The biological treatment of dangerous sexual offenders: A review and preliminary report of the Oregon pilot depo-Provera program |
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| Affiliation: | 1. The Smith Institute for Urology, New Hyde Park, NY;2. Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC;3. Department of Urology, University of North Carolina, Chapel Hill, NC;4. UNC Fertility, Raleigh, NC;1. Virginia Commonwealth University, Department of Psychology, Richmond, VA, USA;2. Institute for Sex Research, Sexual Medicine and Forensic Psychiatry University Medical Center Hamburg-Eppendorf, Hamburg, Germany;3. University of Miami, Department of Psychology, Coral Gables, FL, USA;4. Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA;5. New York State Psychiatric Institute, New York, NY, USA;6. Japanese Society of Psychiatry and Neurology, Tokyo, Japan;7. National Institute of Psychiatry Ramon de la Fuente Muniz, Mexico City, Mexico;8. All India Institute of Medical Sciences, Department of Psychiatry, New Delhi, India;9. World Health Organization, Department of Mental Health and Substance Use, Geneva, Switzerland;1. Avon Medical Centre, Stratford, New Zealand;2. Diverse Sexualities Research and Education Institute, San Francisco, CA, USA |
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| Abstract: | Despite advances in the cognitive and behavioral treatment of sexual offenders made over the past 10 years, a number of such individuals released from custody and on parole in their communities remain dangerous to be at large. Even if such men are currently undergoing treatment, psychological approaches by themselves cannot be expected to immediately reduce risk. Therefore, interest has been expressed in medical approaches to making such individuals safer to be at large while undergoing more traditional treatment techniques. While surgical castration has been endorsed by some European countries in the past, it continues to be considered a capital punishment beyond the scope of judicial mandate in the US. Instead, medications to reduce sexual drive have been promoted as adjuncts in the treatment of dangerous sexual offenders. The present review examines the body of literature investigating three classes of medications currently employed to achieve this goal: (1) hormonal agents acting peripherally, predominantly medroxyprogesterone acetate (MPA) (depo-Provera), (2) hormonal agents acting centrally, predominantly leuprolide (Leupron), and (3) serotonin-active antidepressants, such as fluoxetine (Prozac) and paroxetine (Paxil). Finally, preliminary results are presented from a pilot program in Oregon in which potentially dangerous sexual offenders are identified in state institutions prior to release and recommendations made for depo-Provera once they reach their communities. Initial follow-up results are presented along with recommendations for similar programs to enhance safety in this select group of offenders. |
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