Should people addicted to opiates undergo suboxone treatment instead of other recovery methods?
Debate Rounds (4)
First round is acceptance, second is arguments, third is rebuttals and forth is rebuttals and conclusions.
Thank you, and looking forward to a contender!
Thank you, and Happy New Year! My first debate of 2012!
1) Suboxone is a partial-opiate agonist. It tricks your body into thinking you're still taking opiates. Suboxone is a easy way to undergo recovery WITHOUT having to take time off from work or school. Going cold turkey means you will be laying in bed feeling like death, unable to attend work or school lest you go absolutely crazy. Going on a recovery getaway also means time off from your life which many people cannot afford. Methadone clinics require you usually to show up every morning. This is inconvient to people with normal lives. Therefore suboxone is convienent, and doesn't require you to take sick days, or miss class.
2) If you have decent insurance and live in a city, it is affordable. I know some doctors in more rural areas do not take insurance as well as the pharmacies. Yet, a lot do, and suboxone treatment for some people can mean paying $60-70 a month between co-pays at the doctor and for the medication. Some states have free programs, and rehab clinics often use Suboxone. There are also now generics available.
3) It lacks the major potential to be abused. Simply put, if you have an opiate addiction then Suboxone will not get you high..even if you shoot it up which is a bad idea due to the Naloxone included in it. Psychological dependance CAN occur with Suboxone, but it can also occur with any drug. Another good thing about it, is since Suboxone fills up the opiate receptors then using heroin or oxycodone afterwards will null the effects or significantly weaken them hence reducing the urge to relapse. Patients also report a reduced urge in using while on Suboxone in general. Subocone has very low risk of overdose and has a ceiling effect at 32mg unlike methadone.
4) Going cold turkey has a high relapse rate. Suboxone has a high success rate when people are on it. The relapse rate starts to raise once people get off it it, but it is no higher then when addicts quit cold turkey or finish methadone trestment. Methadone is also statistically a much harder drug to kick then the tapering off of Suboxone. Suboxone has far superior recovery success statistics then methadone, placebos The withdrawal is reported to be extremely brutal, while the withdrawal for suboxone is usually reported to be a lot more mild then other opiates although lasting longer. You can also take Suboxone to taper off of Methadone. This matters because most people can still function in every day life while going thru mild withdrawals, but heavy withdrawals are almost impossible to hide from the public and cope with at the office or in the classroom. The uncomfortable side effects of withdrawal and the pain and sickness that ensues is enough to make a person lose his will to continue the detox and subsequent recovery. Suboxone treatment is also way more likely to succeed with additional treatment such as therapy and a 12 step program...somethinf that is not necessary but always an option. There are also negative attitudes associated with methadone, as well as side effects such as constipation and sweating...something that Suboxone usually lacks. There is also a longer duration of effect with Suboxone.
Two things that I realize that go against suboxone, is that it is ineffective for people who have extremely heavy opiate usage habits and methadone instead works better. But, this is about the average addict and the average addict isn't shooting up bundles of heroin a day.
Sources - 12-step-treatment.com/treatment/the-dangers-of-quitting-opiates-cold-turkey.htm.
Pro's Cont. 1) Suboxone is a partial-opiate agonist. It tricks your body into thinking you're still taking opiates.
- To clarify, Suboxone contains buprenorphine, an opiate, and nalaxone, an opiate antagonist. Receptor antagonists are those substances that bind to, in this case, an opiate receptor without causing a high. A receptor agonist wouldbe a substance that does cause a high. My opponent acknowledges Suboxone is a partial agonist. This process does not "trick your body into thinking you're still taking opiates," as my opponent suggests, rather, for addicts the dose of opiates is so low there is no perceived high. Suboxone does, however, carry the potential for opiate abuse by non-addicts as it is a low dose opiate. Buprenorphine is a thebaine derivative, and is 20-40X more potent than morphine. Morphine carries a high potential for addiction. Heroin was created to treat morphine addiction. Get the picture? I am not suggesting in any way that Suboxone carries the same potential for addiction as heroin, but it is in fact a very powerful opiate. (1)
Pro's Cont. 2) If you have decent insurance and live in the city, it is affordable.
- I don't understand the significance of this paragraph other than to state the ease of getting into a program, if you can afford it. If anything, this makes a case for simplicity in "some" areas, while emphasizing difficulty in others.
