENT: Articles and views in this magazine do not necessarily refl ect those of NADCP We will not rest until there are Drug Courts as an organization, its Board of Directors, and other Problem-Solving Courts within reach or any of its subsidiaries. of every person in need. Table of Contents 18TH ANNUAL TRAINING CONFERENCE

NADCP Conference Visit Conference Headquarters: 4 www.nadcp.org/2012_NADCP_Training_Conference 7 National Drug Court Month 8 NADCP Secures $78 million for Nashville, TN Drug Courts in Fiscal Year 2012! May 30 – June 2, 2012 11 GAO Validates Drug Court Effectiveness 13 Buprenorphine Diversion and its Implications for Drug Courts From the desk of West Huddleston, CEO 15 Visit and Learn from a Mentor Adult Drug Court or Veterans Mentor Court for Free!

16 Perspectives from the Field 17 In Case You Missed It… 19 Veterans Treatment Court Training 20 Sharpen Your Skills with NDCI in 2012 21 The National Drug Court Resource Center: A Cutting Edge Site for the Treatment Court Field 21 NADCP Hailed As Champion In New Book 22 Training A DWI Court Near You– NCDC Is “On The Road Again” 23 NADCP Continues to Increase the International Growth of Drug Courts

24 Did you know…

| 3 18th Annual Training Conference May 30–June 2, 2012

NNADCPADCP 1188TTHH ANNNUALNUAL Nashville, TN TR A AININGINING COONFERENCENFERENCE May 30 – June 2, 2012 DRRUGUG COOURTSURTS WWherehere AAccountabilityccountability MMeetseets CCompassionompassion

NADCP Goes To Nashville

rom May 30 to June 2, over 3,500 Drug Court and Problem-Solving Court professionals will gather in Nashville for four days of cutting-edge education Fand world class entertainment. Don’t miss out on the latest resources for your court! Here are some highlights to get you ready for the conference.

NADCP Conference with others who share your role from The NADCP Conference to the rescue! Online Agenda across the nation? To make the most Where else do thousands of Drug Court The NADCP Conference Agenda is of your conference experience, join us and other problem-solving court specially designed to provide every for this groundbreaking webinar! professionals representing hundreds of discipline in your Drug Court or other For more information, visit our courts across the nation come together to problem-solving court with cutting-edge, conference website. learn and assist each other in solving the greatest burning issues in our fi eld? informative sessions during every hour Expo Hall Clinics! you spend at the conference. With 23 This year, for the fi rst time ever, practi- The NADCP Conference is taking specialized tracks of sessions, including “discipline-specifi c” to the next level: This “Legal Issues,” “Evidence-Based Treat- tioners will lead brief, educational clinics year’s conference includes over 20 ment,” “Incentives and Sanctions,” on navigating the Expo Hall. Are you a discipline-specifi c breakouts, including “Law Enforcement and Probation,” coordinator who wants to learn how to breakouts for judges, treatment provid- “The Business of Drug Court,” over 30 gather information for an RFP on ers, probation offi cers, defense attorneys, three-hour Skills-Building Sessions and treatment? Are you a treatment provider prosecutors, coordinators, case managers, more, the conference offers hundreds or judge who wants more information on of hours of education—dozens for each medically assisted treatment? Are you a law enforcement offi cers, child protective and every member of your team! probation or law enforcement offi cer services professionals and more! The who wants more information on supervi- breakouts will meet multiple times First-Ever Conference sion and/or drug testing technology? throughout the conference program, Webinar! Are you a case manager, administrator or giving attendees enhanced opportunities For the fi rst time ever, NADCP will host evaluator who wants more information to tackle complex issues, discuss ethical two “Conference-at-a-Glance” webinars. on management information systems? and other practice dilemmas and review These webinars, hosted in April and May, No problem. There is a clinic for you! the conference program. The fi rst will walk you through the conference breakout will be held on the morning of agenda, including each track of sessions, Discipline-Specifi c Training May 30 before the start of the fi rst discipline-specifi c trainings, Expo Hall Have you ever heard a professional session—and the facilitator will walk and special events. Want to plan which in a Drug Court or problem-solving you through the program and highlight sessions to attend before arriving in court ask, “Is anyone else dealing with the sessions specially designed for your Nashville? Want to triage critical issues these issues?” discipline.

4 | The Magazine of the National Association of Drug Court Professionals 18th Annual Training Conference May 30–June 2, 2012

Be inspired by the lives changed during the Parade of Transformation!

Defense Attorneys Prosecutors Probation Ethics—Due process—Eligibility— Often, prosecutors in Drug Courts and Probation offi cers in Drug Courts and Drug testing—Advocacy! This year’s other problem-solving courts fi nd other problem-solving courts wear many conference offers more than ever for the themselves acting as gatekeeper, prob- hats: supervision, case manager, cheer- defense attorney on the Drug Court lem-solver, and rule-enforcer, all while leader, drug tester, etc. You can get the team. Want to know the latest case law maintaining a rather untraditional role. most current, evidence-based informa- on termination hearings, judicial recusal, What should prosecutors know about tion on these topics, plus learn about and First Amendment issues in Drug treatment, drug testing and supervision? potential ethical hurdles, effective Courts? Look no further. Want to learn What about that new case law on treatment, incentives and sanctions and from seasoned defense attorneys how to termination hearings? Are there ethical more at the NADCP Conference. It will advocate for your clients while partici- issues to consider? What does being on a include dozens of hours of sessions for pating in the Drug Court staffi ng and Drug Court team really mean? The probation offi cers, including the nation’s court? Look no further. Want to know NADCP Conference offers sessions on all leading experts in drug testing, supervi- the myths about drug testing? Look no of these topics and more! sion, behavior modifi cation and more! further. The NADCP has dozens of Treatment Case Management sessions designed just for you! What is the most current research on The clients in Drug Court and problem- Judicial evidence-based treatment? What is the solving courts face many challenges. Judges are the natural leaders of most most effective intervention with addicted What’s a case manager to do? Attend the Drug Court teams. But leading a Drug adults in the justice system? How about NADCP Conference! The conference Court or multiple problem-solving court juvenile interventions? What are effective offers dozens of hours on issues critical dockets while carrying a large caseload interventions for the addicted and to success as a case manager, including can be a daunting task. How do other mentally ill clients in my program? The “Improving Service Delivery in Rural judges do it? What are the ethical issues? NADCP Conference offers dozens of Areas,” “Trauma Informed Care,” “Smart Is there new case law on issues, includ- hours on AOD and mental health Phones, Texting and Skype: How ing due process? What is the research on treatment, including an entire track of Technology Improves Outcomes,” and incentives and sanctions? The NADCP sessions on Evidence-Based Treatment. much, much more! Conference offers specialized sessions for judges in all of these and dozens of Visit Conference Headquarters: other topics! www.nadcp.org/2012_NADCP_Training_Conference

| 5 18th Annual Training Conference May 30–June 2, 2012

1. Among last year’s surprise guests were KEM, Matthew Perry, Denny Seiwell, Alonzo Bodden and Harry Lennix 2. NADCP Members take themselves very seriously at the conference 3. Attendees enjoy one of the many ancillary events during the 2011 Conference.

Law Enforcement NEW* Trauma Informed Care of problem-solving court teams that Law enforcement is a critical part of the This full-day clinic offers a detailed are successfully implementing Drug Court team. Research has proven look into trauma, its causes, diagnosis trauma-informed? care into their daily that Drug Courts with law enforcement and treatment options, plus a review practice. You can’t afford to miss it! have better outcomes. But where can a law enforcement professional learn about Who gets CLE/CJE/CEUU hourhours for the conference? his or her role on the Drug Court team? The NADCP Conference offers dozens of ttorneys and some judges will receive CLE hours, if they SIGN-IN at EACH sessions for law enforcement! A session they attend. Someme judges rereceive Continuing Judicial Education, based upon the requirements in their state. CoContinuing Education Units (CEU) are ononly 30 Skills Building Clinics on obtained for substance abuseuse professionals if ththeir state is ann ICRC state. Individu- Wednesday, May 30th als in this category will receiveeive a certifi cate of aattendance via e-mail-mail a few months Back by Popular Demand* after the conference. Make suree the ee-mail mail aaddress you give NADCP is correct.rect. Hoursurs provided on the certifi cates are based upon the sign-in sheetsts in each Incentives and Sanctions! session; make sure to SIGN-INSIG AT EACH SESSION to receive hours.urs. States that are Two three-hour Skills-Building certifi ed through NAADAC,NAADA will NOT receive a certifi cate of attendance.dance The Sessions will be held on developing Certifi cate of Attendance provided in the registration pappacket (on-site) wiwill be used incentives and sanctions for your since NADCPADCP is a certifi ed provider. Hours on certifi catesca off attendance wwill not be court. Join our expert faculty as they providedd to other prprofessionals and they SHOULDULD NOTT sign-ingn-in at the ssessions. review the research on behavior Due to a variety of requirements by states, attorneys,? judges and substance abuse change and give practical, professionalsonals should check in at the CLE/CJE/CEU desk at the conference to nuts-and-bolts information on ensure correctorrect informinformation is provided forr credit. how best to motivate behavior change in your court! ? ? 6 | The Magazine of the National Association of Drug Court Professionals National Drug Court Month

May 2012 SAVE THE Drug Courts: Where Accountability Meets Compassion DATE!

