Criminal Justice Reform

If there's one thing Tennesseans can agree on, it's that the criminal justice system needs some improvements. In the summer of 2021, the Reentry Success Act and Alternatives to Incarceration Act passed; at the same time telehealth permissions expanded. Jeremy talks with Judge Duane Slone and Dr. Stephen Loyd about how these policy changes will affect justice-involved people with substance use disorder. In particular, we learn about the novel treatment program in rural Jefferson County, which is the only jail in the entire state to offer in-house medication assisted treatment.

Transcript

SPEAKER_00 0:00

Criminal justice reform is the heart of the opioid effect. In that case, the incarceration rate has been steadily increased, primarily due to the use of the criminal justice system as the primary method of approaching subscriptions abuse. I spoke with Dr. Stephen Lloyd, Chief Medical Officer of ADA Recovery, and Circuit Court Judge Dwayne Sloan about recent efforts on criminal justice reform in Tennessee, new and ongoing programs to address recidivism, and about the impact of Ten ROCs, which is the Tennessee Recovery Oriented Compliance Strategy, which Judge Sloan developed in 2013.

SPEAKER_01 0:49

I'm Stephen Lloyd. I'm an internal medicine and addiction medicine physician in Middle and East Tennessee. I'm the chief medical officer at Cedar Recovery and also work in East Tennessee in the fourth judicial district with Judge Dwayne Sloan in addressing opioid use disorder in patients who are coming into the criminal justice system. And last but not least, I'm in recovery from opioid and benzodiazepine addiction myself personally since July 2004.

SPEAKER_02 1:17

So I'm Circuit Court Judge Dwayne Sloan. I have the fourth judicial district in East Tennessee. That's caught Granger Jefferson Severe Counties. I preside over all of the felony docket in Jefferson County and share that docket in Granger County. A variety of projects related to substance use disorder, including Drug Recovery Court and what we call Tin Rocks, which is Tennessee Recovery Oriented Compliance Strategy and the Jefferson County Jail Medication to Assist Opioid Use Disorder Project that Dr. Woods just mentioned.

SPEAKER_00 1:50

Last summer, Tennessee Governor Bill Lee signed two important criminal justice reform bills, the uh Alternatives to Incarceration Act and the Re-entry Success Act. And I'm I'm bringing these up because I was wondering if you could talk a little bit about what these acts mean and if uh you've seen any of their effects in your work or what effects you might expect.

SPEAKER_01 2:08

So, so from the you know from the legal aspect of this, Jeremy, I'm sure Judge uh will address that. I'll address the other side of it. I was actually uh part of the governor's task force to look at criminal justice reform and you know what we learned were what other states had done as far as as trying to cut down on the number of people incarcerated, because as you probably know, more than sixty percent of the people, and it and it's more than that, because sixty percent is a conservative estimate, are incarcerated for nonviolent drug offenses, and many of them for their own addiction. And so my role um in in the task force was to talk about you know sentencing alternatives. Uh, you know, we know about drug courts, but it has limited capacity. In Tennessee, we have Kenrocks, which is a way to increase that capacity to help people with substance use disorder without uh you know increasing your resources. So you can actually do it in the normal confines of of probation. And one of the big things about that is actually treatment of the underlying substance use disorder. And a lot of times people go into jail, they serve their time, they get out, you did nothing to help them with the problem that they came in with, they go back out, they you know the recidivism rate is really high. So my job on the task force was to show some alternatives and some things that we think might work in decreasing recidivism as far as their effect on what we do currently, uh judge would be much better able to handle that question.

SPEAKER_02 3:23

That the intention of the legislation, again, was strictly, I think, in my view, twofold. Well, threefold. Reduce recidivism, um enhance public safety, and uh improve outcomes for people with substance use disorders and mental health disorders. Uh there are limitations with regard to the number of days someone can be incarcerated. Now, uh the uh legislation was uh based on what um has been nationally researched to improve outcomes. Uh so I wanted to acknowledge that.

SPEAKER_01 3:56

So you look at it as like, oh, you know, the judges violating you on the technicality and bringing you back in jail, and that's filling our jails up. So we got to stop that.