Pro's Cont. 3) It lacks the major potential to be abused...etc.
-Suboxone is a prescription opiate. Prescription opiates are currently the most abused drugs in the US- legal and illicit. Being marketed as a low dose, low potential for dependency opiate addiction treatment, Suboxone carries a high potential for abuse as it will be perceived as safer than other prescription drugs available. With the current state of prescription opiate abuse, another opiate in medicine cabinets across the country is not what we need.
My opponent states that using Suboxone fills up the opioid receptors, and gives the example of someone shooting up heroin or taking oxycodone not being able to get high, or feeling the effects significantly weaker. These statements suggest Suboxone does not work. If your opioid receptors are blocked, why shoot up? Why take the oxy? His next statement is a contradiction: "will null the effects or significantly weaken them hence reducing the urge to relapse." A patient undergoing detoxification with Suboxone who tries to shoot up, or takes an oxy has in fact relapsed. I'd also like to point out that a very low risk of overdose is still a risk of overdose much greater than not taking opiates at all.
Pro's Cont. 4) Going cold turkey has a high relapse rate. Suboxone has a high success rate when people are on it.
-First I'd like to point out that while you're on Suboxone you don't relapse because you are still partaking of your addiction. You have not quit, you have not recovered, and you have not detoxed. My opponent then admits the relapse rate is "no higher" than when addicts quit cold turkey. These statements show no incentive for using Suboxone other than you are being weaned off of your addiction rather than forced to detox naturally. From the point of view of an addict this may be desirable, but when considered from a strictly medical standpoint Suboxone is inferior to cold turkey given the drawbacks mentioned previously by me and my opponent. More on this below. My opponent continues by making statements with the caveats "usually" and "more likely". He mentions side effects which are milder with Suboxone than with methadone. These caveats, and side effects don't exist with cold turkey rehabilitation.
My opponent concludes by stating Suboxone is ineffective for people who have extremely heavy opiate usage, and claims that the average addict isn't shooting up bundles of heroin a day. I would like to point out that the most abused opiates are prescription opiates- not heroin, but 500,000 Americans have used heroin in the past year at least once. In 2007, 2.5 million Americans abused prescription opiates. 10% of high school students have taken prescription opiates without a prescription. From 2000-2005, 4,500 Americans died from methadone abuse. (2)
My contentions are as follows:
1) Suboxone and methadone are both prescription opiates.
When you are undergoing treatment with either, you are still taking opiates, you are still addicted, you are still an addict, and you have not yet detoxified- something that has to occur for any recovery from opiate addiction. Cold turkey, as an alternative, does not present these drawbacks.
2) Cold Turkey detox is the fastest way to get off opiates.
Medically, cold turkey is superior to Suboxone for the various reasons I have already stated. Hundreds of opiate abusers are arrested every year, and forced to undergo detoxification. The vast majority leave jail completely free of opiates in their system. This is the most important first step in beating addiction, given the fact that addiction starts as a physical dependency. Detoxing cold turkey is not a process that takes weeks, followed by months, to be followed by years. The same psychological help, 12 step programs (there are far more cold turkey 12 step programs than Subox 12 steps), family support, etc. that are available to those on Subox are available to those who quit cold turkey. A cold turkey detox takes 5-10 days, and given that most addicts requiring detoxification will have varying levels of time as an addict you will have varying impact on the number of addicts who have jobs, can't take a few days off their job to improve their quality of life in a major way, aren't already causing disruptions at work or at home, or wouldn't otherwise sacrifice their time to fix themselves.
3) Cold turkey guarantees detoxification.
Because one is not ingesting opiates during rehabilitation, once the process is complete, supplemental rehabilitation can commence. An ex-addict can begin a 12 step program within days, or any other program available. The time to detox from Subox is much greater, and my opponent has already indicated supplemental medicine and support will be required to complete the detox.
My opponent as I stated earlier does not realize that those 5-10 days to detox, a lot of people cannot afford to undergo. How effective can you be as a parent or employee when youre feeling like death? Proper Suboxone treatment guided by a good doctor will have you off of.it in 2-3 months, and avoids this completely. You can alsp take Suboxone as a detox drug and not a maintenence drug, and take it for a week with rapid tapering and then quit to lessen the overall withdrawal pains. This avoids having to spend more money, and having to be on it longer. But having a choice is great.