1. Singer James Taylor hugs a Drug Court graduate during a National Drug Court Month celebration 2. Beverly, a 2003 graduateduate of the DC Drug Court stands with presiding Judge Weisburg. 3. A Florida Drug Court graduate raises his hands in celebrationion during a NDCM commencement ceremony.

ach year, National Drug Court Month (NDCM) shines a light on the collective impact of Drug Courts, DWI Courts, Veterans ETreatment Courts and other treatment court models. NDCM is our greatest opportunity to celebrate our work and the countless lives restored, families reunited, and communities made safer. It is also a time for us to show all policymakers – local, state and national – that Drug Courts are a Proven Budget Solution. We must leave no doubt that Drug Courts are a necessary investment to save money and cut drug abuse and crime.

May 2012 Drug Courts: Where Accountability Key Dates Meets Compassion Congressional District This year is expected to be the biggest NDCM to date, Work Weeks: May 1-4 and May 21-30 culminating in a fi nal celebration during the opening This year, we have a tremendous opportunity to engage ceremony of the NADCP’s 18th Annual Training Confer- Members of Congress. Members of the House and Senate ence in Nashville, TN (May 30-June 2). will be in their home districts from May 1-4 and May Visit www.NADCP.org/NDCM-2012 21-30. Your NDCM fi eld kit will have plenty of informa- Your NDCM Resource Center tion on inviting Members to attend your events. Resources include a special NDCM Webinar and Field Kit, Please keep these dates in mind as you schedule events. your guide for planning special NDCM events. For questions regarding NDCM, please contact Chris Deutsch at [email protected] or 571-384-1857.

| 7 NADCP Secures $78 million for Drug Courts in Fiscal Year 2012!

1. NADCP CEO West Huddleston speaks during a Congressional briefi ng 2. Dr. Doug Marlowe testifi es before the Senate Judiciary Committee 3. Hundreds rally on Capitol Hill to support Drug Court funding 4. Matthew Perry and NADCP Board Chair Judge Robert Rancourt meet with Congressman Jerry Lewis (R-CA)

n December, 2011, Congress briefi ngs, hundreds of meetings with no change to the Drug Treatment fi nalized the Fiscal Year Members of Congress, and thousands of Courts at CSAT). letters and phone calls from the Drug (FY) 2012 budget that will • $35 million for Drug Court Discretion- I Court fi eld, we have secured $78 million ary Grant Program at Bureau of Justice fund the Federal government in federal funding for Drug Courts in Assistance (BJA) that was appropriated until September 30, 2012. Fiscal Year 2012. This is a tremendous by Congress a few weeks ago. victory for Drug Courts. NADCP is honored to report We will need YOUR help to ensure Drug that our efforts over the past FY 12 appropriations include: Courts receive adequate funding for year have paid off. • $43 million for Drug Treatment Fiscal Year 2013. The President is Courts at Center for Substance Abuse expected to make his budget request to As a direct result of NADCP’s Capitol Treatment (CSAT) (the bill provides Congress in late February. Watch for Hill strategy, including our Capitol Hill the same level of funding requested by emails from NADCP on how YOU can rally, a hearing before the Senate the Administration and approved by help secure funding for Drug Courts. Judiciary Committee, two Congressional the Senate, and therefore we anticipate

8 | The Magazine of the National Association of Drug Court Professionals 18th Annual Training Conference Nashville, TN May 30–June 2, 2012 May 30 – June 2, 2012

18TH ANNUAL TRAINING CONFERENCE

See you in Nashville!

| 9 NNADCPADCP 1188TTHH ANNNUALNUAL Nashville, TN TR AININGAINING COONFERENCENFERENCE May 30 – June 2, 2012 DRRUGUG COOURTSURTS WWherehere AAccountabilityccountability MMeetseets CCompassionompassion

HOUSING AND PRE-REGISTRATION Please type or print clearly or attach business card. Fill out form completely, DEADLINE: Wednesday, April 18, 2012 providing personal contact information. Registration Deadlines ❏ Mr. ❏ Ms. ❏ Mrs. ❏ Judge The pre-registration due date is April 18, 2012. Registrations post-marked Name ______or faxed after April 18, 2012, regardless of prior applicable discount, will be charged the rate of $700.00. On-site registrants should come to the on-site Title ______registration counter. Agency/Court/Company ______Cancellation/Substitution Policy Cancellation requests received in writing by close of business on April 18, 2012 ______will receive a full refund less a $75.00 processing fee. Request for refund or substitutions must be made in writing. Substitutions are permitted at all Mailing Address ______times. Refunds are not available after April 18, 2012. City ______General Registration Information Deadline: April 18, 2012 State______ZIP ______Go to ALLRISE.org to register online today! Registrations without payment will not be processed. Do not fax a registration Phone ______form without payment by credit card. Please submit one registration form per Fax ______registrant only. Duplications of the form are acceptable. Type information or write clearly and legibly to ensure accuracy. Pre-registering ensures that your Email ______name will be included in the Conference Networking Directory. Your registra- tion fees include all conference workshops regardless of the registration rate ❏ Please check here if you do not wish to be included in the networking directory. you paid. Registration Fees (check applicable rate) As a conference benefit, NADCP provides a networking directory to all attendees. The networking directory includes attendee contact information. (i.e., Drug Court Registrations will not be processed without payment. professionals and vendors of products and services to the Drug Court field). NADCP Federal Tax Identification Number: 54-1791197 ❏ $550 Member Pre-Registration Rate Registration by Mail (Purchase orders are not accepted) (Valid membership number) ______You may mail a registration form along with a check, money order, or with ❏ $650 Pre-Registration Rate credit card information. Mailed registrations should be sent to: ❏ $350 International Rate NADCP Annual Conference, P.O. Box 79289, Baltimore, MD 21279-0289 ❏ $700 On-site Registration Fee (after April 18, 2012) NADCP Federal Identification number is: 54-1791197 $______Total Payment Membership Payment Information (required to process registration) Want to save money? NADCP Members receive $100 off the conference registration fee as well as many other benefits. Visit www.ALLRISE.org today ❏ Check/Money Order Number ______and click on JOIN. If you are interested in learning more about membership and its benefits, visit our website at www.ALLRISE.org and click on MEMBERSHIP. ❏ Visa ❏ MasterCard ❏ Discover ❏ American Express

Housing Reservations ______- ______- ______- ______Deadline: April 18, 2012 Gaylord National Resort & Convention Center Expires______/______Security Code ______Sleeping rooms will fill up quickly!! Make your reservation today! www.nadcp.org/2012_housing Name on Card ______

Questions, Housing & Registration info Signature ______Housing: Mike Soussi-Tanani (571) 384-1879 or email [email protected] Registration: Percy Brooks (571) 384-1850 or email [email protected] Phone No. of Card Holder ______Fax: (703) 575-9402 Please indicate special needs ______Please check the NADCP website for updated information regarding online registration. www.ALLRISE.org ______GAO Validates Drug Court Effectiveness

ADCP is proud to announce that the United States Government Accountability Offi ce (GAO) released its fourth report on Drug Courts, concluding once again that NDrug Courts reduce recidivism and save money. The report, ADULT DRUG COURTS: Studies Show Courts Reduce Recidivism, but DOJ Could Enhance Future Performance Measure Revision Efforts, validated existing Drug Court research by examining over 30 scientifi cally rigorous studies involving more than 50 Drug Courts throughout the country. The GAO was established to support Congress in meeting its constitutional responsibilities and to help improve the performance and ensure the accountability of the federal government. The scope of this report was mandated by the Fair Sentencing Act of 2010.