SPEAKER_02 4:03

That I agree with. There's a trend really across the nation to limit judicial discretion, and I get it because there's lack of understanding about what a uh what substance use disorders are and co-occurring mental health issues are, and there's over-incarceration. There's no question that there's that. Now, typically as a rule, I wouldn't send somebody for a technical violation for having a positive drug screen, for example, for a single day. But some judges might. And a lot of judges, I think, were ordering people to serve the balance of their sentence for a positive drug screen. That's not best practice. So the administration is trying to address uh those issues. I I think that the struggle for like an administration and a legislative body is to try to get that right. And I and I and I applaud the administration and and their efforts and where they're headed. Uh, and and I get it that not all judges are as as educated as they should be.

SPEAKER_01 4:59

I'd only seen this uh put people back in jail a handful of times. And every time outside of one, Jeremy, is because we thought they were an unbelievable threat to themselves. And we thought that they were way too high of risk, and we felt much better with them being incarcerated and being able to keep an eye on them than we did with them in the community. And that's uh all of them but one. And the other one didn't leave Judge any choice, he absconded, right? He ran.

SPEAKER_00 5:25

You can't have you run, right? I mean, it's rare that Judge Sloan's drug court will put a person with substance use disorder back in jail over minor technical violations. But this compassionate approach is not without its criticisms.

SPEAKER_01 5:36

I'm gonna tell you a word I hate. Molycodlin. Oh, you're just mollycodlin. Well, I first of all, I don't even think it's a real word. But we're not we're not doing that. If people responded to be thrown in jail. All right. Nobody would ever get arrested the second time. They just wouldn't. No, I'm not going back in there again. That's it. If that worked, then I would be all for jailing people uh right off the bat. If it worked. And I have never seen it work. It doesn't work. But there are times that because you know you absolutely have to, and and I think those are the times that I see Judge Sloan do it, and I know he hates it.

SPEAKER_00 6:13

The changes to incarceration protocol with respect to substance use disorder have indeed reduced the rate of incarceration. Even so, there are still barriers that patients face. Judge Sloan explained this to me using the example of a hypothetical person with substance use disorder that might present to his court.

SPEAKER_02 6:30

It may be that I can't find an appropriate placement for her within 15 days, even if I was able to arrest her, then it diminishes my ability to hold her into treatment. Got two things. One, I might not have the level of treatment that she needs. Again, I come back, they're lack of services, they're just not there. Two, because of her uh the where her brain is in recovery, right? That she's in the very beginning, she has very limited judgment and insight.

unknown 6:59

Right.

SPEAKER_02 6:59

So um the leverage is important for those two reasons. Because we have the practical realities of lack of treatment services, for one, in this state. It's well recognized in Tennessee that we have a lot of disparity in services available within communities, especially rural communities, where that uh those services are lacking. Those services are not available a lot of times uh because of bed space, or it may be strictly a monetary uh barrier. Until we get there, we're never gonna obtain the best outcomes we can have. I don't care what your legislation says, I don't care what our policies say, if we can't pay for it, we're not gonna have those best outcomes.

SPEAKER_01 7:37

Yeah, the judge is right. How do you get those services into rural areas, right? And and I think it's gonna be pretty far-fetched to think that you're gonna be able to recruit doctors and health care providers into some of these more sparsely uh populated and rural areas. So you're exactly right. Resources is an issue, and and it's you know, money is always money, and always try to look and see, you know, what can we do besides you know need more money? Everybody always needs more money. So I think there's some things that that that we can do, and and the big one, as you you and I've talked in the past, is utilization of telehealth.

SPEAKER_00 8:08

As discussed in our episode on telehealth, the ability to remotely prescribe medications to treat opioid use disorder, known as MOUDs, will expand treatment and reduce risk of overdose.

SPEAKER_02 8:19

Again, the jury's back on the efficacy in reducing overdose deaths, but there's a recent study uh from a couple of rural jails in Massachusetts that shows the reduction in recidivism for people that begin the uh medication to treat opioid-induced disorder inside the local jails and then transition to a trusted provider in the community.

