Medication assisted treatment policy

Policy concerning the use of medications by individuals participating in medication-assisted treatment.

This Policy was originally promulgated on January 28, 2020. The Policy was amended on June 29, 2022 to include opioid treatment programs (“OTPs”) in the definition of the term “Prescriber” as used in the Policy, and to include reference to the Complaint and Investigation Procedures set forth in the Trial Court Policy Prohibiting Discrimination, Harassment, and Retaliation.

I. Purpose

This policy governs the use of medications in Massachusetts Trial Courts by probationers, defendants subject to pretrial conditions of release, defendants on pretrial probation, defendants or probationers participating in a Massachusetts Specialty Court, and litigants in civil matters (hereinafter, “party” or “parties”).

II. Definitions

“Medication” as used in this policy shall mean legally prescribed: 1) medication-assisted treatments to aid in substance and alcohol use disorder recovery: 2) medication used to treat mental-health conditions; and 3) medical marijuana.

“Medication-assisted treatment” (“MAT”) as used in this policy shall refer to “the use of medication in combination with behavioral health services to provide an individualized approach to the treatment of substance use disorder, including opioid use disorder.” 42 C.F.R. § 8.2.

“Prescriber” as used in this policy shall refer to a licensed medical professional, including a physician’s assistant, nurse practitioner, or dentist, or an opioid treatment program (“OTP”) who or which is legally authorized by the jurisdiction in which the medical professional is licensed to practice to prescribe controlled substances.

“Prescription” as used in this policy shall refer to a prescriber’s written direction for the preparation and administration of a controlled substance, including dosage instructions.

“Specialty Court” as used in this policy shall refer to any Adult or Juvenile Drug Court, Mental Health Court, Veterans Treatment Court, Family Drug Court, Family Resolutions Specialty Court, Homeless Court, and any other similar specialized court session within the Massachusetts Trial Court.

III. Scope

This policy applies to all Massachusetts Trial Court departments.

IV. Policy

A. General provisions

Decisions regarding a party’s medication type and dosage shall be made only by a licensed prescriber. In those instances in which a party is subject to the supervision of a court or the supervision of Probation, it shall be that party’s responsibility to ensure that the court is aware of any and all medications that the party is taking prior to and during the party’s term of probation or while on conditions of release or otherwise subject to supervision by the Court. Parties are likewise responsible for informing their prescriber(s) of their participation in a Specialty Court, any condition of probation, pretrial release, supervision, or other court order that requires them to be evaluated for treatment or to abide by a treatment plan or any court order regarding the use of medication during their term of probation, supervision, or participation in a Specialty Court.

B. Compliance with the Americans with Disabilities Act

This policy reflects and is designed to ensure compliance with the Americans with Disabilities Act (“ADA”), 42 U.S.C. §§ 12131-34. Pursuant to the ADA, qualified individuals with a disability may not, by virtue of their disability, be denied or excluded from the benefits of the Trial Court’s services, programs, or activities, or otherwise discriminated against. 28 C.F.R. § 35.130.

A person is an “individual with a disability” under the ADA if the person: 1) has a physical or mental impairment that substantially limits one or more life activities; 2) has a record of such an impairment, or 3) is regarded as having such an impairment. 42 U.S.C. § 12102(1). A person with a substance or alcohol use disorder may qualify as an individual with a disability if they meet one of these three aforementioned criteria. 28 C.F.R. § 35.104.

The ADA’s definition of an “individual with a disability” does not include an individual who is currently engaging in the “illegal use of drugs,” which is defined as “the use of drugs, the possession or distribution of which is unlawful under the Controlled Substances Act . . .”; it “does not include the use of a drug taken under supervision by a licensed health care professional, or other uses authorized by the Controlled Substances Act or other provisions of Federal law.” 42 U.S.C. §§ 12210(a); 12210(d)(1).

A person is “qualified” under the ADA if he or she “meets the essential eligibility requirements for the receipt of services or the participation in [the relevant] programs or activities provided by [the] public entity,” either “with or without reasonable modifications . . . , or the provision of auxiliary aids and services.” 42 U.S.C. § 12131(2).

Consistent with the requirements set forth in the ADA, no court or judge of the Trial Court shall have a policy of requiring that an order, such as an order setting conditions of release or probation or participation in a Specialty Court, be contingent on abstinence from medication that has been prescribed by a prescriber. No court shall have a policy of conditioning admission to, participation in or successful completion of a Specialty Court or other court program, service or activity on abstinence from medication. No court shall have a policy requiring that a party be prescribed medication as a condition of an order of probation, supervision, release, child custody, parenting time, or other such order issued by a court, or as a condition for admission to or participation in a Specialty Court or other court program, service or activity. Whether a person should be prescribed a regimen of medication is a decision to be made by a prescriber on an individualized basis. No court shall have a policy or practice of requiring that a party be prescribed any one form of medication over another.

C. Judicial discretion

Nothing in this policy shall be construed to limit a court’s discretion to order that a party be evaluated for medical treatment or comply with a treatment plan as a condition of release, probation, supervision, or participation in a Specialty Court or other court or probation program. In making such an order, a judge should make an individualized determination, based on the information available, which may include a party’s criminal, medical, and probation history.

Judges retain discretion to mitigate and reduce the risk of abuse, misuse, and diversion of medications. Judges have the authority to monitor medication compliance in the context of a term of probation, supervision, or condition of release and in furtherance of the court’s public safety obligation. Compliance with the ADA does not require that a court allow a party to participate in, or benefit from, its services or programs if the person poses a “direct threat to the health or safety of others.” 28 C.F.R. § 35.139. A determination that a party poses a direct threat should be grounded in current medical knowledge or the best available objective evidence to ascertain: the nature, duration, and severity of the risk; the probability that the potential injury will actually occur; and whether reasonable modifications of policies, practices, or procedures or the provision of auxiliary aids or services will mitigate the risk. Id. A court may not conclude that a party who has been prescribed medication poses a “direct threat” based on generalizations or scientifically unsupported assumptions about medications or persons who are prescribed medication. When a judge or probation officer has a concern about a party’s use or misuse of medication, the judge may take appropriate action to mitigate and reduce the risk of abuse, misuse, and diversion of medications. In many cases, appropriate action will include communication with the prescriber by a probation officer or other member of the Specialty Court team as directed by the judge.

D. Complaint resolution procedure

Any party may make a complaint under this Policy, either orally or in writing, to the Trial Court Office of Workplace Rights & Compliance (OWRC). A complaint may be made by calling the OWRC Hotline at 617-878-0411, emailing [e-mail], or using the OWRC Complaint Form. Complaints will be addressed pursuant to the Complaint and Investigation Procedures provided in the Trial Court Policy Prohibiting Discrimination, Harassment, and Retaliation.

Date published:	January 1, 2020
Last updated:	April 1, 2022