Of the 32 Drug Court programs reviewed, 31 showed reductions in recidivism. Of those that performed statistical comparisons, “The GAO report leaves little doubt the large majority (72%) reported statistically signifi cant that Drug Courts must remain a reductions in crime for the Drug Court participants. This conclu- sion is very much in line with those of several scientifi c meta- cornerstone of criminal justice reform” analyses, which all found that 75% to 80% of Drug Courts signifi cantly reduced crime. In the GAO analysis, Drug Court West Huddleston participants were found to have up to a 26 percent lower rate of CEO of the National Association of Drug Court Professionals. recidivism than comparison groups. Re-arrest rates for Drug

| 11 programs with proven results. Drug Courts break the cycle of “This report reinforces the scientifi c drug addiction and crime, and do so with greater effectiveness and at less expense than any other strategy.” merit of Drug Court research, The GAO included in its review the National Institute of Justice’s confi rming that Drug Courts are Multi-Site Adult Drug Court Evaluation (MADCE), which it called “the most comprehensive study on Drug Courts to date.” a proven solution for reducing drug This fi ve-year study published in July also confi rmed that Drug Courts signifi cantly reduce recidivism and drug use. Additional abuse and crime. We know beyond benefi ts were found to include increases in employment, education, family functioning and fi nancial stability. The a reasonable doubt that at least MADCE cost-benefi t analysis determined benefi ts of $6,208 to 75 to 80 percent of Drug Courts society per participant. The GAO concluded, “This is the broadest and most ambitious study of Drug Courts to date; it is achieve reliable and signifi cant well done analytically and the results, as they relate to the impact of Drug Courts, are transparent and well described.” reductions in crime.” In addition to examining Drug Court research, the GAO ana- lyzed improvements made to the Department of Justice (DOJ) Dr. Doug Marlowe Chief of Science, Law and Policy with the National Association Drug Court grant program since the last GAO review in 2002. of Drug Court Professionals The GAO report indicated that steps taken by the Bureau of Justice Assistance within DOJ to redesign performance measures, including a new process used to assess a sample of Adult Drug Court graduates were found to be up to 58 percent below Court grantees’ performance across a range of variables, have comparison groups. improved the implementation of federal Adult Drug Court grants. The GAO concluded that while there are still areas “GAO reports are objective, fact-based, nonpartisan, and held to for improvement, DOJ’s process of revising its performance the highest research standards,” said Dr. Doug Marlowe, Chief of measures adheres to key practices. Science, Law and Policy with the National Association of Drug Court Professionals. “This report reinforces the scientifi c merit of “The Bureau of Justice Assistance within the Department of Drug Court research, confi rming that Drug Courts are a proven Justice continues to demonstrate outstanding leadership in solution for reducing drug abuse and crime. We know beyond a administering and reporting on Adult Drug Court grants, and reasonable doubt that at least 75 to 80 percent of Drug Courts striving to improve data collection,” said Huddleston. “The GAO achieve reliable and signifi cant reductions in crime. This report clearly demonstrates the importance of new BJA perfor- translates into large cost-savings for taxpayers averaging more mance measures and the responsibility of grant recipients to than $6,000 per participant.” comply with reporting requirements.” The GAO reviewed 11 cost-benefi t studies published between 2004 through 2011. These studies provided information to determine net-benefi t, defi ned as the monetary benefi t of reduced recidivism accrued to society from the Drug Court “ The GAO included in its review program through reduced future victimization and justice system expenditures, less the net costs of the Drug Court program. the National Institute of Justice’s Drug Courts were found to have a cost-benefi t as high as Multi-Site Adult Drug Court $47,852 per participant. “The GAO report leaves little doubt that Drug Courts must Evaluation (MADCE), which it remain a cornerstone of criminal justice reform,” said West called “the most comprehensive Huddleston, CEO of the National Association of Drug Court Pro- fessionals. “Now more than ever, we must invest in cost-effective study on Drug Courts to date.”

12 | The Magazine of the National Association of Drug Court Professionals Buprenorphine Diversion and its Implications for Drug Courts From the desk of West Huddleston, CEO

n January 19, 2012, I sent a broadcast email to the Drug OCourt fi eld and numerous partner agencies titled, “Buprenorphine Availability, Diversion, and Misuse: A Summary of the CESAR Series.” The announcement came on the heels of a series of reports released by the Center for Substance Abuse Research (CESAR) at the University of Maryland that highlight growing concerns about the diversion and/or misuse of Buprenorphine/Naloxone (Suboxone® or Subutex®).

Some interpreted this announcement as a shift in NADCP’s position on Medically “I believe medications should be Assisted Treatment (M.A.T.), noting NADCP’s resolution released in July that integrated into their treatment recognizes M.A.T. for addiction—includ- plan, assuming it is part and ing antagonist medications such as naltrexone, agonist medications such as parcel to a clinical assessment, methadone and partial agonist medica- structured treatment, monitoring, tions such as buprenorphine. The West Huddleston, CEO resolution also warns Drug Courts against and objective criteria and blanket prohibitions of M.A.T. for their participants1. In fact, milestones for tapering the dosage such broad-based policies that deny access to M.A.T. medica- tions have been argued to violate Federal anti-discrimination until they can achieve long-term, laws protecting individuals with disabilities and the United abstinence-based recovery” States Constitution.2

| 13 So to be clear, I am a supporter of M.A.T. and in regards to buprenorphine, I advocate for its use in detox and as a longer- “ Drug Courts are a premier model term therapy for those so seriously opioid-dependent that they cannot stop using by other means. For those individuals, I for the delivery of M.A.T.” believe medications should be integrated into their treatment plan, assuming it is part and parcel to a clinical assessment, not trigger a positive opiate test. Therefore, unless Drug Courts structured treatment, monitoring, and objective criteria and mile- run a specifi c drug test for buprenorphine, participants misusing stones for tapering the dosage until they can achieve long-term, the medication go undetected. abstinence-based recovery. Let’s not throw the baby out with the bathwater. Drug Courts are a Absent such a strategy, unintentional consequences can occur. premier model for the delivery of M.A.T. We have the proper For example, there is growing evidence that diversion and abuse clinical team in place to assess the need for medication, the ability of buprenorphine have steadily increased since 2005 when the to monitor its use through drug testing, and the system to respond 3 fi rst generic was approved for marketing. with judicial authority to compliance issues.

According to the National Forensic Laboratory Information Furthermore, there are other medications in physicians’ arsenals System (NFLIS) and the System to Retrieve Information from that can be used in the treatment of alcohol and drug depen- Drug Evidence (STRIDE), federal, state and local laboratories dence that are non-addictive, non-intoxicating, and has no diversion potential. For example, depot naltrexone (Vivitrol®), which has long been associated with alcohol treatment, was “Drug Courts should regularly and approved by the FDA in 2010 for the prevention of relapse to randomly test for buprenorphine opioid dependence following opioid detoxifi cation. Therefore, treatment programs associated with Drug Courts have more to ensure compliance with its options at their disposal than they used to. prescribed and intended uses as We must be careful that the news of buprenorphine misuse and diversion not cause our views about M.A.T. to migrate from a well as to detect non-medical use therapeutic tool to aid in the recovery of addiction to a harmful, among all participants.” addictive drug being abused by clients who wish to avoid a positive drug test. Instead, Drug Courts should regularly and randomly test for buprenorphine to ensure compliance with its prescribed and intended uses as well as to detect non-medical identifi ed fi ve times the number of buprenorphine exhibits in use among all participants. 2010 compared to 2006. According to the Drug Abuse Warning Network (New DAWN ED), an estimated 14,266 emergency room visits were associated with buprenorphine misuse in 2009, 1. National Association of Drug Court Professionals, (2011). NADCP Resolution of the Board more than three times the number in 2006.4 of Directors on the Availability of Medically Assisted Treatment (M.A.T) for Addiction in Drug Courts. Retrieved from http://www.nadcp.org/learn/positions-policy-statements-and- Whether these increases in buprenorphine misuse are associated resolutions/board-resolutions with addicts purchasing the medication on the street to manage 2. Legal Action Center.(2011). Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System. Retrieved from http://www.lac.org/doc_library/lac/ withdrawal symptoms or are due to use by naive opioid abusers publications/MAT_Report_FINAL_12-1-2011.pdf to get high, Drug Courts are forced to take notice and address it. 3. Johanson, C.-E., et al. (2012), Diversion and abuse of buprenorphine: Findings from The key problem Drug Courts face is that buprenorphine cannot national surveys of treatment patients and physicians. Drug and Alcohol Dependence Vol. 120, Issue 1, Pages 190-195 be detected in an onsite drug test for opiates, nor will most 4. Drug Enforcement Administration Offi ce of Diversion Control. (2011). Buprenorphine. laboratories test for buprenorphine unless specifi cally requested Retrieved from http://www.deadiversion.usdoj.gov/drugs_concern/buprenorphine.pdf and purchased. Despite what some believe, buprenophine does

14 | The Magazine of the National Association of Drug Court Professionals Visit and Learn from a Mentor Adult Drug Court or Veterans Mentor Court for Free!

