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Once-resistant rural court officials begin to embrace medications to treat addiction

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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.

Prescription Drug Buprenorphine
Bottles of the generic prescription pain medication buprenorphine, which is used as an alternative to methadone to help people recovering from heroin addiction. 

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.



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Georgia man fakes cancer diagnosis in attempt to win back ex-wife

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In the early hours of New Year’s Day 2021 in Canton, Georgia, Morgan Metzer was awakened to a terrifying sight. A man wearing a mask and all black clothing was standing at her bedroom doorway. The man ran and jumped on top of her. “That’s when he started pistol-whipping me,” Morgan said. The assailant used zip ties to constrain her wrists before strangling her nearly unconscious twice.

Morgan Metzer
An evidence photo of Morgan Metzer following the attack at her home. She was found with her wrists zip-tied, and bruising on her face. 

Cherokee County Sheriff’s Office


“‘You’re gonna regret this, you’ve done really wrong now,'” Morgan recalled the man told her in a deep and gravelly voice that he seemed to be trying to disguise. She said it sounded like Batman. Morgan Metzer’s harrowing attack is the focus of this week’s all-new “48 Hours” reported by contributor Nikki Battiste.  “The ‘Batman’ Intruder” airs Saturday, Dec. 14 at 10/9c on CBS and Paramount+.

Afterward, the attacker placed a pillowcase over her head and picked Morgan up and left her on the back porch, which was connected to the bedroom. He told her not to move until she heard two car honks or he’d kill her. Then all went quiet except the sound of the stream near her secluded home.

Forty minutes passed, but then terror struck again. Morgan heard someone walking towards her and up the porch steps. Initially terrified her attacker had returned, she was surprised to hear a familiar voice.

“‘Oh honey, what happened?'” Morgan remembered her ex-husband, Rod Metzer, said when he found her.

Rod called 911 and law enforcement showed up to the scene. Rod’s rescue of his ex-wife appeared to be an act of heroism.

Morgan and Rod Metzer
Morgan and Rod Metzer

Morgan Metzer


Rod said he had been looking out for Morgan despite their divorce, which came after a nearly 20-year history together. They started dating when Morgan was 14 and Rod was 17 before marrying in their early 20s. The couple had twins, who were spending a few days with Morgan’s sister in Florida when the attack occurred.

Morgan said her decision to file for divorce came after years of what she described as mental and physical abuse from Rod. Rod moved out of Morgan’s home into his own apartment and Morgan was ready to move on. Their divorce was finalized just weeks before the attack.

However, this new start for Morgan was cut short. Earlier in the week, Morgan said Rod called her with shocking news that he had pancreatic cancer.

“And so I rushed to go see him,” Morgan told Battiste. “He showed me doctors’ notes and whatnot.” She allowed Rod to stay at her home to help him cope with his diagnosis. “I needed to be supportive still because it’s the father of my children.” 

During this time, Morgan said Rod was constantly trying to get back together with her. But she had no interest and on the morning of New Year’s Eve, she told Rod he needed to share his health news with his parents.

“He said, ‘No, absolutely not. I’m not telling anybody.’ And that’s when I was like, ‘OK, get out,'” Morgan recalled. Morgan said Rod left, but still spent the day texting her about reconciling. Fed up, Morgan lied and told Rod she was going to sleep at her parents’ home that New Year’s Eve night.

How Rod knew Morgan was at her home, along with the coincidental timing of his arrival after her attack, raised questions with investigators who spoke to Rod at the scene. Rod said he was planning on spending the night at his apartment. However, he told them he heard someone knock on his ground floor apartment window and say Morgan’s name. After Rod tried calling Morgan with no answer, he decided to drive to her house to check on her. He told investigators that going to her house instead of her parents’ was just out of habit.

After interviewing both Morgan and Rod at the scene, investigators became suspicious of Rod’s story. They ordered search warrants on Rod’s apartment, car and electronic devices, uncovering his internet search history. The searches included, “How to get sympathy from your ex” and “How to change the sound of your voice.” One search also stood out to investigators: “cancer letter from hospital.”

Investigators also discovered a fake email account created by Rod, posing as a doctor, to send the cancer diagnosis letter that he showed Morgan. But there was even more.

“He had created a bill for a doctor’s office to show that he was being treated for pancreatic cancer,” said Rachel Ashe, the deputy chief assistant district attorney for Cherokee County. She said Rod “did all of this in order to convince Morgan that he had pancreatic cancer.” He never did.

