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Editorial Comment 7/9: The law and addiction medicine

by William Haning, MD, DFAPA, DFASAM | July 8, 2019

Editorial Comment:  The law and addiction medicine

Please look to the last link and edit, a question of crime vs. misconduct in the California penal system.  The issue tried relates to possession of cannabis in a controlled or special setting. In this instance, the inmates who were originally convicted may be seen as having committed a type of status offense, similar to when a minor consumes alcohol or violates curfew.  This judgment must have been exasperating to both sides of the aisle, prosecution and defense, and entertaining to the gallery.

But what it emphasizes is one of the stronger roles available to the addiction medicine practitioner: a source of forensic expertise, in drug-related civil and criminal cases.  While much of the expertise requested in court cases or hearings is in the realms of culpability and capacity, areas traditionally reserved to addiction psychiatry and forensic psychiatry, there is not enough expertise to go around. Those readers involved in institutional settings are probably accustomed to injustices arising from the lack of a knowledgeable resource in determining the severity of the risk of a particular drug and its quantity; or the effects of intoxication and withdrawal. Most commonly addictionists choose to practice in one (or more) of four areas: patient care, administration of programs, education, and research. Forensic addiction medicine is a particularly demanding area, and while the financial rewards can be gratifying, the rules, circumstances, and expectations of courtroom process as well as of forensic evaluation are demanding. It is also not a forgiving endeavor; there are many landmines buried in the path to the expert witness chair.  Ironically, by the time one of us has had enough experience to declare competence in this field, his or her opinion may be devalued as coming from a "hired gun."

We are confronted with an enormous, underserved population heading into prison or already there, who warrant expert opinions. The current Addiction Medicine Milestones (ACGME January 2019) mention legal consultation only in passing (a level IV expectation in resolving ethical dilemmas concerning professionals). It is an area of curricular design that deserves more attention, even while the fellowship curriculae are already straining to the bursting point with material to learn in the space of one year.

- W. Haning, MD, DFAPA, DFASAM