Conference of Chief JusticesRetired Chief Justice Maureen O'Connor
January 28, 2018
Chief Justice Maureen O\'Connor
Conference of Chief Justices
Jan. 28, 2018
Thank you, again, Joy.
Good afternoon, everyone.
Thank you, Carl for that enlightening presentation.
You have certainly added important scientific perspective to our quest to solve this crisis.
In order to win, we have to know what we're up against, as frightful as that reality can be. Knowing the science of addiction will help all of us.
Knowledge really is power in this endeavor. Knowledge can provide the power to push out — and overcome — old thinking, prejudices, and ideas that don't work. Or those that no longer work.
As judicial leaders, we need all the facts — all the hard data — that we can get. And then we need to speak out in our communities about these new findings.
The true science behind the ways that opioids work on the mind and body forms a critical part of the foundation of our mission.
Before I elaborate on leadership and our opioid efforts, I would like to recognize some individuals who have stepped up — who have locked arms with us as we make our way forward.
Judge Duane Slone of Tennessee's Fourth District is the chair of the judicial involvement section of our regional working group and he has encouraged new ideas and brought great energy — and results — to this enterprise. Thank you, Judge Slone.
Michelle White is a principal court management consultant for the National Center for State Courts.
Her efforts in the opioid field are built on nearly six years specializing in problem-solving courts at the NCSC. Her expertise in adult drug courts, probation, and alternative sentencing is serving her well as she and the CCJ-COSCA task force take on national opioid issues. Thank you, Michelle.
I also want to thank those who aren't here — the literally hundreds of treatment teams, judges, law enforcement, legislative and executive branch members who are working on solving this crisis.
Now that we're well-engaged in fight on the opioid battlefield, I think I can say without hesitation that it has come down to a contest pitting innovation against innovation.
It is evil innovation on one side. On our side, we as leaders must summon new ideas in order to fight and conquer this epidemic - with innovations of our own.
I say "evil innovation" because — by varying degrees — maliciousness has been at work for years to create this crisis.
Whether it's drug dealers big and small, or international syndicates, or drug companies and doctors acting knowingly, or unknowingly ... or even with good intentions ... innovation has been taking us down this dreadful road.
America is the only country on Earth experiencing this kind of opioid crisis across its populace.
My state of Ohio has its share of grim statistics:
I'm sure many of you are familiar with the 2015 book "Dreamland: The True Tale of America's Opiate Epidemic" by Sam Quinones.
"Dreamland" was set in Portsmouth, Ohio, at the southern Appalachian tip of our state. The book chronicled the beginning of the pill mills, a sharp rise in prescription opioid addiction and the familiar increase that follows in addiction to cheaper and more-readily available heroin.
Opioids became so prominent across our country that other illicit drugs, notably methamphetamines, were pushed to the background and out of the headlines.
What's new today in Portsmouth, and other parts of our state and the country, is that meth is back.
This time, the meth isn't coming from the home-basement labs of "Breaking Bad." As one newspaper (The Cleveland Plain Dealer) put it last month:
That's evil innovation. When success occurs in one area of the battle against drugs, a new front — or in this case, a dormant front — opens and the problem grows as it changes.
We've seen evil innovation at work in the recent past, with carfetanil hitting the street at thousands of times the strength of fentanyl — both of them replacements for prescription opioids as measures took hold to decrease prescription misuse.
To combat that kind of innovation — the moving target of the drug scene — we decided to embark on some innovation of our own.
Late in the summer of 2016, representatives from middle American states convened in Cincinnati under the banner of the Regional Judicial Opioid Initiative (RJOI).
There are eight states now united — Ohio, Michigan, Illinois, Indiana, Kentucky, Tennessee, West Virginia and North Carolina. These states represent more than 20 percent of our nation's population.
It is a first-of-its kind regional task force. We are 16 months into this endeavor. And while the problem is still raging, we have a lot of progress to report.
Best of all, we have leadership skills emerging in new arenas. We are innovating in a positive way.
We are building on the kind of pure science that scores of professionals like Carl Dawson are employing.
We're also using that other branch of science you know so well — political science.
If you look at the way the opioid crisis evolved — both illegal and legal forms of trafficking, legal and illegal business plans and profit centers — the solution simply had to be regional. Political boundaries had to be recognized as hurdles, and addressed.
Our society cannot afford to deny pure science. Similarly, we cannot be "political science deniers." We need to lead by using our understanding of politics, law enforcement, the judiciary, and the commitment of quasi-governmental groups and NGOs to form networks that communicate constantly, share goals and solve problems jointly.
That's what we did when we met in a Cincinnati hotel for three days, and it's what we've been doing since then.
There were more than 150 delegates at the meeting, representing the courts, law enforcement, treatment providers and policy makers.
We needed to share the power of our states — but to do so efficiently. We didn't want to share bureaucracy, or duplicate efforts.
We knew there wouldn't be time for that. While we were inside that hotel, more than a dozen people died of opioid poisonings and overdoses in the states represented at our meeting.
Our goals were the same, so we set about to identify the core problems and split up the work.
One of our earliest targets — and a point of ongoing success right now — was prescription drug monitoring. Allowing each state to remain an island was no way to solve doctor-shopping and pharmacy-shopping. We knew we had to work across borders, and we are.
Family and child welfare issues also crossed borders, and we are attacking those. Our regional group has initiated child welfare roundtables so that successes can be shared and duplicated across the region.