Also another reason that many addicts do not quit is their fear of withdrawal pains and sickness. Suboxone gives an addict an easier and less painful route that can be managed and takes away this fear. In fact without Suboxone, me and many people I know including doctors and other professionals would not be clean today. Suboxone enabled us to continue our lives and took away the fear of withdrawal sickness. Any thing that helps more people quit is fine by me. Methadone is also too extreme for pill poppers and people who don't use needles. Your point that being cold turkey means complete detoxification is true, but with Suboxone you're in the process and not getting high which is the most important aspect of it.
Con's rebuttal to Cont. 1) Suboxone is an opiate. Suboxone use is intoxication by an opiate. While under Suboxone therapy you are still an addict. Buprenorphine, the opiate in Suboxone, is 20-40X more potent than morphine, etc.
My opponent responds to this rebuttal by saying that addicts know Suboxone is weaker than heroin, and will not shoot up, and this somehow means they will not relapse. He ignores the fact that in presenting his contention he implied addicts might actually still try to shoot up while on Suboxone, even though the effect will have been lessened. Furthermore he ignores the facts, which I presented, regarding prescription opiate addicts which do not shoot up. He also ignores the fact that Suboxone is a prescription opiate. Pro's Contention 1 has not been adequately defended against my rebuttals, and therefore should not stand.
Con's Rebuttal to Pro's Cont. 2) I stated I didn't understand the significance of him pointing out that Suboxone is affordable and easy to access in support of his premise.
My opponent responds in Round 3 by stating Suboxone is cheaper, and more available than methadone. I do not dispute that fact. What I dispute is the implication that Suboxone is the cheapest, and most available method for detox. Cold turkey is the cheapest, and most readily available method of detoxification from opioid addiction, and therefore Pro's contention 2 should not stand.
Con's Rebuttal to Pro's Cont 3) Suboxone is a prescription opioid. Prescription opiates are currently the most abused drugs in the US. Suboxone carries a high potential for abuse because it is readily available, produces a high in non-addicts, and is low in cost. Shooting up while on Suboxone is relapse regardless of whether or not a high is achieved.
My opponent responds by acknowledging cold turkey is better because you are not taking any drugs. He goes on to say Suboxone is more CONVENIENT than cold turkey. This debate is not about convenience. It is about what method is better for treating addiction. My opponent claims that the lingering effects of addiction can sometimes last up to 3 weeks, and I assume he means after cold turkey given that he follows up by saying this is not an issue with Suboxone because you are being weaned. The problem with this defense is that we have both already acknowledged that a patient should continue treatment, and seek support after detox regardless of the initial method of recovery. If the lingering effects of addiction last 3 weeks after cold turkey, and cold turkey takes 5-10 days, this implies an addict can be completely detoxed with no lingering effects after one month of cold turkey. An addict on Suboxone is still an addict one month later. An addict on Suboxone can still be an addict 3 months later, according to my opponent.
Rebuttal to Cont. 4) Relapse rates are equal for Suboxone and cold turkey rehabilitation according to my opponent, if not better with cold turkey. He claims the relapse rate of addicts on Suboxone is "no higher" than for addicts quitting cold turkey. This implies the relapse rate is equal or insignificantly lower. No incentive for Suboxone over cold turkey other than being weaned, and the convenience for those who work.
My opponent then makes an emotional appeal asking how effective one can be while undergoing cold turkey detoxification. My response to this question is that if detoxification is extreme enough to effect the efficiency of a worker, parent, or other person, then the addiction is equally extreme. Withdrawal symptoms are directly proportional to the level of abuse. An addict that requires Suboxone rehabilitation because the withdrawal symptoms would be too grave going cold turkey is likely not an effective parent or worker to begin with. This is actually a repeat from my Round 2 which my opponent did not dispute in his Round 3 argument. Because my opponent has provided no support for his claim of a significantly lower relapse rate for Suboxone over cold turkey, and because he did not dispute my rebuttal, Pro's contention 4 should not stand.
Rebuttal to Pro's final statement: The fact that Suboxone is ineffective on heavy users would eliminate it's effectiveness on a large portion of opiate abusers. I gave statistics for the amount of people who abuse heroin, the amount of people who abuse prescription opiates, etc.