• Starting a Veterans Treatment Court? Mentor Adult Drug Treatment Court Sites • Starting an Adult Drug Court? • San Diego County Drug Court • Looking for the most innovative practices Drug Courts San Diego, CA are using today? • Women’s Rehabilitation Alternative Probation Program (WRAP) NDCI Mentor Court Network for Adult Drug Courts and Chicago, IL Veterans Treatment Courts are exemplary court programs that • Greenup/Lewis County Drug Court you can observe and learn from at no cost. Whether you are Greenup, KY starting your own court or interested in learning the most • Ramsey County Drug Court up-to-date and innovative practices being implemented today, St. Paul, MN these learning sites are for you. • 13th Judicial Circuit Drug Court Columbia, MO • Billings Adult Treatment Court Billings, MT • Philadelphia Treatment Court Philadelphia, PA • York County Drug Court York, PA The Boone County Drug Court team stands ready. • Benton County Drug Court They are one of 14 sites Corvallis, OR you can visit and learn from for free. • Teton County DUI/Drug Court Jackson, WY NDCI, in collaboration with the Bureau of Justice Assistance (BJA) and Center for Substance Abuse Treatment (CSAT) within the Substance Abuse and Mental Health Mentor Veterans Services Administration (SAMHSA), is pleased to offer the Mentor Court Network for Treatment Courts Adult Drug Courts and Veterans Treatment Courts for you to visit and learn from. • Buffalo Veterans Treatment Court Buffalo, NY HOW TO APPLY • Tulsa Veterans Treatment Court Tulsa, OK To learn more about the program and apply to visit a Mentor Court, • Orange County Veterans visit NDCI.org. If you have any questions about the Mentor Court Treatment Court program please contact Ingrid Gutierrez, Training Coordinator: Santa Ana, CA 571-384-1855 or [email protected] • Santa Clara County Veterans Treatment Court San Jose, CA

| 15 Perspectives From the Field Drug Court’s First ‘Pom-Pom Girl’

Holli Casillas shows up to cheer on Drug Court graduates

by George Bowden Snohomish Adult Drug Court Everett, WA

wenty-fi ve miles north escalating criminal conduct. Homeless and you know, she’ll bring pom-poms to of Seattle is Everett, facing prison time after an arrest for auto court.” That comment wasn’t lost on the theft and possession of methamphetamine; prosecutor, John Stansell, but raised as a Washington, the county she was released from jail to participate in cheesehead (Green Bay Packers fan), he T Drug Court. did tell her that if she ever showed up seat for Snohomish County with pom-poms they’d better be red and Snohomish County’s Drug Court can and its Adult Drug Treatment white (for Wisconsin) or green and become a bit vociferous. Judge George Court. While each of the 100 yellow (for the Packers). Bowden encourages participants to participants is unique, Holli applaud and cheer for each other— even Shopping at the dollar store a week later, Casillas stands out as perhaps those heading to jail for the weekend. After Holli noticed some Seahawks pom-poms attending a graduation ceremony, Holli and there, in a corner, for $1, a pair of the only pom-pom girl in the realized this was a “we” program and that red and white pom-poms. Sold! She more than 2,500 Drug Courts she too could provide encouragement for brought them to court but was afraid to across the country. others. She began attending every court bring them out. Then she thought, if session, even when she wasn’t calendared. everyone can applaud, she could add a Now 43 years old, Holli was introduced to little “extra” to that encouragement. And At one Drug Court hearing, when Holli drugs at age 18. Her hope for a nursing so, we now have new tradition—Sno- had stepped out, there were jokes that career gave way to drug dealing, abusive homish County’s offi cial pom-pom girl. relationships, loss of parental rights and she was probably in the bathroom practicing her cheerleading. “Next thing

16 | The Magazine of the National Association of Drug Court Professionals In Case You Missed It…

“ At BJA, we are proud to support these Drug Court and Mental Health Court programs that serve the men and women who fought so bravely to protect our nation.”

Denise O’Donnell BJA Director

Justice Department Funds More Than $1 Million to Veterans Treatment Courts On Veterans Day, NADCP announced that the Depart- these soldiers need in order to help them rejoin our ment of Justice’s Bureau of Justice Assistance (BJA) communities safely as the heroes we know them to be.” awarded $1 million in support for Veterans Treatment “By identifying justice-involved veterans early and Courts in Fiscal Year 2011 under the Adult Discretionary connecting them with mental health and substance Drug Court Program. A total of over one million dollars abuse services at home, Veterans Treatment Courts was provided to: the Judicial Council of California; can stabilize veterans and ensure that they are able Hennepin County, Minn.; the 13th Judicial District Court to return to honor and live productive lives,” said BJA in Yellowstone County, Mont.; and Spokane County, Director Denise E. O’Donnell. “At BJA, we are proud Wash. to support these Drug Court and Mental Health Court “Eighty-one percent of all justice-involved veterans programs that serve the men and women who fought have a substance abuse problem prior to incarcera- so bravely to protect our nation.” tion, and twenty-fi ve percent of these veterans have a Veterans Treatment Courts are eligible to apply mental illness,” said Assistant Attorney General Laurie for Fiscal Year 2012 funding at the Drug Court O. Robinson. “It is our hope that these veteran Drug Discretionary Grant Program. For details visit: Courts can provide the services and treatment that www.ojp.gov/BJA/funding

NADCP Responds to “Drug Court” Reality Show On September 22, NADCP released an offi cial Position Court, NADCP Does Not Support the Casting of Individuals in Statement on Last Shot with Judge Gunn, a nationally syndi- Drug Court, and NADCP Does Not Support the Casting of cated court-based reality television show. For several weeks, Individuals in Substance Abuse Treatment. NADCP researched publically available information on the Immediately upon its release, several media outlets posted show’s production in order to develop the statement and a stories quoting the statement. On September 26, Last Shot with corresponding public relations strategy. NADCP has serious Judge Gunn premiered with very little mainstream media concerns about the show’s representation as a Drug Court and coverage. To read NADCP’s full statement on Last Shot with its casting of individuals in substance abuse treatment and Judge Gunn, visit www.NADCP.org/Learn and select Positions, objects to the show on the following grounds: The Proceed- Policy Statements, and Resolutions. ings Depicted in Last Shot with Judge Gunn are NOT Drug

| 17 Governors Look to Drug Courts to Ease State Budgets and Reform Justice Systems

Drug Courts are at the forefront of criminal justice reform efforts being pursued by governors seeking a solution to overburdened budgets, overcrowded prisons, and families torn apart by drug addiction and crime. Governors from Georgia, New Jersey, Tennessee and Virginia have made Drug Courts a priority in 2012. Georgia Tennessee On January 10, Georgia On January 5, Tennessee Governor Nathan Deal Governor Bill Haslam devoted a substantial portion outlined a plan to lower the of his State of the State state’s violent crime rate by address to announcing his increasing punishment for plan to expand Drug Courts violent criminals and throughout the state: diverting drug addicted offenders into Drug Court. The plan calls for the following I am also recommending $10 million in next year’s budget for action items: the creation of new Accountability Courts–Drug, DUI, Mental Health and Veteran Courts–all of which have proven to be Expand access to drug treatment courts across Tennessee, both cheaper and more effective than traditional courts for with emphasis on treating serious meth and prescription those lower risk offenders falling under their jurisdiction. In drug addictions; focus more of state drug treatment court fact, Drug Courts around this nation have proven to reduce funding for courts serving defendants who would otherwise recidivism by as much as 35%. be incarcerated at the state’s expense; establish regional residential drug treatment court facilities; establish a uniform, effective, and comprehensive evaluation process New Jersey on the performance of drug treatment courts. On January 17, New Jersey Governor Chris Christie announced in his State of the Virginia State address a commitment A week after the Tennessee to expand Drug Courts announcement, Governor throughout the state by Bob McDonnell delivered allowing judges to sentence remarks to the Virginia’s individuals to the program rather than send them to prison: General Assembly, telling At the same time, let us reclaim the lives of those drug them: offenders who have not committed a violent crime… In this year’s budget I have Experience has shown that treating non-violent drug provided localities with a mechanism for obtaining authori- offenders is two-thirds less expensive than housing them in zation for new Drug Courts, at their expense, as long as they prison. And more importantly – as long as they have not meet certain requirements and provide data necessary to violently victimized society – everyone deserves a second evaluate their success. chance, because no life is disposable. Stay informed. NADCP has developed a webpage to keep you up to date as other governors pledge to expand Drug Courts. Visit www.allrise.org for more info.

18 | The Magazine of the National Association of Drug Court Professionals Veterans Treatment Court Training

t the 18th Annual Training Conference, NADCP pulled directly from the Veterans Treatment Court Plan- will continue to provide the most comprehensive ning Initiative (VTCPI) such as “The Promise and Key Apresentations specifi c to Veterans Treatment Components of VTCs,” “The Veteran Target Population,” Courts (VTC) and justice-involved Veterans. On Wednes- and “Combat Operational Stress Reactors.” Additional day, May 30 the all-day Veterans Forum will go in-depth topics on the Track are “Federal and State Agency Support” into advance VTC topics such as Post-traumatic Stress and “Rural VTCs.” In addition to these structured sessions, Disorder, its intersection with Intimate Partner Violence, there will be discipline-specifi c breakouts during the Issues in Mentoring, and more. The Veterans Track – conference for both Veterans Treatment Court practitioners Thursday, May 31 and Friday, June 1 – will include sessions and U.S. Department of Veterans Affairs employees.