Rod Metzer eventually pleaded guilty to 14 counts relating to the attack on Morgan Metzer. He was sentenced to 70 years – 25 in prison followed by an additional 45 years of probation. 



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6 endangered Mekong giant catfish — one of the world’s largest and rarest freshwater fish — spotted in Cambodia

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Six critically endangered Mekong giant catfish — one of the largest and rarest freshwater fish in the world — were caught and released recently in Cambodia, reviving hopes for the survival of the species.

The underwater giants can grow up to 10 feet long and weigh up to 660 pounds, or as heavy as a grand piano. They now are only found in Southeast Asia’s Mekong River but in the past inhabited the length of the 3,044 mile-long river, all the way from its outlet in Vietnam to its northern reaches in China’s Yunnan province.

The species’ population has plummeted by 80% in recent decades due to rising pressures from overfishing, dams that block the migratory path the fish follow to spawn and other disruptions.  According to the World Wildlife Fund, some experts believe there may only be a few hundred Mekong giant catfish surviving.

Scientists, officials and fishermen release a 300-pound giant freshwater catfish after it was tagged, into the Mekong River, near Kampong Cham province
Scientists, officials and fishermen release a 300-pound giant freshwater catfish after it was tagged, into the Mekong River, near Kampong Cham province, Cambodia, December 10, 2024. 

Chhut Chheana/USAID Wonders of the Mekong Handout via REUTERS


Few of the millions of people who depend on the Mekong for their livelihoods have ever seen a giant catfish. To find six of the giants, which were caught and released within 5 days, is unprecedented.

The first two were on the Tonle Sap river, a tributary of the Mekong not far from Cambodian capital Phnom Penh. They were given identification tags and released. On Tuesday, fishermen caught four more giant catfish including two longer than 6.5 feet that weighed 264 pounds and 288 pounds, respectively. The captured fish were apparently migrating from their floodplain habitats near Cambodia’s Tonle Sap Lake northward along the Mekong River, likely to spawning grounds in northern Cambodia, Laos or Thailand.

“It’s a hopeful sign that the species is not in imminent, like in the next few years, risk of extinction, which gives conservation activities time to be implemented and to continue to bend the curve away from decline and toward recovery,” said Dr. Zeb Hogan, a University of Nevada Reno research biologist who leads the U.S. Agency for International Development-funded Wonders of the Mekong project.

Much is still unknown about the giant fish, but over the past two decades a joint conservation program by the Wonders of the Mekong and the Cambodian Fisheries Administration has caught, tagged and released around 100 of them, gaining insights into how the catfish migrate, where they live and the health of the species.

“This information is used to establish migration corridors and protect habitats to try to help these fish survive in the future,” said Hogan.

Cambodia Catfish
In this photo released by Zeb Hogan, USAID Wonders of the Mekong Project, people hold a Mekong giant catfish to release it in Mekong River in Kampong Cham, Cambodia on Tuesday, Dec. 10, 2024. 

Zeb Hogan, USAID Wonders of the Mekong Project via AP


The Mekong giant catfish is woven into the region’s cultural fabric, depicted in 3,000-year-old cave paintings, revered in folklore and considered a symbol of the river, whose fisheries feed millions and are valued at $10 billion annually.

Local communities play a crucial role in conservation. Fishermen now know about the importance of reporting accidental catches of rare and endangered species to officials, enabling researchers to reach places where fish have been captured and measure and tag them before releasing them.

“Their cooperation is essential for our research and conservation efforts,” Heng Kong, director of Cambodia’s Inland Fisheries Research and Development Institute, said in a statement.

Apart from the Mekong giant catfish, the river is also home to other large fish including the salmon carp, which was thought to be extinct until it was spotted earlier this year, and the giant sting ray.

That four of these fish were caught and tagged in a single day is likely the “big fish story of the century for the Mekong”, said Brian Eyler, director of the Washington-based Stimson Center’s Southeast Asia Program. He said that seeing them confirms that the annual fish migration was still robust despite all the pressures facing the environment along the Mekong.

“Hopefully what happened this week will show the Mekong countries and the world that the Mekong’s mighty fish population is uniquely special and needs to be conserved,” he said.

Threats to endangered aquatic species

Besides overfishing and plastic pollution, the Mekong River Basin has been degraded by upstream dams and climate change, which have had a major impact on water levels in the critically endangered catfish’s aquatic home.

According to WWF, threats to the Mekong giant catfish include infrastructure development such as dams that block migration routes.