My opponent responded to this rebuttal simply by saying the facts don't matter because I didn't state how many people a year die from Suboxone use. My opponent ignores the fact that I was merely pointing out the amount of people who would be considered "heavy users" in respond to his statement that Suboxone is ineffective on heavy users. The rest of my opponent's Round 3 is emotional appeal, and a case for why Suboxone is "good". He makes no case for why it is better than cold turkey, and doesn't even bother rebutting my contentions. My contentions still stand as follows:
1) Suboxone and methadone are both prescription opiates.
- My opponent does not deny this. He does not deny cold turkey is better than being on Suboxone when there is no question of convenience.
2) Cold turkey detox is the fastest way to get off opiates.
- Not only does my opponent fail to rebut this contention, he actually supports it with his own facts.
3) Cold turkey guarantees detoxification.
- The only caveat my opponent added to this contention is that there "may" be lingering effects for 3 weeks. This is not a rebuttal.
None of Pro's contentions stand against my rebuttals, and Pro has not presented a rebuttal to my own contentions.
1) My opponents rebuttal to my first one refuses to acknowledge the fact that it doesn't matter if Suboxone is a prescription opiate. A addict can just as easily shoot up while going cold turkey. At least while he is ON suboxone, he will be deterred because it won't do anything. When you go cold turkey, your cravings are heightened beyond belief. Therefore Suboxone detox is less painful, takes away your cravings for the time being, and easier to manage. Also, the longer you go without using the less of a chance you will relapse. Therefore I still fail to see the importance and superiority of cold turkey being a quicker method. The statistics of addicts relapsing while on Suboxone is very low, but admittingly once they are off it then it gets alot higher to cold turkey levels. Never the less, it doesn't mean that Suboxone is any worse then going cold turkey.
2) Yes, technically cold turkey is the cheapest...but by having to take off a week or two of work the amount of money you may lose in terms of paychecks may be greater then the cost of Suboxone treatment. I stand in my opinion that the convienence and uninterruption of life with Suboxone outweighs the cheaper method of going cold turkey.
3) I never said or denied that shooting up while on Subs isn't relapse. Using even once is relapse. Secondly, what does Suboxone producing a high in non-addicts have to do with anything. Addicts do not get on Suboxone to abuse it. That is the point of making the drug so it doesn't get you high. My opponent seems to have a grudge against prescription drugs. If Suboxone was OTC, would you care as much?
The speed of complete recovery (i.e. being off everything) does not seem that important to exclude or demote suboxone treatment. Why wouldn't the most convinent, least painful and life-intrusive way be the most efficient method? Also, while I did state that further treatment like programs or seeing a psychologist would be recommended, it's not completely necessary. Since we both agree it would be also recommended for methadone users and people who quit cold turkey...then what does it matter? I am not claiming that Suboxone is a magic pill. Yet, what I do think IS magical about it is that its existence encourages a lot of people to quit using opiates who may of not done it without it/been too afraid of withdrawals.
4) Opiate addiction effects all levels of society. Working at a pharmacy, I see it every day. Everyone from elderly people whose doctors write scripts for them like nothing, to lawyers, doctors and even politicans. Since the advent of prescription opiates, addicts are no longer viewed as simply low-class heroin addicts. Secondly, a lot of addicts are addicted because they are in serious pain and fighting serious illnesses. My opponents claim that all addicts probably aren't good workers or parents is simply wrong. Anyone can be an addict and you wouldn't even know it.
Also, "heavy users" aren't a huge chunk of users as you claim. I mean peoples definition of heavy users may vary, but using heroin doesn't make you a heavy user even if you inject it. In the drug community, heavy users are people who shoot up at least half a bundle a day (a bundle is ten bags). I have no legit source for this because it is just opinion. You can search drug forums and get different answers but that is the typical amount. Prescription wise, it would be at least 5 oxycontin 80mg's a day, or ten percocet 10's a day (they are much weaker). Whether voters want to exclude this or not is fine, since it is just opinion I've gathered and come to accept. Opiates are heavily addictive. Taking them even as prescribed direction-wise for even just a week can lead you to withdrawals if stopping. Fact is, most people aren't heavy users and therefore Suboxone WILL work for MOST of them. Just becausw you overdosed and died doesn't mean that you were a heavy user. You stated yourself that suboxone is extremely stronger then morphene. Though suboxone has a ceiling effect at 32mg, this means that you can take four 8mg pills at a time. That covers the majority of addicts by far. In fact it is very rare for anyone to even have to take more then a few at a time for it to work. You also agreed that the worse the addiction, the worse the withdrawals. This means that even for more advanced stage addicts, cold turkey would be absolutely miserable, but methadone may be too much overkill. As I said before, most people cannot lay in bed with the worst flu imaginable for a week. People have lives and whether you think that "most likely" addicts who let it get that bad are basically losers is your opinion. Look at Rush Limbaugh...the guy is a millionaire politician.
