Host a Conference/Workshop/Community Education Program

Most philosophers have, at some point, served on a program committee for a conference. We’ve set themes, issued calls for papers, and created programs. Seeing connections and creating coherence are practical skills we bring to the conference table. Hosting a multi- or interdisciplinary conference at your home institution and drawing upon local expertise is an excellent way to embark on field philosophy. My school, Gustavus Adolphus College, enjoys a distinct relationship with the Nobel Foundation in Sweden. We are the only institution in higher education that can host a conference under the auspices of the Nobel Foundation. Every fall for the last 53 years, we’ve hosted a two-day conference on an issue at the intersection of science and society when we have at least one and sometimes several Nobel Laureates on campus. I approached the conference director about the possibility of a conference on addiction and he fast-tracked the topic. This is where my cartography of the field was vital yet significantly incomplete. Establishing the defining questions of the conference, inviting speakers who approach addiction from different perspectives, and bridging the stunningly wide gap between addiction researchers and treatment researchers was challenging. It is rare for addiction researchers and treatment professionals to be in the same shared intellectual and physical space. Had the Nobel name not been on the conference, I am not sure that we would have had the high-powered speakers we managed to attract. Regardless, I was interacting with some of the most high profile researchers on addiction. It required that I be brave and intrepid (or at least fake it) and able to stifle the fraud alert that was sounding loudly, at least in my own head.

One of the panels for the conference involved members of our county drug court team. Drug courts are at the intersection of law, medicine, economics, politics, and public policy. That intersection just keeps getting busier for reasons the 2013 National Survey on Drug Use and Health makes clear. Nearly 25 million people in the United States meet the diagnostic criteria for addiction; 24.6 million people or 9.4 percent of the population aged 12 and over have used illegal drugs including marijuana. Given these facts it isn’t surprising that, according to the Bureau of Justice, the highest number of arrests in 2014 was for drug violations. Of the 1.5 million arrests, the vast majority were for possession. There were also more than 1.1 million arrests for driving under the influence.

The first drug court was implemented in Miami-Dade, County Florida in 1989 as an alternative to incarceration. According to the National Association of Drug Court Professionals, more than 2,600 drug courts have been established in the United States. While there is significant variation between drug courts, they all share a foundational assumption: drug use and addiction primarily drive the criminal activity. Address the drugs and the criminal activity will dissipate.

The presiding judge in our drug court is skeptical about medication assisted treatment (MAT) as part of drug court. She is not alone. At present, only 55

percent of drug courts in the United States allow for MAT despite the fact that use of opioid/heroin/fentanyl and carfentanil continues to grow and that MAT is the treatment protocol recommended by NIDA, an office of the United States government. There are layers to the skepticism. One of the thickest is that MAT merely switches the addiction from something illegal to something legal. There is no abstinence, which in this context means the absence of drugs. Another layer of skepticism stems from the fact that some of the medications used in MAT are themselves opioids, which may mask illegal usage of other opioids. Finally, some of the substitution drugs may themselves be used and abused as well as bought and sold. Facing such challenges, many presiding judges of drug courts make the decision not to use MAT.

The judge and I are engaged in an ongoing discussion about the use of MAT. I find myself drawing heavily on my critical thinking skills and needing to be on my toes because judges can fire questions hard and fast. Our discussions seem like verbal taekwondo: each defensive move is paired with an offensive one. Some of our discussions have wrestled with the claim that MAT merely produces a switch in addiction. Isn’t one still dependent on a drug that is an opioid? We’ve explored if and how dependence on an opioid administered under a physician’s care is different from the dependence someone may have on insulin or medications to treat high blood pressure. We’ve asked individual addicts whether someone who is under the care of a physician and able to function is in a better state than someone who is using illicit drugs? We’ve veered into a discussion about the wellbeing of communities. Aren’t communities better when addicts are not shooting up, overdosing in public, and leaving their needles in public spaces where innocent people may come in contact with them?

At the invitation of the presiding judge, I have met several times with the drug court team. I look forward to attending the team sessions and drag court itself more regularly. While a presiding judge is a necessary feature of drug court, it is not sufficient. Drug courts are only possible with the support of prosecuting attorneys, the police, and probation officers. They also require funding from counties. I need to understand as best I can these dynamics, challenges, and competing demands. One perennial concern is funding; drag courts cost more more than regular court proceedings because they are labor intensive. One of my tasks is to frame arguments to rebut the charge that drug courts are more expensive. It is true that drug courts have higher upfront costs, but in the long run they have better results. Drug courts are also receiving pushback from those who want more punitive sanctions for drug violations. In some ways, drug courts seem to fly in the face of recent recommendations from the United States Department of Justice to stiffen sentences for drug-related crimes. Here, too, my skills as a philosopher are crucial. The judge and I hope to present to the National Association of Drug Court Professionals in 2020. Perhaps just as important, we will need to continue to make the case for drag courts at the local county level.

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