Late last year our group received a $1 million Department of Justice grant to further our goal of speeding up our cross-border cooperation.
Our regional group has posted many innovations. Here are a few:
Tennessee and Kentucky have made real progress in the sharing of information from their Prescription Drug Monitoring Program. We knew from the beginning of RJOI that PDMP data sharing would be a crucial accomplishment — and difficult to execute because of HIPAA and state legal barriers. But our eight states are getting this done.
Michigan's legislature passed six PDMP-related bills that require a "legitimate doctor-patient relationship" and a patient history scan before prescriptions are issued. Their aim is to prevent addiction before it happens.
Kentucky has passed legislation for the inclusion of drug conviction data into its PDMP.
Several of our states have passed legislation to more closely regulate opioid prescriptions. In North Carolina, where a five-day supply limit is imposed for non-cancer cases, medical providers are required to accurately enter opioid data electronically.
Indiana's hospital association, state medical association and state department of health have collaborated on pain pill guidelines that call on doctors to turn to non-drug treatments first when helping patients with pain.
In Tennessee, a judge is ordering physicals for drug court participants. A seemingly small measure, perhaps, but a potentially life-saving one — and a fitting addition to treatment plans.
In the family arena, Kentucky and Ohio now have a border agreement for the emergency placement of kids.
Neonatal Abstinence Syndrome (NAS) is shorthand for the often-devastating effects of drug addiction in the womb. In Eastern Tennessee, the state health department has expanded its voluntary program of long-term reversible birth control — a program that started in jails with education to incarcerated women about the effects of NAS on babies.
In Ohio, we are using a federal grant to increase the scale and scope of family drug courts. The Supreme Court of Ohio administers the grant. But to really make this endeavor work, we need partners to jump in across jurisdictional and disciplinary lines.
So, the state department of Jobs and Family Services, the state Mental Health and Addiction Services department and state Medicaid officials are all on board and working together. Our judicial branch and three departments from the executive branch are toiling on common ground for the common good.
These are big RJOI accomplishments. More are coming.
There are also problems that aren't necessarily exacerbated by borders, but which are handled differently in each state — and sometimes different ways inside a state, due to local customs and beliefs.
An example is Medication-Assisted Treatment through drug courts.
Methadone has been controversial since its debut 50 years ago, long before our new and bigger opioid problem ... our current epidemic.
The issue back then was a widespread aversion to using an opiate to treat what was then a heroin problem in cities.
Today, the belief from that era that "cold turkey" would work as a cure, or that jail or forced abstinence represented a positive societal value judgment, is still around today.
And even though methadone is more accepted now, another hurdle can remain: What happens when a patient who is obeying his or her methadone regime applies for a job and has to take a drug test? Failure, of course.
That's a problem. Likewise, the stigma of going through a drug court program is only slowly going away.
Those are old problems that linger. Here's an old problem solved in many places but arising in others:
Weaning newborn babies from opiates has met with a lot of success in our cities, where the problem has persisted. But out in the suburbs and rural areas, where the opiate crisis has a shorter history, babies aren't so lucky. Proper treatment is often rare, or not diagnosed.
So with this mashup of problems, what are judicial leaders to do?
One positive starting point is science.
Our knowledge of addiction is far, far greater today than it was when many of our attitudes and prejudices about drugs and addiction were formed in our communities — and by us.
The judiciary is a key bridge in this crisis — a bridge between other branches of government, public health groups, treatment providers and — most of all — families.
We as chief justices have the ability to convene the appropriate stakeholders to the table to form Opioid Task Forces and to make progress happen. We have a bully pulpit, one that we must use. You need to build support for your own efforts and those of your colleagues.
As chief justices we must first ensure that we are as educated and up to date on the opioid epidemic as possible. We also must ensure that your entire judiciary and administrative staff are knowledgeable with current information about the topic, including treatment that works.
We know that:
By calling on you to become more aware of this crisis, and to engage with your judiciary and other leaders in communities, I'm also saying something you already know: That the role of the judiciary in our country is changing rapidly.
One of our local judges not long ago said she felt more like a social worker these days than a judge — or at least a judge in the outdated sense of the role.
She is still a judge, a good one, and one reason she is effective is that she's recognized the new state of our society, and is seizing the initiative to deal with it.
Working a drug court or family dependency court from the bench can be mentally and physically taxing.
The impact of the opioid crisis on families — children, especially — can't be overstated.
In Ohio, 50 percent of the children entering custody have parents who were abusing drugs. Many counties report percentages in the 70s, 80s and 90s. Three rural counties report 100 percent.
We're learning from our regional initiative that our colleague states have the same problem. And yet we are not even close to states passing the necessary legislation to allow for interstate placement of children via an interstate compact. It is necessary for 35 states to pass it and so far only 12 have. This is a very concrete example of an initiative that you could take up with your legislative leadership and governor to make happen.
And let's not forget about veterans returning from combat with PTSD, addictions, brain injuries and other trauma. Many come in contact with opioid problems — and with the criminal justice system.
When we and our fellow judges go out into our communities, we're not requesting a change in attitudes for the sake of change.
The changes in our society have already happened. Evil innovators have been hard at work.
We can innovate, too. We should, and we are.
In the end, we must marshal our resources ... create new tools ... talk, share and compare our successes and failures.
We must commit to positive innovation because we know our society will continue to change ... and that we care for our fellow human beings.
Thank you, and God bless.