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

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

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

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 2011http://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/drug_courts_fact_sheet_5-31-11.pdf

Prevalent Presenting Issues of Drug Court ClientsNot in Ranked Order

• Alcohol addiction

• Prescription drug addiction

• Illicit opioid addiction

Source: Jefferson County Drug Court, 2012

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 presentationSource: Jefferson County Drug Court, 2012

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

Approximate Cost Per Client Attending a12-Month Outpatient Treatment Program

Medicaid Cost DSS Cost Private or Self Pay Cost

Assessment: $152 Assessment: $64 Assessment: $80

1 Individual Session: $122 1 Individual Session: $64 1 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 client Total: $6,784 per client Total: $8,480 per client

Source: CREDO Community Center for the Treatment of Addictions, 2012

Approximate Cost for 149 Clients Attending a 12-Month Outpatient Treatment

2002 - Present

$100,000.00

$300,000.00

$500,000.00

$700,000.00

$900,000.00

$1,100,000.00

$1,300,000.00

Cost

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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

Approximate Calculated Cost of Clients Who Attended Inpatient Treatment, 2002 - Present

$50,000.00

$150,000.00

$250,000.00

$350,000.00

$450,000.00

$550,000.00

Cost

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

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

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

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.

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

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.

Projected Cost of Five (5) Drug Court Clients* with Vivitrol Medication-supported Treatment

$10,000.00

$30,000.00

$50,000.00

$70,000.00

$90,000.00

$110,000.00

*MEDICAID Rate, $5,162 per Client Used to Calculate Outpatient Cost

A Modest Proposal (Not Jonathan Swift’s)Voluntary Participation of 5 Drug Court Clients*

$50,000.00

$150,000.00

$250,000.00

$350,000.00

$450,000.00

$550,000.00

$650,000.00

$750,000.00

$850,000.00

* Each cost category includes $25,810 for Outpatient and $25,000 for Court Cost for 5 Clients

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

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)

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.

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.

Questions, Concerns, Suggestions