DILEMMA OF DRUG COURTS

Most proponents and providers of methadone maintenance are outraged that this form of treatment, shown for 40 years to be without parallel in efficacy, is generally denied defendants by judges and prosecutors in "drug courts," even those defendants who are already receiving methadone and responding well to the treatment.

Sure - it's indeed outrageous that the courts presume to overrule physicians and dictate what medical treatment is and is not permissable. But it's almost as troubling when physicians accept patients who are sent to them under circumstances that are diametrically opposed to the concept of "voluntarism." It's also distressing, to say the least, for the doctor to accept a situation in which patients will be punished by imprisonment simply because the treatment they received was less than optimally effective - ie, when illicit drug use persists.

Drug court defenders say no one is really "forced" to participate; but it's clearly disingenuous in the extreme to suggest that "Hey, it's a free country; the defendant is always able to choose the option of going to prison instead of to the methadone program." In any event, this obvious absurdity is little comfort to the physician who participates in a system that everyone knows is - and is intended to be - a way to blackmail people into accepting treatment.

No easy answers - but worth thinking about.