One of Trump's first major solutions to the opioid crisis could actually make the problem worse

donald trump opioid crisis

  • President Donald Trump’s opioid commission plans to recommend that drug courts be established in every federal judicial district.
  • Drug courts are meant to divert some defendants with substance abuse disorders into treatment programs rather than prison.
  • But public health experts say drug courts are a harmful way of incorporating the criminal justice system into addiction treatment.

The White House Opioid Commission will recommend on Wednesday that drug courts be established in every federal judicial district in an effort to combat the opioid crisis, according to a draft report obtained by STAT News.

Thousands of drug courts have sprung up across the country since the first was created in 1989, with the goal of diverting certain defendants with drug abuse and addiction issues to treatment, rather than prison. The White House commission’s report, however, found that fewer than one-third of federal judicial districts and just 44% of US counties had drug courts as of 2015.

Drug courts are geared toward criminal defendants arrested on low-level possession charges, or other drug-driven crimes that could carry criminal penalties, Chris Deutsch, communications director for the National Association of Drug Court Professionals, told Business Insider earlier this year. 

The push towards drug courts, Deutsch said, is part of a larger movement toward tailored, evidence-based criminal justice programs that serve different populations and needs.

“Rather than entangling someone in the system for a low-level possession, they can be diverted,” Deutsch said. “We need systems in place that — no matter where you are in the system — you are being diverted based on an assessment. There should be an evidence-based program for you.”

Deutsch declined on Tuesday to comment on the White House commission’s draft report before its formal release.

Drug courts have come under scrutiny by public health experts who say that incorporating the criminal justice system into treatment for a disease such as opioid-use disorder is harmful and can often result in punishing participants by sending them to prison if they relapse, as most people addicted to opioids do.

Many of the cases that come before drug courts shouldn’t touch the criminal justice system at all, according to Mae Quinn, director of the MacArthur Justice Center in St. Louis, a public interest law firm that uses litigation as a tool to provoke criminal justice reform.

“When we try to put a criminal justice overlay over what should be a public health issue, it’s not a good match,” Quinn told Business Insider earlier this year. “We need community-based voluntary options. You shouldn’t have to be arrested to get access to a program.”

Mixing healthcare and criminal justice

opioid addiction heroin crisisDrug courts are also notorious for providing neglectful care to their participants, according to David Patterson, a public health expert at Washington University in St. Louis.

Patterson, who has worked on drug courts in Kentucky and has worked in treatment for more than 15 years, said he has seen drug courts that push participants into signing contracts that bind them to questionable treatment methods such as writing papers, attending boot camps, and various forms of therapy that, in some cases amount, to “pseudoscience.”

Another pitfall is that in the drug court system, judges essentially take on the roles of “clinical treatment directors,” Patterson said, allowing them vast discretion to determine treatment options or jail or prison time, based on participants’ adherence to the court’s rules.

“There is such political branding of drug courts that they are able to treat people however they want to,” Patterson told Business Insider earlier this year.

Andi Peterson, a 26-year-old Utah resident, was one such participant. Peterson told Business Insider last year that she was in and out of drug court for nearly two years after a felony arrest for narcotics possession, where she repeatedly relapsed, was put in jail for months at a time, and eventually faced up to 15 years in state prison. 

Peterson said she was unable to stay off opioids in drug court, despite the treatment provided. She eventually was successful while serving a year in prison, after which she was released. She has stayed in recovery since.

Stories like Peterson’s, said Patterson, are what make him wary of drug courts.

“[The court takes] custody of people with a medical illness and they treat them like it’s a criminal issue. That’s malpractice,” Patterson added. “This would never happen to people with cancer, but because they are an addict they get away with it.”

Vivitrol and drug courts

vivitrol opioids

One issue in particular that has sprung up over the last five years has been the proliferation of drug courts that mandate participants use Vivitrol, a monthly injection that blocks opioid receptors in the brain. Though a recent study suggests some success for Vivitrol, most addiction experts recommend maintenance treatments like Suboxone or methadone despite those treatments having some potential for diversion or abuse. 

“The #1 recommended treatment across the world is indefinite maintainence treatment on Suboxone or methadone. It’s not controversial except in the minds of people who don’t like science,” Mark Willenbring, a leading addiction psychiatrist who runs Alltyr, a treatment clinic in Minneapolis, told Business Insider last month.