SPEAKER_00 8:41

Wonderful.

SPEAKER_02 8:42

Uh, do we have anything similar starting up here? Yeah, we sure do. We have we have the it's the only one in the state that I know of, uh, and that's the one we're doing in Jefferson County, where everybody that comes into the local jail is given a brief screening to determine if they have an opioid use disorder. So you begin the medication while they're still in jail, and then when they go from jail, then they're linked to a trusted provider. For example, Dr. Lloyd. When they leave the jail as a part of their sentence, they're to continue to comply with those recommendations that were made, including their medications. There are then frequent reports given to the court, and the court does a compliance review, and that's our TINROCs that were, you know, that we've already established that we're going to then layer into this project. We we expect our outcomes to be better than Massachusetts. And that's been of course it's been followed, and it'll be and uh we'll we'll have data on that um as time goes forward.

SPEAKER_00 9:38

Would that be because of its connection to 10 rocks?

SPEAKER_02 9:40

I think so, yeah. We started it in 2013. Um it uh ironically enough, it we we started it because of my bias against medications to treat opioid use disorder, uh, particularly um uh what I refer to as suboxone and uh and methadone, because I just wasn't seeing any good outcomes and I really just was not uh uh knowledgeable about uh the efficacy of those medications. But what I found though was that the medications were often being prescribed, but the uh what was driving the uh the behavior uh in uh the substance use disorders was a mental health need um that was not being addressed. And it's really simple. I mean, you it's uh number one, uh the essential components are number one that you have an accurate assessment uh that uh determines the um appropriate level of treatment, uh, and then the referral to the best available treatment services and other services for their appropriate length of time. And number two, accountability, and uh that's provided by the probation officer and some degree the court, the judge. And number three, our leverage.

SPEAKER_01 10:49

Yeah, you know, so so ten rocks, first of all, judge taught taught me about it when I was uh I was the assistant commissioner for substance abuse services for the state when I met uh when I met Judge, and and I love drug courts, and he's like, Steve, drug courts have a limited capacity, they're really good. What do you think about this? And he explained 10 rocks to me, and he said, he said, you know, Steve, the judge sets conditions of probation or parole regardless of what the crime is, right? No matter if it's property crime, domestic, whatever it is, the judge set the conditions. So what if the judge set the conditions of the of the probation around being compliant uh with getting an assessment for your alcohol and drug issues, as well as holding you compliant in the treatment process? And Jeremy, it was genius, it was genius.

SPEAKER_02 11:29

Interestingly enough, I was talking with uh Beth Macy, the author of uh Dope Sick, and and I said I've talked for a long time about the three essential components of Tinrocks, but um I've I've added a fourth essential component, and and that component is the secret sauce, and that is relationship. It's the relationship that's developed and the trust that's developed between the the person that's criminal justice involved and the probation officer that understands substance use disorders, that understands adverse childhood uh experiences and the and trauma and and how that might cause a person to behave in a certain way. Then this relationship is developed there and there's trust there between the probation officer who are the rock stars of Tin Rocks. The same thing when they come in front of me in front of the judge, they don't trust me in the beginning because they're not used to dealing with people in authority that um and then being good outcomes from their childhood. Uh, but when they but that trust is developed over time. So, like anyone that you have a good relationship with, you know, you know, you you want to do your best for them uh and be your best self for them. You know they care about you, so that when they're making suggestions or uh requiring you to do certain things, you know it's because that person cares about you.

SPEAKER_01 12:44

And if you ever come to our court, you'll see uh we routinely tell our our clients that we love them, uh that we're proud of them. Uh when they slip or they or they fail, and I don't want to say fail, when they're unsuccessful, you don't come in there and see judge putting people back in jail. Now there are times that that that has to be a consequence, but boy, it's rare.

SPEAKER_00 13:08

For more episodes on in-depth discussions on Tennessee policies related to substance use disorder by a range of local experts. Please subscribe to us wherever you get podcasts and visit our website at smart.tennessee.edu. I'm Jeremy Corvellis. Thank you for listening and see you next month.