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Once-resistant rural court officials begin to embrace medications to treat addiction
DANDRIDGE, Tenn. — Rachel Solomon and judges hadn’t been on the best of terms. Then Judge O. Duane Slone “dumbfounded” her.
Solomon was given her first Percocet at age 12 by a family member with a medicine cabinet full. It made her feel numb, she said. “Nothing hurt.” By 17, she was taking 80-milligram OxyContins. A decade later, she was introduced to heroin.
During those years, Solomon was in and out of trouble with the law.
Then, five years ago, at 32, she arrived in Slone’s courtroom, pregnant, fearing the worst. But the state circuit court judge saw promise. He ruled that Solomon would serve jail time for an outstanding warrant for aggravated burglary and then would be placed in a program for pregnant or parenting women recovering from addiction. She would retain custody of her son, Brantley, now 4.
Slone also offered an option that many judges, particularly in rural jurisdictions, at that time were averse to extending: medication for opioid use disorder, or MOUD.
A study conducted a decade ago found that barely half of drug treatment courts offered medication treatment. Those that didn’t cited uncertainty about its efficacy and noted political, judicial, and administrative opposition. But research in the years since has persuaded many of the most insistent abstinence-only advocates.
According to Monica Christofferson, director of treatment court programs at the Center for Justice Innovation, amid an accelerating opioid crisis there has been a “huge shift” among judges, prosecutors, and law enforcement agencies away from the stigma associated with medication treatment. Simply put, “MOUD works,” Christofferson asserted.
By 2022, more than 90% of drug courts located in communities with high opioid mortality rates that responded to a survey said they allow buprenorphine and/or methadone, the medications most commonly used to treat addiction. The study also found that 65% of drug court program staffers have received training in medication for treatment, and a similar share have arranged for clients to continue receiving medications while serving jail time for program violations. Still, almost 1 in 4 programs told researchers they overrule medication decisions.
Federal legislation has lowered the barriers to it. And Bureau of Justice Assistance funding for treatment-court programs now mandates that medication for substance use disorder be provided.
Joe Raedle / Getty Images
Solomon experienced that shift in real time in Slone’s courtroom as the judge allowed her access to medication to treat her addiction to opioids.
As a young prosecutor in the 1990s in mostly rural eastern Tennessee, Slone was embedded with a drug task force and was well versed in efforts to counteract the supply side of the opioid crisis. Then, as a circuit court judge, he’d put his share of people behind bars on drug-related convictions.
As the crisis deepened, he started to wonder if addressing the demand side would be more effective.
Like so many other prosecutors and judges, Slone believed abstinence was the only path to recovery. But in 2013, after consulting with substance use disorder experts, he relented, introducing medication as an alternative to incarceration for pregnant women. By 2016, he had fully embraced it throughout his recovery courts — even as most judges, he said, “still believed that it was substituting one drug for another.”
Building from evidence-based research, Slone has launched programs that show how a judge, and a region, can trade an abstinence-only, lock-’em-up approach for one that offers a full range of paths to recovery.
Before witnessing medication treatment’s efficacy, Slone said, he would tell a defendant charged with a drug offense, “‘This is your second chance. If you violate the conditions of your probation, I’m going to put you in jail.'”
Often, six months later they’d be back in his courtroom, charged with a low-level crime and having tested positive for drugs. “They’re 19, maybe 20 years old, and I’m executing a five-year sentence. It makes me sick to my stomach now.”
Slone was sure there must be a better way.
A drug recovery court, which he co-founded in his 4th Judicial District in 2009, was a first step. It allows defendants with nonviolent drug-related charges to avoid jail time by entering treatment and counseling. They’re closely monitored by a team that includes a judge, case manager, public defender, prosecutor, and probation officer. If the participant violates the terms of the agreement, the first step is a reassessment of treatment needs. Multiple violations may result in incarceration.
Because this form of drug court is resource-intensive, relatively few people can be enrolled. So in 2013, Slone introduced the Tennessee Recovery Oriented Compliance Strategy, or TN-ROCS, an alternative to jail for those who aren’t considered at high risk of recidivism but are deemed in urgent need of treatment. Many are pregnant women or mothers of young children.
Given the reduced need for supervision, the program can accommodate more participants. So far, more than 1,000 people have been on the district’s TN-ROCS docket.
Both the recovery court and TN-ROCS offer three medication options: buprenorphine, methadone, and naltrexone.
Since TN-ROCS’ launch, Slone said, his community has seen a decrease in property crimes and its jail population. Over its first five years, all 34 pregnant women in the program gave birth to healthy babies and 30 kept custody of their children. TN-ROCS is now being replicated across the state.
One barrier to broader acceptance of medication treatment in both rural and urban communities, Christofferson said, is a lack of education.
Corey Williams agrees. He advocates for educating criminal justice system officials. Williams is an officer with the Lubbock, Texas, Police Department and is a consultant with the Law Enforcement Action Partnership, which promotes drug policy and criminal justice reform. He believes that if more criminal justice officials had personal experience with medication to treat substance use disorder, they’d view it differently.