To respond to your final points,
1) going cold turkey is better then being on Suboxon.e if you care about detoxing quickly, don't care about withdrawals and don't have a life.
2) I don't think it really matters if Suboxone is a prescription drug or not. You fail to tell me why it matters other then giving me statistics about prescription drug deaths, none of which include statistics on Suboxone.
3) The speed of detox is really not important and I don't see why cold turkey would be better just because it's faster...especially since the relapse rates for it are not good. In fact, some addicts go cold turkey on purpose, and then start using again to get better highs.
If cold turkey offering complete detoxification and quicker, makes it better then you have to explain why. I have no statistics from you explaining how the speedy complete detoxification of going cold turkey leads to better rates of relapse or anything positive. As you said, I'm not denying all these things and do support them but I fail to see why it matters.
Basically, my opponent hasn't explained or given me any facts why greater quickness, being prescription, and complete detoxification without being on a drug means that it is a better way to go. All my opponent has explained is that cold turkey is quicker and potentially cheaper which are legit claims...but why does that overshadow convience, elimination of major withdrawals and the fear of them that prevents people from quitting, ability to continue every day life, and most importantly a doctor to help you through everything. When you're going cold turkey, you don't have a doctor to help you through it and maybe prescribe you something else to help you thru the periods of tapering, or recommend OTC products. Even when you go to rehabs they give you something, usually Suboxone but sometimes methadone.
1) My opponent's only defense to my rebuttal to his first contention is that it doesn't matter that Suboxone is a prescription opiate. He claims an addict can just as easily shoot up while going cold turkey, but that is not a defense of his contention. His contention was a claim that Suboxone was "not" a prescription opiate, and that it "tricked" the body into thinking it was on opiates. My rebuttal showed he was wrong. He goes on to repeat the nonsensical statement that addicts don't relapse while on Suboxone, but relapse rates are equal once off them. This also is not only not an adequate defense of his first contention, but it supports my overall premise that cold turkey is better than Suboxone. By admitting this statement, he is essentially saying you can go three months cold turkey, and have been clean for three months before you relapse, or you can be on Suboxone for three months, have never stopped taking opiates, and as soon as you're off you have an equal chance of relapsing as the three month cold turkey addict. This shows absolutely no incentive to use Suboxone other than the non-beneficial fact that you're still on opiates. My original rebuttal to Pro's Contention #1 stands as he never presented an adequate defense to that rebuttal, and follow up.
2) My opponent, again, only comes to defend his contentions in his final argument. Even so, he begins his defense to his second contention by giving it up all together. He admits cold turkey is cheaper than Suboxone. He then goes on to say the convenience of an uninterrupted life outweighs the cheaper method of cold turkey. This is not a defense of his second contention. The fact that my opponent never defended against my rebuttal to this second contention, his subsequent statements in support of my rebuttal, and conclusion completely ignoring his original contention means Pro's Contention #2 does not stand.
3) My opponent never defends his third contention. He claims Suboxone lacks a high potential to be abused, but thinks that Suboxone producing a high in non-addicts has nothing to do with the potential to be abused. He ignores the fact that Suboxone is made of a drug that is 20-40X more potent than morphine, which is a regularly abused prescription opiate. He does not understand the correlation of facts between prescription opiate abuse, and one more prescription opiate being on the market. My opponent even attempts the ad-hominem of stating I have a grudge against prescription drugs. This is complete disregard for the facts, and not a defense of his contention. My opponent never presents an adequate counter to my rebuttal of his 3rd contention, therefore Pro's Contention #3 does not stand.
