The federal court system has long had a reputation for hard-line drug policies, handing down mandatory sentences that send even low-level offenders to prison for years.
Drug courts, specialized diversion programs that let eligible nonviolent defendants avoid incarceration if they undergo addiction treatment, have become increasingly prevalent at the state level. Yet they remain unusual in the federal system, found in fewer than one in four judicial districts across the country.
The Trump administration’s opioid commission wants that to change, calling for drug courts to be extended nationwide as “a proven avenue to treatment for individuals who commit nonviolent crimes because of their SUD [substance use disorder].”
Supporters say drug courts are a compassionate, practical response to addiction-fueled crime and a revolving prison door. But the experience in Massachusetts, where participants in the state drug courts have often been sent to jail for days, weeks, and even months if they relapse or are kicked out of treatment programs, has given rise to skepticism about expanding the approach on the federal level.
Offenders are required to remain sober as a condition of the program, and they are regularly tested for drug and alcohol use. But critics say incarcerating participants who relapse defeats the purpose of the program and violates national standards for drug courts, which recommend jail only when participants pose a threat to public safety or when all other measures have failed.
“What matters is what sort of care people are getting,” said Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital. “If people . . . are sent to prison because they continue to use substances, that’s not effective treatment.”
Treatment specialists also cautioned that any expansion of federal drug courts must include oversight to ensure that defendants are being treated consistently and being sent to effective, well-run treatment programs.
During the opioid crisis, poorly run treatment programs and sober houses, many of them unlicensed, have proliferated, specialists say.
“I would be really hesitant to expand without an infrastructure to keep an eye out on this whole process,” said Susan Grady, clinical director of Serenity at Summit New England, a detox and residential treatment program. “There hasn’t been enough oversight.”
The proposal to expand federal drug courts was among 56 recommendations made by the opioid commission, which includes Massachusetts Governor Charlie Baker and former congressman Patrick Kennedy. The panel was created by President Trump to address the opioid crisis, which he has called a “national health emergency.”
In federal drug court, defendants accused of drug-related crimes who have a history of addiction and no violent criminal record must agree to a rigorous process that requires they stick to treatment as part of pretrial probation. Typically, the program takes at least a year to complete and can end with a dismissal of the charges.
Through a combination of treatment and sanctions, the approach reduces drug use, crime, and incarceration costs, supporters say.
“They not only do wonderful things for the participants in them but they put a human face on a system that is so desperately in need of some humanity,” said John Gleeson, a retired federal judge who in 2012 helped start the drug court in Brooklyn, N.Y. “Instead of tearing communities and families apart you’re putting people right back in their community with their addictions under control.”
Establishing drug courts in every district in the country, however, will be expensive. The panel did not estimate the cost of implementing its full recommendations, but Kennedy said it would cost about $200 billion over 10 years.
That level of investment will be difficult, Kennedy said, if the $1.5 trillion tax-cut bill moving through Congress becomes law.
“The tax bill poses the biggest threat to the addiction crisis,” said Kennedy, who testified on the opioid crisis before a Senate Appropriations subcommittee Tuesday.
Boston already has a diversion program for federal defendants charged with drug crimes, although not everyone qualifies.
Xavier Ramos, a 27-year-old from Taunton, was in court last month awaiting a sentence for his role in a heroin distribution ring.
Ramos had no violent offenses on his record, and even prosecutors acknowledged that his drug-dealing was at least partially motivated by his own addiction. He had been sober since his arrest in 2015, and promised the judge he would stay that way.
“I just want to get back to my kids,” Ramos told US District Judge George A. O’Toole Jr. at the hearing. His two young boys, ages 6 and 9, watched anxiously with their mother and grandmother as his lawyer asked O’Toole for a three-year sentence.
O’Toole sentenced him to five years in prison.
Ramos, who began taking Percocet as a teenager and heroin in 2013, finally began receiving treatment in jail as his case wound through the courts, his lawyer said.
Ramos failed to get into Boston’s diversion program
“He’s a very good kid who has gotten himself into an inordinate amount of trouble, which has given him a criminal record that doesn’t, in any way, accurately reflect who he is,” said his lawyer, George Gormley. “But it is going to hang around his neck for a good period of time, all because of this drug addiction.”
After he was sentenced, Ramos turned to face his family. He winked at his children, who waved at him.
“I love you,” he mouthed.