Williams’ wife, Brianne Williams, became addicted to opioids in medical school. She participated in a series of abstinence-only programs and was free of the drugs for seven years, then relapsed. She was arrested for writing herself a prescription for opioids and placed on probation.
She had entered a Suboxone treatment program, but her probation officer incorrectly informed her she couldn’t remain on Suboxone on probation. Williams relapsed, failed a drug test, and served 30 months in federal prison. After her release, she went back on Suboxone — a brand-name combination of buprenorphine and naloxone — and has maintained her sobriety. “It improved my life drastically,” she said. She now hopes to regain her medical license and specialize in addiction treatment.
The relative unavailability in rural areas of medication treatment is certainly a problem. A shortage, Christofferson noted, is not only an issue in itself, but also a barrier to overcoming stigma. More openings available, more success stories. More success stories, less stigma. Fewer provider options also means one bad actor — a provider who overprescribes or is otherwise negligent — perpetuates the stigma. Strict oversight is essential.
Physician Stephen Loyd influenced Slone’s decision to embrace medication treatment and is now a member of Slone’s recovery court team. Loyd was practicing internal medicine in eastern Tennessee when he developed a 100-pill-a-day addiction to prescription opioids. He was the inspiration for the character Michael Keaton portrayed in the Hulu series “Dopesick.” Loyd overcame his addiction and served as the state’s “opioid czar” under Gov. Bill Haslam from 2016 to 2018.
While in state government, Loyd helped plant the seed for TN-ROCS. He told Slone the first judge to take such an initiative would “be on the cover of Time magazine, because your success rates are gonna go up dramatically; you’re gonna save a bunch of lives.”
“He didn’t get on the cover of Time,” Loyd allowed, “but he did win the William H. Rehnquist Award.” The William H. Rehnquist Award for Judicial Excellence is among the country’s highest judicial honors.
Rachel Solomon contends one of those lives saved was hers.
Today she and her son are together; she’s employed. She remains on Suboxone. She feels good. And she feels fortunate she arrived in Slone’s courtroom when she did.
“He’s the reason I am where I am today,” she said. “He really is.”
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
The number of people killed and/or wounded in shootings over the Fourth of July week in the U.S. dipped this year, making it the fourth year in a row gun violence around July 4 has dropped, according to a tally by the Gun Violence Archive.
From July 1 to July 7, 340 people were killed and 756 were wounded for a total of 1,096 shooting victims across the U.S., according to the Gun Violence Archive. In 2023, the week of July 4 in the U.S. saw 451 people shot and killed and another 1,130 wounded. These numbers exclude those who died by suicide.
The archive also recorded 20 mass shootings —which it defines as a shooting in which four or more people are shot and/or killed, not including the shooter— over Fourth of July week this year. That was down from 28 a year ago.
Chicago, which saw a spike in gun violence this year, had the most shootings and deaths over the 2024 holiday, with more than 100 shot and 19 killed since Wednesday, according to the Chicago Police Department. That was a 91% increase in shooting victims compared with last year.
In 2022, the Illinois suburb of Highland Park was the site of a devastating mass shooting in which seven people were killed and dozens more were wounded when a gunman opened fire on the city’s Fourth of July parade. That parade returned this year for the first time since the shooting.
Gun violence in Chicago made Illinois have the most individual shooting incidents of any state over the holiday week this year. California also saw a fairly high number of shooting incidents this year, which is unsurprising given that it is the nation’s most populous state.
The number of shooting victims over the Fourth of July week has been dropping every year since 2020, but they still remain above 2019 levels. That year, there were 1,177 total victims, with 318 deaths and another 859 people wounded. The numbers then spiked in 2020, when 536 people were killed and 1,172 were wounded, for a total of 1,708 gunshot victims.
The Gun Violence Archive also recorded 34 mass shootings in 2020, the highest number over the last six years and a leap up from 18 in 2019.
The U.S. has also seen a slight dip in gun violence overall in the first half of 2024 compared with last year. From Jan. 1 through June 30 of last year, 9,683 people were killed and 18,630 people were wounded in shootings. Over that same period this year, 8,539 were killed with another 16,192 were wounded.
— Erin Cauchi and Anna Schechter contributed reporting.
CBS News
The best Apple AirPods deals ahead of Prime Day 2024 offer great audio at record low prices
Apple
When it comes to headphones, Apple AirPods are massively popular. These crowd-pleasing earbuds pair easily with Apple devices (like your iPhone) and sound great, too. If you’re ready to see what all the fuss is about, you can save some serious cash on each model of the customer-loved earbuds right now, thanks to some must-see early Amazon Prime Day deals.
The second-generation AirPods Pro are Apple’s premium earbuds, with excellent noise cancellation, spatial audio, and waterproofing that makes them ideal candidates for wearing at the gym. There are also the more affordable AirPods that are great for casual listening. For Apple users wanting high-end over-ear headphones, AirPods Max are great for immersive sound.