The pharmaceutical company Alkermes, the company behind Vivitrol, drew headlines recently after investigations by ProPublica, The New York Times, and the Associated Press reported how the company grew its business from $30 million in 2015 to $209 million a year later, primarily by marketing Vivitrol directly to hundreds of drug courts, particularly to judges in areas hard-hit by opioids who are wary of maintainence treatment.

It is as yet unclear how or when the federal drug courts would be established or what kind of treatment modality they would use.

Establishing more drug courts was just one of 53 recommendations contained in the commission’s report, according to STAT News. President Donald Trump on October 26 declared the opioid crisis a “national public health emergency” and announced several measures the federal government plans to take to address the issue.

SEE ALSO: Trump just declared the opioid crisis a ‘public health emergency’ — here’s what that means

DON’T MISS: Recovering heroin addict explains why it’s so hard to stay clean — even in rehab

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Criminal Minds Exclusive: A Bizarre Kidnapping Case Has the BAU Stumped – TV Guide

It’s another week, and that means another case for the BAU on Criminal Minds.

This time the team is heading to Virginia to tackle a bizarre kidnapping case that has seen four women disappear in the last five years. The satellite office wasn’t able to crack it, so now the big dogs are going in. The only problem is, the team seems stumped as well.

All four women were taken at night with none of their personal belongings. There also have been no bodies found, which means the unsub is keeping them all alive somewhere, “or he’s really good at permanent concealment.” Thanks for that bit of optimism, Prentiss!

Hey Baby Girls: Shemar Moore Answers Your Burning Questions

Since the episode is titled “The Bunker,” we’re going to hope that this Criminal Minds case ends up happier than most, but you never really know.

Criminal Minds airs Wednesdays at 10/9c on CBS.

(Full disclosure: TV Guide is owned by CBS)

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Lies My Client Told Me – Slate Magazine

Manafort hiding while leaving home, Oct. 30, 2017
Former Trump campaign manager Paul Manafort hides behind his car visor as he leaves his home in Alexandria, Virginia, on Monday.

Jonathan Ernst/Reuters

It’s not an overstatement to characterize the attorney-client privilege as the cornerstone of criminal law, an inviolable right that can and must withstand all manner of legal aggression.* It’s also one of the small handful of criminal procedural notions sewn directly into our pop culture fabric. Even if all your legal knowledge comes from watching Law & Order, you’re still likely aware of your Miranda rights; that law enforcement needs probable cause to search your apartment and maybe (but maybe not) your car; and most especially that when you meet with your lawyer, you can tell her the whole ugly story because she can’t be forced to testify against you or even to divulge what you’ve discussed to anyone. Period. Right?

Well … mostly right. On Monday, Politico reported that Chief Judge Beryl A. Howell of the U.S. District Court for the District of Columbia had agreed to allow Robert Mueller to use something called the crime-fraud exception to attorney-client privilege to compel testimony from an attorney who formerly represented Paul Manafort and Manafort’s onetime employee Rick Gates. Although that development got lost in the blizzard of Robert Mueller news, Howell’s willingness to pierce attorney-client privilege, as well as her frank description of falsehoods as falsehoods, was in some sense the big news of the day. It was an astonishing win for the special counsel, one that reveals both Mueller’s willingness to use tough tactics and the ways in which the judicial branch may be willing to treat the cover-ups that emerge from the Trump probe. In a way, the decision revealed that the courts may be as tired of houses built of deception as the rest of us are.


Other than relatively common third-party waivers (which happen when the attorney-client communication occurs outside that protective bubble), exceptions to the sacred attorney-client privilege are incredibly rare. The crime-fraud exception is perhaps the rarest exception of them all. These cases are so infrequent precisely because they require uniquely awful behavior by the client and even sometimes by the client’s attorney. Rule of thumb? Behind any successful crime-fraud exception application there is almost certainly one hell of a story.

In a 37-page opinion dated Oct. 2 and unsealed this week, Judge Howell determined that Manafort and Gates’ former attorney could be compelled by Mueller “to testify before a grand jury regarding limited aspects of her legal representation of the Targets, which testimony the [special counsel’s office] believes will reveal whether the Targets intentionally misled [the Department of Justice] about their work on behalf of a foreign government and foreign officials.”