The nation’s most respected Justice For Vets is honored to have Veterans Service Organizations been featured in the following: support Justice For Vets.

American AMVETS Blue Star Marine Corps American Bar AMVETS The Atlantic Legion Mothers League Association Magazine Monthly

Military Families National Association Veterans of C-Span The US Conference of United of State Directors of Foreign Wars Mayors Magazine Veterans Affairs

Outreach NADCP works with our nation’s In January, NADCP military leaders to fi nd new presented Veterans approaches to serving justice- Treatment Courts to involved veterans. Veterans mayors across the nation Treatment Court Committee during the U.S. Confer- Chair General Barry McCaffrey and Justice For Vets ence of Mayors Annual Right to Left: Matt Stiner, Brad Cooper, Director of Development and Outreach Matt Stiner met Director, White House Offi ce of the First Winter meeting in with General Craig McKinley, National Guard Bureau Lady/Joining Forces; Hollandale Beach, Washington, D.C. as Chief about Veterans Treatment Courts serving veterans FL Mayor Joy Cooper; Sumter, SC Mayor part of the Community/ Joseph McElveen and Barbara Thompson, Military Relations and members of the National Guard. Director, Department of Defense, Offi ce of Family Policy. Task Force.

| 19 Sharpen Your Skills with NDCI in 2012

NDCI is committed to offering the highest-quality trainings so you can keep your court running at its best.

GUESS WHAT? • The Promise of Drug Courts • Targeting and Eligibility You can bring any training NDCI offers to your state or jurisdiction at no cost to you! Request your ON-DEMAND Training at: www.NDCI.org • Psychopharmacology • Treatment: What Works? • Team Building Subject Matter Training NDCI’s wide-ranging curriculum • Confi dentiality In 2012, NDCI will host the following listing includes: regional training programs: • Comprehensive Drug Court • Motivational Interviewing • Responding to Client Behavior: Incen- Judicial Training • Operational Tune-up Training tives and Sanctions • Comprehensive Drug Court • Incentives and Sanctions • Re-Tooling Your Drug Court Program: Coordinator Training • Ensuring Sustainability of Operational Tune-Up • Comprehensive Drug Court Drug Court Programs Prosecutor Training • Supervising Methamphetamine On Demand Statewide • Comprehensive Drug Court Addicts in Drug Court and Regional Trainings Defense Attorney Training • Cultural Competency for • Comprehensive Drug Court Drug Court Practitioners. Drug Court Statewide and Regional Treatment Provider Training Trainings are available to Drug Court HOW TO APPLY Professionals at all levels of experience. • Comprehensive Drug Court Community Supervision Training Contact Brie Johnson at • Comprehensive Drug Court [email protected] or 571-384-1873 Case Management Training for more information.

20 | The Magazine of the National Association of Drug Court Professionals The National Drug Court Resource Center

A Cutting Edge Site for the Treatment Court Field

The National Drug Court Resource Center “Tune In On Tuesday” Webinar was designed to provide comprehensive Series: NDCI responds to your needs no online resources to the dedicated profes- matter where you live. Our webinars featurere sionals working in Drug Courts, DWI the topics and issues that are most impor- Courts, Veterans Treatment Courts, Tribal tant to you presented by leading experts inn Healing to Wellness Court, Mental Health the fi eld. Want to have your voice heard? Courts and other treatment court models. Let us know what is important to you. Over the last few months, we’ve uploaded Visit www.NDCRC.org to sign up. We also 200 pages of new content ranging from new DISCUSS: Important topics on the inter- host an extensive library of past webinars research, PowerPoint presentations, active discussion board. Share your tips available to view at your convenience. webinar recordings, and sample forms. with the fi eld and gain insight from your Find what you’re looking for today at www. BROWSE: Thousands of materials in colleagues around the world. Current topics NDCRC.org. the new NDCRC Library. Search by topic include: or keyword and get access to the latest • Program Fees TU LEES EN ESPANOL: NDCRC now fea- research, articles, and resources. Along tures a Spanish-language section of materi- • Sharing Innovative Practices the way check out the new Did You Know als, including contracts, policies, participant • Rural Drug Courts function which provides helpful tips and handbooks, and publications-all in one links you to additional information. It’s all at your fi ngertips, visit place and available to download for free! www.NDCRC.org! NADCP Hailed as ‘Champion’ Organization in New Book

How Information Matters: Networks and Public Policy Innovation

NADCPN is the focus of a Court fi eld, the publication of guiding drug court mission was an important new book that examines principles, dissemination of research, and factor in the diffusion and implementation the role of non-profi ts in innovation and collaboration with local, of drug court programs at the local level creating national informa- state and federal government entities with and in state government during a period tion networks to facilitate creating a uniquely effective information of twenty years.” signifi cant policy change. network that has fostered the widespread NADCP fi ghts every day to put Drug In How Information growth and success of Drug Courts. Courts within reach of every person in Matters Auburn Univer- Hale writes, “As the champion, the need. How Information Matters is an sity professor Kathleen NADCP developed several tools that extraordinary analysis of the progress we Hale argues that NADCP provided stability and consistency for have made over the last two decades, and is a ‘champion’ organization whose government administrators who became an important reminder of the intercon- mission, structure and strategic planning interested in drug court as federal grants nectedness of the Drug Court movement. played a key role in institutionalizing for programs came online…The sus- Drug Court policy. Hale credits NADCP’s How Information Matters is now available tained commitment of the NADCP to the development of the professional Drug at www.nadcp.org/books

| 21 Training A DWI Court Near You– NCDC Is “On The Road Again”

n December 8, 2011, the National Highway Traffi c OSafety Administration (NHTSA) released the 2010 High- way Fatality fi gures showing a fi ve percent decline in the number of alcohol-impaired traffi c fatalities, down from 10,759 in 2009 to 10,228. The good news is these numbers have declined by nearly Alcohol Impaired Fatalities 5,600 since 1991 and fewer people are being killed by impaired drivers. However, there is still a long way to go. To continue that decline, DWI Courts must expand and play an even larger role. Hardcore impaired drivers (impaired drivers with a BAC of .15 or higher or a repeat DWI offender) are a signifi - cant portion of the 10,000 fatalities. More DWI Courts are needed nationwide to reduce these deaths even further. To meet the need, NCDC has already started training new teams this year. With training programs scheduled in California, Georgia, Texas, Missouri, and Massachusetts, the number of DWI Courts will continue to expand. More individuals are seeing the difference a DWI Court can make in their community. It is an exciting time as we see lives changed, and communities everywhere made safer.

However, training brand new teams is just • Alcohol Testing: Leveraging An tab and then click Newsletter. To receive a part of what NCDC is doing. Plans are Exploding Technology future editions contact the NCDC being made for the NADCP Annual Director, David Wallace, at dwallace@ Be sure to register for the largest conference Training Conference in Nashville to help dwicourts.org and asked to be added to in the world on substance abuse, mental educate and train established DWI Courts the distribution list. It’s free! health and the criminal justice system. on the latest research and tools. Some of DWI Courts are life saving and life the current sessions planned for DWI Finally, are you getting the most recent transforming, and NCDC is committed to Courts include: information from NCDC through The raising community awareness and provid- DWI Court Reporter? The DWI Court • The Reality and the Science for ing the tools needed for DWI Courts to Reporter is NCDC’s quarterly newsletter Separate Treatment Tracks for Drug do this important work. As NCDC on topics of the day ensuring the DWI and DWI Offenders continues to move forward, do not Court fi eld has the latest information hesitate to contact us if you need any • Female Impaired Drivers: What Do You about traffi c safety matters and addiction Need to Know? issues when dealing with the DWI support or information. • CARS–Driving a New Comprehensive offender. If you haven’t read the Mental Health Assessment for the newsletter, past issues can be found at Impaired Driver www.dwicourt.org under the Resources

22 | The Magazine of the National Association of Drug Court Professionals NADCP Continues to Increase the International Growth of Drug Courts

NADCP At Work Around the World

NADCP is on an international outreach campaign to help spread Drug Courts around the world! Here are some of the countries we visited and impacted over the past year.

