1. Basic Cost / Benefit Analysis of Drug Court Client Costs Prescription Drug Abuse and Overdose Prevention Rapid Response Drug Task Force Presented to the Rapid Response Drug Task Force Meeting on January 22, 2013

2. Research-based Drug Court Results Substance Use: Significant reductions in drug relapse Crime: Significant reductions in criminal behavior Other Psychosocial Outcomes: Participants experience benefits in other areas of their lives besides drug use and criminal behavior *Employment *Educational *Financial Source: Source: The Multi-Site Adult Drug Court Evaluation: Executive Summary http://www.urban.org/uploadedpdf/412353-multi-site-adult-drug-court.pdf

3. What Makes Drug Courts Work? Role of the Judge Role of Other Offender Attitudes Role of Court Policies and Practices Source: The Multi-Site Adult Drug Court Evaluation: Executive Summary http://www.urban.org/uploadedpdf/412353-multi-site-adult-drug-court.pdf

4. Drug Courts Save Do$$ars Every $1 spent on drug courts yields $2.21 in savings in the criminal justice system alone Approximately 120,000 clients nation-wide receive – Help to break the cycle of addiction – Recidivism Source: Fact Sheet Drug Courts, May 2011 http://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/drug_courts_fact_sheet_5-31-11.pdf

5. Prevalent Presenting Issues of Drug Court Clients Not in Ranked Order Alcohol addiction Prescription drug addiction Illicit opioid addiction Source: Jefferson County Drug Court, 2012

6. Jefferson County Drug Court Clients, 2002 – Present Either Completed the Program or were Terminated 149 completed the drug court program – 49 clients attended outpatient treatment only – 82 clients attended inpatient residential treatment, 28-90 day program – 14 clients attended medium residential treatment, 4 – 6 months – 41 clients attended long-term residential treatment, 8 – 12 months Some clients attended inpatient treatment programs more than once 83 clients were terminated by the drug court program; some died and others had their cases transferred; 79 clients went to NYS prison The 60 new drug court clients are NOT included in this presentation Source: Jefferson County Drug Court, 2012

7. Drug Court Cost Per Client Drug court cost per client is $5,000 – Pays drug court coordinator’s salary, benefits and fringes – Pays for portion of drug court judge’s time – Pays for drug testing supplies – Pays for other office supplies Source: Jefferson County Drug Court, 2012

8. Approximate Cost Per Client Attending a 12-Month Outpatient Treatment Program Medicaid CostDSS CostPrivate or Self Pay Cost Assessment: $152Assessment: $64Assessment: $80 1 Individual Session: $1221 Individual Session: $641 Individual Session: $80 2 Group Sessions @ $47 p/session x 52 weeks = $4,888 2 Group Sessions @ $64 p/session x 52 weeks = $6,656 2 Group Sessions @ $80 p/session x 52 weeks = $8,320 Total: $5,162 per clientTotal: $6,784 per clientTotal: $8,480 per client Source: CREDO Community Center for the Treatment of Addictions, 2012

9. Approximate Cost for 149 Clients Attending a 12-Month Outpatient Treatment 2002 - Present Source: CREDO Community Center for the Treatment of Addictions, 2012; MEDICAID: $5,162 per Client; $DSS: $6,784 per Client; Private or Self Pay Cost per Client: $8,480

10. Approximate Calculated Cost of Clients Who Attended Inpatient Treatment, 2002 - Present Source: CREDO Community Center for the Treatment of Addictions, 2012; Calculated at Public Assistance Allowance of $957 per Month plus $158 Allowance for Personal Needs = $1,115 per Client per Month, $37.17 Per Day per Client, Using the Lowest Length of Stay

11. Clients Who Were Terminated by Drug Court and Went into NYS Prison, 2002 - Present To date, 83 clients have been terminated by drug court Approximately 79 clients were transferred to NYS prison Average cost to house a NYS prisoner for 1 year is $50,000 Sentences range from 1-3 years up to 4.5 – 9 years For the purpose of this presentation, the average stay is calculated at 3 years Source: Jefferson County Drug Court, 2012