The crime-fraud exception holds that if a client seeks legal advice in furtherance of a crime, privileged communications between the attorney and client are waived. In effect, the distinction is as follows: You can safely tell your lawyer where you buried the bodies, but you can’t ask your lawyer how to bury the bodies.

The indictment against Manafort and Gates is a veritable laundry list, 12 counts in all, but the charges can be summarized as conspiracy to launder money, failure to disclose foreign bank accounts, failure to register as agents of a foreign principal, and making false and misleading statements to the Foreign Agents Registration Unit. The special counsel’s office alleges that Manafort collected millions of dollars for work he did on behalf of the Ukrainian government between 2007 and 2012 yet declined to report that work to FARA and failed to inform the Internal Revenue Service about the income he earned from this activity.


Fast-forward to late March 2016, when Manafort became Donald Trump’s campaign manager. That lasted until Manafort’s Russian connections—specifically the August 2016 discovery of handwritten ledgers showing $12.7 million in undisclosed cash payments to Manafort—suddenly become a problem for Trump. The then–Republican nominee accepted Manafort’s resignation on Aug. 19, 2016.

A short time later, Trump won the presidential election, an event that surprised many, including perhaps even Trump himself. Consequently, key figures in the Trump campaign began to receive a level of scrutiny they likely hadn’t anticipated. A short time after the election, Manafort and Gates responded to FARA’s request for an explanation of their activities. No doubt aware of their quandary—they should’ve registered but didn’t—Manafort and Gates sought legal help, and so it was their attorney who responded to FARA three times: on Nov. 23, 2016; Feb. 20, 2017; and June 27, 2017.

The problem here was that some of these letters made assertions that turned out to be, from the vantage of the special counsel’s office and then the judge, quite false. As Judge Howell characterized it, the “2017 FARA Submission attempts to paint the Targets as mere spectators in a game when they actually were integral players.” Judge Howell notes that the special counsel’s office wasn’t seeking confidential notes or discussions between counsel and her clients. Mueller and his team merely wanted to confirm facts she had passed along as having originated with Manafort and Gates. To put it another way, Mueller is asking the judge to get him answers to simple questions about whether Manafort and Gates lied to counsel and whether counsel in turn passed those lies along.

In her opinion, Judge Howell says she’s well aware of the centrality of the attorney-client privilege. “The attorney-client and work-product privileges play vital roles in the American legal system, by encouraging persons to consult freely and candidly with counsel, and counsel to advocate vigorously on their clients’ behalves, without fear that doing so may expose a client to embarrassment or further legal jeopardy,” she writes. She pits that privilege, though, against the need to have grand juries do their work, noting that they are “an essential bedrock of democracy, ensuring the peoples’ direct and active participation in determining who must stand trial for criminal offenses.”


The nature of counts 11 and 12 of the indictment—lying, falsifying, and misleading the government—went a long way toward dictating the availability of the crime-fraud exception, which requires a showing that the engagement of legal advice was to further a “criminal or fraudulent scheme.” The evidence suggests Manafort and Gates planned to lie and decided that having a lawyer do that lying for them might help shield them from prosecution. But in so doing they made it easy for Judge Howell to find the requisite nexus between the crime—the lies—and the crime-fraud exception. In addition to allegedly laundering money through Cyprus corporations and Hamptons landscapers, Manafort is effectively being called out for laundering his alleged lies through his attorney. (It’s worth noting that it’s not Manafort and Gates’ attorney who is on the hot seat here. That’s largely because the crime-fraud exception applies when the crime in question involves lying to the government and your attorney is merely a conduit for those lies.)

Assuming the indictment’s accuracy, Manafort has been a modern-day version of Henry Hill in Goodfellas: accepting millions of dollars from dictators, funneling that cash through dozens of foreign corporations, and buying up the good life here in the states (one can never have too many $1,000 neckties). High risk, high reward, and … wait, is that helicopter following me? It shouldn’t surprise anyone, then, to see Manafort allegedly playing fast and loose with his own lawyers. Like his former boss, Manafort seems to hold the view that attorneys are hired help, good for emptying ashtrays and passing along lies.

*Correction, Oct. 31, 2017: This piece originally mistated that it would not be an understatement to characterize the attorney-client privilege as the cornerstone of criminal law. It would not be an overstatment. (Return.)

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