Santa Barbara County Superior Court Judge Judge Rogelio Flores was given NADCP International Committee Board Chair Judge Rogelio Flores with the honor to sit next to Magistrado Alberto Amiot, Juez del Segundo Juzgado Dominican Republic President Leonel Fernandez. Judge Flores delivered the de Garantia en Santiago, Chile while the Drug Court calendar was called, opening keynote address at a conference in Santo Domingo on August 1, 2011. November 8, 2011.

| 23 Did you know…

Our YouTube channel has garnered over and recovery. If you’re on Facebook, Like Our social media team is gearing up for 100,000 views. From celebrity PSAs, Us at Facebook.com/AllRise.org and join May, when Drug Courts around the highlights of last year’s massive National thousands of Drug Court professionals, country will celebrate National Drug Conference, to important news stories, concerned citizens, graduates and Court Month. We will post inspiring these videos are yours to share on websites partner organizations. National Drug Court Month content or use to promote your Drug Court. to our social media all month long. NADCP Tweets! Follow #NADCP and Subscribe to our channel and stay up-to- Want to see your court highlighted? #JusticeforVets Twitter feeds. Every day we date! Visit youtube.com/NADCP Send us your news stories, pictures and post interesting, thought provoking videos and show the world that your The All Rise Facebook page is where content to twitter. Join the conversation Drug Court is Where Accountability people come together to share and discuss and follow us today! Meets Compassion. news related to Drug Courts, addiction

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You helped him get through opioid detoxification… NOW YOU CAN HELP HIM PREVENT RELAPSE

VIVITROL® (naltrexone for extended-release injectable suspension) 380 mg/vial is indicated for the prevention of relapse to opioid dependence, following opioid detoxification. Treatment with VIVITROL should be part of a comprehensive management program that includes psychosocial support. Opioid-dependent patients, including those being treated for alcohol dependence, must be opioid-free at the time of initial VIVITROL administration. The first and only once-monthly, nonaddictive, nonnarcotic medication approved to prevent relapse to opioid dependence, following opioid detoxification1

WARNING: HEPATOTOXICITY1 WARNINGS AND PRECAUTIONS Naltrexone has the capacity to cause hepatocellular injury ÎHepatotoxicity when given in excessive doses. ÎInjection site reactions Naltrexone is contraindicated in acute hepatitis or liver ÎEosinophilic pneumonia failure, and its use in patients with active liver disease must ÎHypersensitivity be carefully considered in light of its hepatotoxic effects. ÎUnintended precipitation of opioid withdrawal The margin of separation between the apparently safe dose of Î Opioid overdose at the end of a dosing interval, after missing naltrexone and the dose causing hepatic injury appears to be a dose and following an attempt to overcome opioid blockade only five-fold or less. VIVITROL does not appear to be a ÎDepression and suicidality hepatotoxin at the recommended doses. Î Intramuscular injections When reversal of VIVITROL blockade is required for Patients should be warned of the risk of hepatic injury and advised Î pain management to seek medical attention if they experience symptoms of acute hepatitis. Use of VIVITROL should be discontinued in the event of ADVERSE REACTIONS symptoms and/or signs of acute hepatitis. The adverse events seen most frequently in association with VIVITROL therapy for alcohol dependence (ie, those occurring CONTRAINDICATIONS in *5% and at least twice as frequently with VIVITROL than VIVITROL is contraindicated in: placebo) include nausea, vomiting, injection site reactions ÎPatients with acute hepatitis or liver failure (including induration, pruritus, nodules and swelling), muscle ÎPatients receiving opioid analgesics cramps, dizziness or syncope, somnolence or sedation, anorexia, ÎPatients with current physiologic opioid dependence decreased appetite or other appetite disorders. ÎPatients in acute opioid withdrawal Î Any individual who has failed the naloxone challenge test or The adverse events seen most frequently in association with has a positive urine screen for opioids VIVITROL therapy in opioid-dependent patients (ie, those ÎPatients who have previously exhibited hypersensitivity to occurring in *2% and at least twice as frequently with VIVITROL naltrexone, polylactide-co-glycolide (PLG), carboxymethylcellulose, than placebo) were hepatic enzyme abnormalities, injection site or any other components of the diluent pain, nasopharyngitis, insomnia and toothache.

PLEASE SEE BRIEF SUMMARY OF FULL PRESCRIBING INFORMATION, 1. VIVITROL [full prescribing information]. Waltham, MA: Alkermes, Inc; rev October 2010. INCLUDING BOXED WARNING, ON ADJACENT PAGES.