4) My opponent not only never defended his statement about relapse rate, but presented statements of fact in support of my premise. He admits Suboxone has relapse rates as high as cold turkey. He goes on to say that heavy users aren't as large a chunk of the population. He goes on to give fabricated numbers regarding his opinion of what constitutes heavy use, and says he will leave it up to the readers to decide if they will include it in their decision. I challenge these statistics as false, as my opponent has already admitted he made them up. He concedes the fact that while you're on Suboxone you cannot relapse because you are still on opiates. He does go on to make an adamant defense against cold turkey detox by making claims against it's convenience. He completely ignores the facts which he corroborated in his Round 3 argument that withdrawal systems are proportional to the level of addiction. He paints this awful picture of withdrawal for cold turkey detox addicts, and ignores this previous fact when claiming these withdrawal symptoms would be as severe for even light addicts, which he seems to imply are the bulk of opiate addicts. He points out Rush Limbaugh by claiming he's a multimillion dollar politician. First of all, he's not a politician, he's an entertainer and political pundit. He was also involved in a very public case involving his illegal possession of prescription opiates. I don't see how this is a defense against his assumption that he is not a loser, but ok. This line of thinking ignores what we agree on- withdrawal symptoms are directly proportional to the level of addiction. As such, a nasty round of cold turkey withdrawals would imply a high level of addiction. We can all give personal experiences, and if they counted I would speak of a co-worker who had fibromaelgia and scoliosis, and worked at a military hospital. She was on prescription opiates- a cocktail of Vicodin, Purcocet, and Fentanyl. I wouldn't even consider this person an addict, as she only took the pills for a year- the amount of time they were prescribed, and came right off them when the prescription terminated. This co-worker had no perceivable withdrawal symptoms when she quit. We did not know she went "cold turkey," and we all assumed eventually she'd be fired for addiction given the fact that she was regularly on her medication while on the job. Problem is her medication would cause her to fall asleep on the job, and when she was awake she would regularly have incoherent slurred speech, and she would fall asleep right before your eyes. This person was dangerous- and nobody even noticed when she quit. I take that back- we noticed that she stopped falling asleep, we noticed no more slurred speech, and an increase in her productivity. This co-worker went cold turkey considering her level of intoxication. On the one hand one can argue that she wasn't addicted, even though this goes against the fact that opiates create a strong physical dependence. Given her high use rate and combination of drugs, she could have been considered a heavy user. In fact, she frequently exhibited symptoms of heroin addiction like teeth grinding. She stopped, and nobody at work noticed physically, rather as evidenced by her productivity. On the other hand, one can argue she was a light addict and experienced light withdrawals.
My opponent did not defend his contentions adequately. He did not rebut my contentions adequately. I've also run into some information that may just nullify all of his arguments, and finally convince him of the severity of strength of Suboxone, and the fact that it is a dangerous prescription opoid which also requires cold turkey withdrawal:
These experiences not only imply that Suboxone is addictive enough for getting off it to be considered "detox" by addicts, but they imply equal or greater difficulty than cold turkey because you are still going cold turkey to get off Suboxone, or you need some other drug to detox off of it. This carries double the risk of withdrawal symptoms given the fact that switching to Suboxone from other opiates may also cause withdrawals. Suboxone use can also cause death by overdose. Suboxone use is exempted from patients with lung problems, brain problems, liver problems, kidney problems, gall bladder problems, adrenal gland problems, etc. etc. exempting many potential candidates. http://www.everydayhealth.com...
Pro has not presented a solid case as to why Suboxone is better than going cold turkey. I have proven cold turkey to be safer, cleaner, and required even after Suboxone use. My opponent couldn't make a case because there is none. As such, I urge the readers to vote con. Thank you.
1 votes has been placed for this debate.
Vote Placed by esisCOA 5 years ago
|Agreed with before the debate:||-||-||0 points|
|Agreed with after the debate:||-||-||0 points|
|Who had better conduct:||-||-||1 point|
|Had better spelling and grammar:||-||-||1 point|
|Made more convincing arguments:||-||-||3 points|
|Used the most reliable sources:||-||-||2 points|
|Total points awarded:||4||2|
Reasons for voting decision: Pro had better points and overall better arguments, Con posted more sources. and pro get conduct because con repeatedly changed pros wording.
You are not eligible to vote on this debate
This debate has been configured to only allow voters who meet the requirements set by the debaters. This debate either has an Elo score requirement or is to be voted on by a select panel of judges.