Not sure which type of AirPods will work best for you? Be sure to check out our in-depth AirPods buyer’s guide for all the info you need to make a purchasing decision before these pre-Prime Day deals go away.
Apple AirPods Pro 2nd Generation: $169 ($80 off)
Apple
With up to 30 hours of battery life via their charging case, the sleek Apple AirPods Pro 2nd Generation wireless earbuds deliver exceptional listening time.
These upgraded earbuds surpass the original AirPods Pro in every way. An improved wireless chip and enhanced active noise cancellation give you an immersive listening experience, and their attractive curves make them even more pleasing to the eye.
For anyone who appreciates lengthy battery life and the very best sound quality, these are a fantastic choice. With all the upgrades over the previous model, the AirPods Pro 2nd Generation represent Apple’s most advanced earbuds yet.
This version of the AirPods now comes with a USB Type-C charging case that also supports wireless charging. Another feature we love: the touch controls built into the stems.
Regularly $249, you can score Apple AirPods Pro 2 for $169 at the Walmart Deals sale or at Amazon as an early Prime Day deal.
Apple AirPods (2nd Generation): $69 ($60 off)
Apple
Though not the newest model, the second-generation Apple AirPods are still a popular choice when it comes to earbuds. Keep in mind, these are not the Pro model, but they’re still worth grabbing.
For Apple users, these are the most seamless earbuds around. They connect effortlessly whenever you need them. While they work with any Bluetooth device that generates audio, they function at their best when they’re paired with an Apple device, such as an iPhone, iPad, Apple Watch, iMac or MacBook.
With a wireless charging case providing more than 24 hours of battery life, one-tap setup for Apple devices, and a low-latency wireless connection for immersive entertainment, it’s easy to see why these earbuds are a hit and continue to sell out.
If you want an affordable option with broad appeal, this version of the AirPods make an excellent everyday wireless earbud option.
Right now, you can grab a pair of AirPods (2nd Generation) for just $69, one of the lowest prices we’ve seen.
Apple AirPods (3rd generation): $129 ($74 off)
Apple
If you don’t need the fanciest AirPods, but still want something new, check out the third generation of the original AirPods. These are perfect for staying current and for everyday use — without breaking the bank.
These AirPods come packed with features like spatial audio, dynamic head tracking and longer battery life. You can get about 30 hours with the included MagSafe charging case. They’re not as advanced at the AirPods Pro 2nd Generation, but they generate really impressive audio.
These AirPods still receive regular Apple updates, so you’ll still get most of the new goodies the other newer models get.
Apple AirPods Max (Pink): $450 ($99 off)
Amazon
If you want to indulge in a luxurious pair of premium quality headphones and you’re already an Apple user, look no further than the AirPods Max. These headphones look just as good as they sound. And in our coverage of the 11 best spatial audio headphones and earbuds for 2024, these were a top pick.
With lavish cushioned ear cups, booming audio, spatial audio with dynamic head tracking, and absolutely fantastic active noise cancellation, the AirPods Max make a bold statement. Everyone will know what you’re wearing — and they’ll probably be jealous, because these things absolutely bump.
Plus, transparency mode lets you tune into your surroundings when needed. And at 15 hours of playtime, these headphones keep your music flowing all day. Beyond performance, the AirPods Max make a fashion statement with a range of stylish color options.
These are the perfect option for anyone looking for a pair of excellent over-the-ear headphones who also wants something stylish.
Currently, only the Pink AirPods Max colorway is on sale at Amazon for $450, so keep an eye out for the other models if you’re hoping to get another kind.
Target tells its customers to expect more while paying less — but soon, its shoppers won’t be able to purchase anything at all with a once-popular form of payment.
The retail giant said in a statement that it will stop accepting personal checks as payment starting July 15. The change, which was earlier reported by Minneapolis TV station KARE, will take place after Target’s Red Circle week, a sales event that ends on July 13.
The change comes amid waning use of personal checks, a form of payment that 9 in 10 consumers used at least once a year as recently as 2009, according to research from the Federal Reserve Bank of Atlanta. But today, only about half of Americans write checks at least once a year, with many shifting to digital payments such as Venmo, Zelle or PayPal, GoBankingRates found.
Target pointed to the shift in consumer preferences as its reason to stop accepting personal checks as payment.
“Due to extremely low volumes, we’ll no longer accept personal checks starting July 15,” a Target spokesperson said in an email. “We have taken several measures to notify guests in advance to aid an easy and efficient checkout experience.”
Target will continue to accept cash; digital wallets; buy now, pay later services; and credit and debit cards as well as SNAP/EBT cards, it said.
A few other retailers don’t accept personal checks, including Aldi’s and Whole Foods, with the latter saying it doesn’t allow checks in order to speed up the checkout process.
Even though fewer Americans are writing checks today, they remain popular with older consumers, GoBankingRates found in its survey. About 1 in 5 people over 66 write several checks each month, while about half of people under 55 don’t write a single check the entire year.
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