Alkermes® and VIVITROL® are registered trademarks of Alkermes, Inc. ©2011 Alkermes, Inc. All rights reserved VOD 0031 0611 Printed in U.S.A. www.vivitrol.com VIVITROL® (naltrexone for extended-release injectable suspension) Unintended Precipitation of Opioid Withdrawal: To prevent occurrence of an acute 380 mg/vial abstinence syndrome (withdrawal) in patients dependent on opioids, or exacerbation of a Intramuscular pre-existing subclinical abstinence syndrome, opioid-dependent patients, including those being treated for alcohol dependence, must be opioid-free for a minimum of 7-10 days before BRIEF SUMMARY See package insert for full prescribing information (rev. October 2010). starting VIVITROL treatment. Since the absence of an opioid drug in the urine is often not sufficient proof that a patient is opioid-free, a naloxone challenge test should be employed if WARNING: HEPATOTOXICITY the prescribing physician feels there is a risk of precipitating a withdrawal reaction following Naltrexone has the capacity to cause hepatocellular injury when given in excessive administration of VIVITROL. Patients treated for alcohol dependence with VIVITROL should doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use be assessed for underlying opioid dependence and for any recent use of opioids prior to in patients with active liver disease must be carefully considered in light of its initiation of treatment with VIVITROL. Precipitated opioid withdrawal has been observed in hepatotoxic effects. The margin of separation between the apparently safe dose alcohol-dependent patients in circumstances where the prescriber had been unaware of the of naltrexone and the dose causing hepatic injury appears to be only five-fold or additional use of opioids or dependence on opioids. Opioid Overdose at the End of Dosing less. VIVITROL does not appear to be a hepatotoxin at the recommended doses. Interval, After Missing a Dose and Following an Attempt to Overcome Opioid Blockade: Patients should be warned of the risk of hepatic injury and advised to seek After opioid detoxification, patients are likely to have reduced tolerance to opioids. Although medical attention if they experience symptoms of acute hepatitis. Use of VIVITROL VIVITROL blocks the effects of exogenous opioids for 28 days after administration, cases should be discontinued in the event of symptoms and/or signs of acute hepatitis of opioid overdose with fatal outcomes have been reported in patients who used opioids at [See Warnings and Precautions]. the end of a dosing interval or when missing a dose. Patients who have been treated with INDICATIONS AND USAGE: VIVITROL is an opioid antagonist. VIVITROL should be part VIVITROL may respond to lower doses of opioids than previously used. This could result in of a comprehensive management program that includes psychosocial support. Opioid- potentially life-threatening opioid intoxication (respiratory compromise or arrest, circulatory dependent patients, including those being treated for alcohol dependence, must be opioid- collapse, etc.). Patients should be aware that they may be more sensitive to lower doses free at the time of initial VIVITROL administration. VIVITROL is indicated for the treatment of of opioids after VIVITROL treatment is discontinued. Reduced tolerance is especially of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting concern at the end of a dosing interval, that is, near the end of the month after VIVITROL was prior to initiation of treatment with VIVITROL. Patients should not be actively drinking at the administered, or after a dose of VIVITROL is missed. It is important that patients inform family time of initial VIVITROL administration. In addition, VIVITROL is indicated for the prevention members and the people closest to the patient of this increased sensitivity to opioids and of relapse to opioid dependence, following opioid detoxification. the risk of overdose. There is also the possibility that a patient who is treated with VIVITROL CONTRAINDICATIONS: VIVITROL is contraindicated in: patients with acute hepatitis could overcome the opioid blockade effect of VIVITROL. Although VIVITROL is a potent or liver failure, patients receiving opioid analgesics, patients with current physiologic antagonist with a prolonged pharmacological effect, the blockade produced by VIVITROL opioid dependence, patients in acute opioid withdrawal, any individual who has failed is surmountable. This poses a potential risk to individuals who attempt, on their own, to the naloxone challenge test or has a positive urine screen for opioids, and patients who overcome the blockade by administering large amounts of exogenous opioids. Any attempt have previously exhibited hypersensitivity to naltrexone, polylactide-co-glycolide (PLG), by a patient to overcome the antagonism by taking opioids is very dangerous and may lead carboxymethylcellulose, or any other components of the diluent. to fatal overdose. Injury may arise because the plasma concentration of exogenous opioids attained immediately following their acute administration may be sufficient to overcome WARNINGS AND PRECAUTIONS: Injection Site Reactions: VIVITROL injections may be the competitive receptor blockade. As a consequence, the patient may be in immediate followed by pain, tenderness, induration, swelling, erythema, bruising, or pruritus; however, danger of suffering life-endangering opioid intoxication (e.g., respiratory arrest, circulatory in some cases injection site reactions may be very severe. In the clinical trials, one patient collapse). Patients should be told of the serious consequences of trying to overcome the developed an area of induration that continued to enlarge after 4 weeks, with subsequent opioid blockade. Depression and Suicidality: Alcohol- and opioid-dependent patients, development of necrotic tissue that required surgical excision. In the postmarketing including those taking VIVITROL, should be monitored for the development of depression period, additional cases of injection site reaction with features including induration, or suicidal thinking. Families and caregivers of patients being treated with VIVITROL should cellulitis, hematoma, abscess, sterile abscess, and necrosis, have been reported. Some be alerted to the need to monitor patients for the emergence of symptoms of depression or cases required surgical intervention, including debridement of necrotic tissue. Some suicidality, and to report such symptoms to the patient’s healthcare professional. Alcohol cases resulted in significant scarring. The reported cases occurred primarily in female Dependence: In controlled clinical trials of VIVITROL administered to adults with alcohol patients. VIVITROL is administered as an intramuscular gluteal injection, and inadvertent dependence, adverse events of a suicidal nature (suicidal ideation, suicide attempts, subcutaneous injection of VIVITROL may increase the likelihood of severe injection site completed suicides) were infrequent overall, but were more common in patients treated reactions. The needles provided in the carton are customized needles. VIVITROL must not with VIVITROL than in patients treated with placebo (1% vs. 0). In some cases, the suicidal be injected using any other needle. The needle lengths (either 1.5 inches or 2 inches) may thoughts or behavior occurred after study discontinuation, but were in the context of an not be adequate in every patient because of body habitus. Body habitus should be assessed episode of depression which began while the patient was on study drug. Two completed prior to each injection for each patient to assure that the proper needle is selected and that suicides occurred, both involving patients treated with VIVITROL. Depression-related the needle length is adequate for intramuscular administration. Healthcare professionals events associated with premature discontinuation of study drug were also more common should ensure that the VIVITROL injection is given correctly, and should consider alternate in patients treated with VIVITROL (~1%) than in placebo-treated patients (0). In the 24- treatment for those patients whose body habitus precludes an intramuscular gluteal injection week, placebo-controlled pivotal trial in 624 alcohol-dependent patients, adverse events with one of the provided needles. Patients should be informed that any concerning injection involving depressed mood were reported by 10% of patients treated with VIVITROL 380 site reactions should be brought to the attention of the healthcare professional. Patients mg, as compared to 5% of patients treated with placebo injections. Opioid Dependence: exhibiting signs of abscess, cellulitis, necrosis, or extensive swelling should be evaluated by In an open-label, long-term safety study conducted in the US, adverse events of a suicidal a physician to determine if referral to a surgeon is warranted. Eosinophilic Pneumonia: nature (depressed mood, suicidal ideation, suicide attempt) were reported by 5% of opioid- In clinical trials with VIVITROL, there was one diagnosed case and one suspected case of dependent subjects treated with VIVITROL 380 mg (n=101) and 10% of opioid-dependent eosinophilic pneumonia. Both cases required hospitalization, and resolved after treatment subjects treated with oral naltrexone (n=20). In the 24-week, placebo-controlled pivotal trial with antibiotics and corticosteroids. Similar cases have been reported in postmarketing that was conducted in Russia in 250 opioid-dependent patients, adverse events involving use. Should a person receiving VIVITROL develop progressive dyspnea and hypoxemia, depressed mood or suicidal thinking were not reported by any patient in either treatment the diagnosis of eosinophilic pneumonia should be considered. Patients should be warned group (VIVITROL 380 mg or placebo). Intramuscular Injections: As with any intramuscular of the risk of eosinophilic pneumonia, and advised to seek medical attention should they injection, VIVITROL should be administered with caution to patients with thrombocytopenia develop symptoms of pneumonia. Clinicians should consider the possibility of eosinophilic or any coagulation disorder (e.g., hemophilia and severe hepatic failure). When Reversal pneumonia in patients who do not respond to antibiotics. Hypersensitivity Reactions of VIVITROL Blockade is Required for Pain Management: In an emergency situation in Including Anaphylaxis: Cases of urticaria, angioedema, and anaphylaxis have been patients receiving VIVITROL, suggestions for pain management include regional analgesia observed with use of VIVITROL in the clinical trial setting and in postmarketing use. Patients or use of non-opioid analgesics. If opioid therapy is required as part of anesthesia or should be warned of the risk of hypersensitivity reactions, including anaphylaxis. In the analgesia, patients should be continuously monitored in an anesthesia care setting, by event of a hypersensitivity reaction, patients should be advised to seek immediate medical persons not involved in the conduct of the surgical or diagnostic procedure. The opioid attention in a healthcare setting prepared to treat anaphylaxis. The patient should not therapy must be provided by individuals specifically trained in the use of anesthetic drugs receive any further treatment with VIVITROL. and the management of the respiratory effects of potent opioids, specifically the Musculoskeletal & Arthralgia, 11 5 1 4 24 12 12 6 37 9 establishment and maintenance of a patent airway and assisted ventilation. Irrespective Connective Tissue arthritis, joint of the drug chosen to reverse VIVITROL blockade, the patient should be monitored closely Disorders stiffness Back pain, back 10514126147276 by appropriately trained personnel in a setting equipped and staffed for cardiopulmonary stiffness resuscitation. Alcohol Withdrawal: Use of VIVITROL does not eliminate nor diminish alcohol Muscle 310016852215 withdrawal symptoms. Interference with Laboratory Tests: VIVITROL may be cross- cramps f) reactive with certain immunoassay methods for the detection of drugs of abuse (specifically Skin & Subcutaneous Rash g) 84312126105256 opioids) in urine. For further information, reference to the specific immunoassay instructions Tissue Disorders is recommended. Nervous System Headache h) 39189 36512534169421 ADVERSE REACTIONS: Clinical Studies Experience: Because clinical trials are conducted Disorders Dizziness 9 4 4 16271327135813 under widely varying conditions, adverse reaction rates observed in the clinical trials of a syncope drug cannot be directly compared to rates in the clinical trials of another drug and may not Somnolence, 213128494205 reflect the rates observed in practice. In all controlled and uncontrolled trials during the sedation premarketing development of VIVITROL, more than 1100 patients with alcohol and/or opioid Metabolism & Anorexia, 6 3 5 2030141364811 dependence have been treated with VIVITROL. Approximately 700 patients have been Nutrition Disorders appetite decreased NOS, appetite treated for 6 months or more, and more than 400 for 1 year or longer. Adverse Events disorder NOS Leading to Discontinuation of Treatment: Alcohol Dependence: In controlled trials of 6 months or less in alcohol-dependent patients, 9% of alcohol-dependent patients treated a) Includes the preferred terms: diarrhea NOS; frequent bowel movements; gastrointestinal with VIVITROL discontinued treatment due to an adverse event, as compared to 7% of upset; loose stools the alcohol-dependent patients treated with placebo. Adverse events in the VIVITROL 380 b) Includes the preferred terms: abdominal pain NOS; abdominal pain upper; stomach mg group that led to more dropouts than in the placebo-treated group were injection site discomfort; abdominal pain lower reactions (3%), nausea (2%), pregnancy (1%), headache (1%), and suicide-related events c) Includes the preferred terms: nasopharyngitis; pharyngitis streptococcal; pharyngitis NOS (0.3%). In the placebo group, 1% of patients withdrew due to injection site reactions, and 0% of patients withdrew due to the other adverse events. Opioid Dependence: In a controlled d) Includes the preferred terms: anxiety NEC; anxiety aggravated; agitation; obsessive trial of 6 months, 2% of opioid-dependent patients treated with VIVITROL discontinued compulsive disorder; panic attack; nervousness; post-traumatic stress treatment due to an adverse event, as compared to 2% of the opioid-dependent patients e) Includes the preferred terms: malaise; fatigue (these two comprise the majority of treated with placebo. cases); lethargy; sluggishness f ) Includes the preferred terms: muscle cramps; spasms; tightness; twitching; stiffness; rigidity Common Adverse Reactions: Alcohol Dependence: g) Includes the preferred terms: rash NOS; rash papular; heat rash Table 1: Treatment-emergent Adverse Reactions (Reactions in 5% of patients with * h) Includes the preferred terms: headache NOS; sinus headache; migraine; frequent headaches alcohol dependence treated with VIVITROL and occurring more frequently in the combined VIVITROL group than in the placebo group). Common Adverse Reactions: Opioid Dependence In the open-label, long-term safety study conducted in the US, the commonly-reported Body System Adverse Reaction/ Placebo Naltrexone for extended-release injectable Preferred Term suspension adverse reactions among the opioid-dependent patients in the study were similar to those commonly observed events in the alcohol-dependent populations in VIVITROL clinical trials N=214 400 mg 380 mg 190 mg All N=25 N=205 N=210 N=440 as displayed in Table 1, above. For example, injection site reactions of all types, N%N%N%N%N% nausea and diarrhea occurred in more than 5% of patients on VIVITROL in the open- Gastrointestinal Nausea 24 11 8 32 68 33 53 25 129 29 label study. In contrast, 48% of the opioid-dependent patients had at least one Disorders adverse event in the “Infections and Infestations” Body System. Adverse Reactions/ Vomiting NOS 12 6 3 12 28 14 22 10 53 12 Preferred Terms of nasopharyngitis, upper respiratory tract infection, urinary tract a) Diarrhea 21103 12271327135713 infection, and sinusitis were most commonly reported. Abdominal pain b) 178 4 16231123115011 In the placebo-controlled study in opioid-dependent patients conducted in Russia, the Dry mouth 9462410584245 overall frequency of adverse events was lower than in the US population described above. Infections & Pharyngitis c) 23110 0 221135175713 Infestations Table 2 lists treatment-emergent clinical adverse events, regardless of causality, occurring Psychiatric Insomnia, sleep 25122 8 291427135813 in *2% of patients with opioid dependence, for which the incidence was greater in the Disorders disorder VIVITROL group than in the placebo group. All adverse events were assessed as having a Anxiety d) 1782824121684210 maximum intensity of “mild” or “moderate”. Depression 940017873245 Table 2: Treatment-emergent Clinical Adverse Events (Events in * 2% of patients with General Disorders & Any ISR 106 50 22 88 142 69 121 58 285 65 opioid dependence treated with VIVITROL and occurring more frequently in the VIVITROL Administration Site Injection site 83 39 18 72 92 45 89 42 199 45 Conditions group than in the placebo group). tenderness Injection site 18 8 7 28 71 35 52 25 130 30 Body System Adverse Event/ Placebo VIVITROL 380 mg induration Preferred Term N=124 N=126 Injection site pain1670 0 341722105613 n%n% Other ISR 8 4 8 3230151685412 Investigations Alanine 7 6 16 13 (primarily nodules, aminotransferase swelling) increased Injection site 0 0 0 0 2110136348 Aspartate 321310 pruritus aminotransferase Injection site 1150014794235 increased ecchymosis Gamma- 4397 Asthenic 26123 12472340199020 glutamyltransferase conditions e) increased Infections & Infestations Nasopharyngitis 3 2 9 7 Influenza 5 4 6 5