12. Approximate Total Cost, 232 Clients (149 Completed and 83 Terminated) * 2002 - Present 232 Clients, Outpatient, $5,162 p/Client, MEDICAID Rate $1,197,584 232 Clients, Drug Court Cost, $5,000$1,160,000 82 Clients, 28-90 Days Inpatient, 28 Days $37 p/Day $84,952 14 Clients, 4 – 6 Months Inpatient, 120 Days $37 p/Day $62,160 41 Clients, 8-12 Months, 240 Days $37 p/Day $364,080 79 Clients, NYS Prison, $50,000 p/Year, 3 Years$11,850,000 MEDICAID Rate, $5,162 p/Client; Public Assistance Allowance, $1,115 p/Month ($957 PA Allowance plus$158 Personal Needs Allowance); Lowest Length of Stay, NYS Prison at $50,000 p/Year, $150,000 for 3 Years was Used to Calculate Cost

13. Medication-supported Treatment (MST) Methodone – opioid agonist – diversion potential Suboxone – partial opioid agonist – diversion potential Vivitrol – opioid and alcohol antagonist – no diversion potential – Long-term drug users whose livers are injured may not be eligible for Vivitrol Source: SAMHSA. (2012). An Introduction to Extended-Release Injectable Naltrexone for the Treatment of Opioid Dependence. Volume 11, Issue 1. HHS Publication No. (SMA) 12-4682.

14. Benefits of Vivitrol Non-opiate based, non-addicting opioid antagonist No euphoria because it does not stimulate the dopamine reward pathway No street value No diversion potential NOTE: For the purpose of the cost calculation, $1,000 per shot was used Source: Alkermes, “Mechanism of Action,” 2012

15. Vivitrol Is Not a Magic Bullet Patients have better treatment outcomes when Vivitrol is combined with – Behavioral therapy – Relapse prevention strategies – Self-help groups – Vivitrol has not been studied as a sole component of treatment Source: SAMHSA. (2012). An Introduction to Extended-Release Injectable Naltrexone for the Treatment of Opioid Dependence. Volume 11, Issue 1. HHS Publication No. (SMA) 12-4682.

16. Projected Cost of Five (5) Drug Court Clients* with Vivitrol Medication-supported Treatment *MEDICAID Rate, $5,162 per Client Used to Calculate Outpatient Cost

17. A Modest Proposal (Not Jonathan Swift’s) Voluntary Participation of 5 Drug Court Clients* * Each cost category includes $25,810 for Outpatient and $25,000 for Court Cost for 5 Clients

18. Ancillary Costs of Addiction Crimes ancillary to people’s prescription drug and/or illicit drug addictions – Drug-induced crimes Theft Robbery Vandalism Drunk and/or Impaired Driving Domestic Abuse – Spousal Abuse – Child Abuse Source: Battling Prescription Drugs and Alcohol: Another Weapon, Sheriff James M. Cummings, Barnstable County, Massachusetts, April 2012, http://www.bsheriff.net/column30.html http://www.bsheriff.net/column30.html

19. Limitations of the Data The breakdown of clients for Medicaid, DSS, and Private or Self Pay is not known. The breakdown of how many clients went inpatient more than once and their respective lengths of stay is not known. For clients who went inpatient the lowest number of days or months was used to calculate the approximate cost. For clients who went to NYS prison, the average sentence was calculated at 3 years. (Source: Jefferson County Drug Court, 2012)

20. Limitations of Data, cont’d Some prisoners are released before the average 3-year sentence is completed, but that number is not known. For cost analysis, only CREDO’s outpatient fee scale was used. Inpatient costs were at the per day Public Assistance Allowance, $1,115 ($957 plus $158 Personal Needs Allowance). Cost of detoxification for clients who may have required it is not known. 83 drug court clients were terminated but it is not known at which point that termination occurred. Therefore, cost of the 83 clients for 12 months outpatient treatment and court cost are included in the analysis.

21. Conclusion Drug Courts reduce recidivism. Drug Courts reduce substance abuse. Introduction of medication-supported treatment can be an effective tool for motivated clients. Vivitrol has the potential to save considerable Jefferson County and NYS monies.

22. Questions, Concerns, Suggestions