“Without the ability to move up and down rivers, the fish have fewer opportunities to breed,” WWF says.

Scientists, officials and fishermen release a 300-pound giant freshwater catfish after it was tagged, into the Mekong River, near Kampong Cham province
Scientists, officials and fishermen release a 300-pound giant freshwater catfish after it was tagged, into the Mekong River, near Kampong Cham province, Cambodia, December 10, 2024. 

Zeb Hogan/USAID Wonders of the Mekong Handout via REUTERS


Cambodia has placed tough restrictions on fishing in the vast river to try and reduce the number of endangered aquatic species killed in nets.

Numbers of Irrawaddy dolphins — which once swam through much of the mighty Mekong — have dwindled despite efforts to preserve them.

In 2022, Cambodian fishermen got a shock when they inadvertently hooked an endangered giant freshwater stingray four metres (13 feet) long and weighing 180 kilos.

Over the past 25 years, the CFA and researchers tagged and released around 100 giant catfish as part of a conservation program that encourages fishermen to report catches of rare species.

Conservationists said the recent giant catfish catches mark “a new era of conservation” and “new hope for the survival of a species that has become increasingly rare in much of its native habitat”.

Agence France-Presse contributed to this report.



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Former anti-drugs chief known as “Macho” extradited from Bolivia nearly 3 years after U.S. offered $5 million reward

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Bolivia’s former anti-narcotics chief was extradited to the United States on Thursday to face federal drug trafficking charges in a New York court.

Authorities said that Maximiliano Dávila, who served as anti-narcotics chief in the final months of Evo Morales ‘ 2006-2019 administration, helped facilitate planeload shipments of cocaine to the United States. According to the U.S. Justice Department, Dávila exploited his position “to secure access to Bolivian airfields for cocaine transport and to arrange for members of Bolivian law enforcement under his command—including individuals armed with machineguns—to provide protection for those drug loads.”

Dávila  — who authorities say is also known as “Macho” — boarded a private jet sent from the U.S. specifically for his extradition.

On Feb. 2, 2022, the U.S. State Department announced a reward of up to $5 million for information leading to Dávila’s conviction. He is charged with conspiring to provide top level protection for cocaine shipments to the U.S. as well as related weapons charges involving the possession of machine guns. According to the State Department, Dávila “allegedly used his position to safeguard aircraft used to transport cocaine to third countries, for subsequent distribution in the United States.”

Bolivia US Extradition
Police escort former police colonel Maximiliano Davila, center, as he was presented to the media at a Bolivian Police Command office in La Paz, Bolivia, Jan. 23, 2022.

Juan Karita / AP


In late November, Bolivia’s Supreme Court approved Dávila’s immediate extradition to the U.S. He has denied any wrongdoing.

Morales expelled the U.S. Drug Enforcement Administration from Bolivia in 2008, accusing it of plotting to overthrow his government at a time rising commodity prices and a wave of leftist politics throughout South America were challenging longstanding U.S. influence in the region. Meanwhile, the two countries haven’t exchanged ambassadors in more than 15 years.

The drug investigation that led to the charges against Dávila was started by the DEA’s Special Operations Division in 2017, according to court records.

As part of the probe, criminal informants working under the DEA’s direction recorded conversations in which a co-defendant of Dávila bragged of having access to an MD-11 military cargo plane to transport 60 tons of cocaine into the U.S.

The co-defendant, Percy Vasquez-Drew, said that “he and other traffickers had been able to operate with impunity in Bolivia because the DEA and the CIA had been kicked out” and remaining anti-drug officials in the country were easily bribed, prosecutors said in court filings.

Vasquez-Drew was later arrested in Panama on a U.S. warrant. He pleaded guilty in 2020 to a single count of conspiring to smuggle more than 450 kilograms of narcotics into the U.S. Earlier this year, his sentence was reduced to 100 months in federal prison.

Bolivia is the world’s third-largest producer of cocaine.

It’s unclear how close Dávila is to Morales, a former coca grower. But the two appeared together in an October 2019 photograph celebrating Morales’ birthday standing next to several cakes decorated with coca leaves. Also in the picture was the former head of Bolivia’s national police.

While the DEA has arrested numerous Bolivian drug traffickers over the years, including one of Dávila’s predecessors, Morales himself has never been accused of drug trafficking. He has vociferously denounced the U.S.-led drug war in Latin America and defended traditional uses of coca – the raw ingredient of cocaine.



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