Psychiatric Disorders Insomnia 1 1 8 6 Labor and Delivery: The potential effect of VIVITROL on duration of labor and delivery Vascular Disorders Hypertension 4365 in humans is unknown. Nursing Mothers: Transfer of naltrexone and 6ß-naltrexol into human milk has been reported with oral naltrexone. Because of the potential for General Disorders and Injection site pain1165 tumorigenicity shown for naltrexone in animal studies, and because of the potential Administration Site Conditions for serious adverse reactions in nursing infants from VIVITROL, a decision should be

Gastrointestinal Disorders Toothache 2254 made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Pediatric Use: The safety and efficacy of VIVITROL have not been established in the pediatric population. The pharmacokinetics Nervous System Disorders Headache 3243 of VIVITROL have not been evaluated in a pediatric population. Geriatric Use: In trials of alcohol-dependent subjects, 2.6% (n=26) of subjects were >65 years of age, and one Laboratory Tests: Eosinophil Count: In clinical trials, subjects on VIVITROL had increases patient was >75 years of age. Clinical studies of VIVITROL did not include sufficient in eosinophil counts relative to subjects on placebo. With continued use of VIVITROL, numbers of subjects age 65 and over to determine whether they respond differently from eosinophil counts returned to normal over a period of several months. Platelet Count: younger subjects. No subjects over age 65 were included in studies of opioid-dependent VIVITROL 380 mg was associated with a decrease in platelet count. In clinical trials, subjects. The pharmacokinetics of VIVITROL have not been evaluated in the geriatric alcohol-dependent patients treated with VIVITROL experienced a mean maximal decrease population. Renal Impairment: Pharmacokinetics of VIVITROL are not altered in subjects in platelet count of 17.8 x 103/μL, compared to 2.6 x 103/μL in placebo patients. After 24 with mild renal insufficiency (creatinine clearance of 50-80 mL/min). Dose adjustment is weeks of treatment, opioid-dependent patients treated with VIVITROL experienced a mean not required in patients with mild renal impairment. VIVITROL pharmacokinetics have maximal decrease in platelet count of 62.8 x 103/μL, compared to 39.9 x 103/μL in placebo not been evaluated in subjects with moderate and severe renal insufficiency. Because patients. In randomized controlled trials, VIVITROL was not associated with an increase in naltrexone and its primary metabolite are excreted primarily in the urine, caution is bleeding-related adverse events. Hepatic Enzyme Elevations: In short-term, controlled trials, recommended in administering VIVITROL to patients with moderate to severe renal in alcohol-dependent patients, the incidence of AST elevations associated with VIVITROL impairment. Hepatic Impairment: The pharmacokinetics of VIVITROL are not altered in treatment was similar to that observed with oral naltrexone treatment (1.5% each) and subjects with mild to moderate hepatic impairment (Groups A and B of the Child-Pugh slightly higher than observed with placebo treatment (0.9%). In the 6-month controlled classification). Dose adjustment is not required in subjects with mild or moderate hepatic trial conducted in opioid-dependent subjects, 89% had a baseline diagnosis of hepatitis impairment. VIVITROL pharmacokinetics were not evaluated in subjects with severe C infection, and 41% had a baseline diagnosis of HIV infection. There were frequently hepatic impairment. observed elevated liver enzyme levels (ALT, AST, and GGT); these were more commonly Drug Interactions: Patients taking VIVITROL may not benefit from opioid-containing reported as adverse events in the VIVITROL 380 mg group than in the placebo group. medicines. Naltrexone antagonizes the effects of opioid-containing medicines, such as Patients could not enroll in this trial if they had a baseline ALT or AST value that was more cough and cold remedies, antidiarrheal preparations and opioid analgesics. than three times the upper limit of normal. More patients treated with VIVITROL in this study experienced treatment-emergent elevations in transaminases to more than three times the OVERDOSAGE: There is limited experience with overdose of VIVITROL. Single doses up to upper limit of normal than patients treated with placebo. Shifts to more than three times the 784 mg were administered to 5 healthy subjects. There were no serious or severe adverse upper limit of normal occurred in 20% of patients treated with VIVITROL as compared with events. The most common effects were injection site reactions, nausea, abdominal pain, 13% of placebo patients. Shifts in values of AST to more than three times the upper limit somnolence, and dizziness. There were no significant increases in hepatic enzymes. In were also more common in the VIVITROL (14%) arm compared with the placebo (11%) arm. the event of an overdose, appropriate supportive treatment should be initiated. Opioid-dependent patients treated with VIVITROL experienced a mean maximal increase This brief summary is based on VIVITROL Full Prescribing Information from baseline ALT levels of 61 IU/L compared with 48 IU/L in placebo patients. Similarly (rev. October 2010). for AST, opioid-dependent patients treated with VIVITROL experienced a mean maximal increase from baseline AST levels of 40 IU/L compared with 31 IU/L in placebo patients. Creatinine Phosphokinase: In short-term controlled trials in alcohol-dependent patients, more patients treated with VIVITROL 380 mg (11%) and oral naltrexone (17%) shifted from normal creatinine phosphokinase (CPK) levels before treatment to abnormal CPK levels at the end of the trials, compared to placebo patients (8%). In open-label trials, 16% of patients dosed for more than 6 months had increases in CPK. For both the oral naltrexone and VIVITROL 380 mg groups, CPK abnormalities were most frequently in the range of 1–2 x ULN. However, there were reports of CPK abnormalities as high as 4 x ULN for the oral naltrexone group, and 35 x ULN for the VIVITROL 380 mg group. Overall, there were no differences between the placebo and naltrexone (oral or injectable) groups with respect to the proportions of patients with a CPK value at least three times the upper limit of normal. No factors other than naltrexone exposure were associated with the CPK elevations. More opioid-dependent patients treated with VIVITROL 380 mg (39%) shifted from normal CPK levels before treatment to abnormal CPK levels during the study as compared to patients treated with placebo (32%). There were reports of CPK abnormalities as high as 41.8 x ULN for the placebo group, and 22.1 x ULN for the VIVITROL 380 mg group. USE IN SPECIFIC POPULATIONS: Pregnancy: There are no adequate and well-controlled studies of either naltrexone or VIVITROL in pregnant women. VIVITROL should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Pregnancy Category C: Reproduction and developmental studies have not been conducted for VIVITROL. Studies with naltrexone administered via the oral route have been conducted in pregnant rats and rabbits. Teratogenic Effects: Naltrexone has been shown to increase the incidence of early fetal loss when given to rats at doses * 30 mg/kg/day (11-times the human exposure based on an AUC(0-28d) comparison) and to rabbits at oral doses * 60 mg/ kg/day (2-times the human exposure based on an AUC(0-28d) comparison). There was no evidence of teratogenicity when naltrexone was administered orally to rats Alkermes® and VIVITROL® are registered trademarks of Alkermes, Inc. and rabbits during the period of major organogenesis at doses up to 200 mg/kg/day Manufactured and marketed by Alkermes, Inc. (175- and 14-times the human exposure based on an AUC comparison, respectively). (0-28d) ©2010 Alkermes, Inc. VIV 107G December 2010 Printed in U.S.A. All rights reserved. 1029 N. Royal Street, Suite 201 • Alexandria, VA 22314

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