Criminal Justice

Opiods, Justice & Mercy

Paige Mahaffey hugs Judge David Matia on her last day in drug court. Photograph by Rebecca Sell.

It’s not every day that a criminal defendant hugs a judge. But in courts across the country, these are unusual times.

A judicial embrace is a hard-won moment of congratulations for people with addictions graduating from the Cuyahoga County Drug Court in Cleveland. After more than a year in the diversion program—battling addictions, fighting demons and reclaiming life—hugs and tears are inevitable as participants cross a sobriety threshold most never thought possible.

“It’s been an absolute ride, this drug court,” said one new graduate. “I was always a quitter, and today I choose to be a fighter. If you have the will, you can overcome anything.”

The cycle of overdose, arrest, jail and rehab has been difficult to crack as the opioid crisis scales up and out, consuming communities. But court diversion programs such as the one helmed by Judge David Matia are expanding, and the arbiter behind the bench has increasingly become an advocate on the sidelines. Local courts are pivoting from crime and punishment to carrot-and-stick—using more humane, interventional approaches to deal with the defendants with addictions who are overwhelming their dockets.

See also: Opioid family court cases increase

This sort of crisis management is not the typical task of the judiciary, but it’s one that’s climbed courthouse steps across the country as judges nationwide have become first responders in the opioid epidemic.

“Drug court changes a judge,” says Matia, who was appointed to his position in 2008. “It changes your perspective on crime and punishment and rehabilitation. It has you question the ‘pounding the nail into the wood with a hammer’ approach we have toward criminal rehabilitation—it isn’t always effective. It changed my perspective on how I handle my criminal docket. The fulfillment of really making a difference can’t be replicated.”

Upon successful completion of drug court, graduates accept certificates; have their felony charges dismissed; thank their families, case managers and counselors; and they hug Judge Matia. It’s a proud moment for not just the graduates but also for families, friends and drug court alumni who pack the room for the March 14 ceremony.

“I was caught in the mindset of self-destruction,” one graduate said of his descent into heroin addiction, “riding a train to prison or death.” But through Cuyahoga County’s forward-thinking intervention system, he has escaped both—for now.

ADDICTION, USA

Opioid addiction in America is a dizzying array of crisis and carnage. Drug overdose is the leading cause of death for Americans under age 50, according to the New York Times. Prescription opioid painkillers have been linked to more than 200,000 deaths between 1999 and 2016, according to the Centers for Disease Control and Prevention. And the CDC reports that 115 Americans die every day, on average, from an opioid overdose. So far, six states—Alaska, Arizona, Florida, Maryland, Massachusetts and Virginia—have declared some form of public health emergency in the wake of the opioid crisis.

man hugging man at his desk

Judge David Matia: “Drug court changes a judge. It changes your perspective on crime and punishment and rehabilitation. It changed my perspective on how I handle my criminal docket. The fulfillment of really making a difference can’t be replicated.” Photographs by Rebecca Sell

Peddled by drug cartels and Big Pharma, opioids have seeped into America’s veins through street dealers, pill mills, online sellers and IV bags. Once the province of emergency rooms, prescription opioids have morphed into a drug-cabinet staple for millions of Americans. And the popularity of heroin, once widely viewed as a base and dangerous drug, has soared as its price plummeted and availability increased. Mexico and China are flooding U.S. markets with deadly synthetic opioids, and emergency responders and local governments are struggling to deal with the fallout.

“The U.S. represents 5 percent of the world’s population but 85 percent of the hydrocodone and 99 percent of the OxyContin consumed,” notes Dennis Wichern, who spent more than 30 years with the U.S. Drug Enforcement Administration before retiring in December as a special agent.

Opioid addiction is uniquely American. Other countries recognized the harm of prescription painkillers early on, with governments blocking the sale of a wide variety of opioids and other analgesics. But in many ways, courtesy of Big Pharma marketing, Americans are raised with the expectation that almost any pain—physical, psychic or emotional—can and should be escaped with a drug.

This belief was accelerated in 1996, when the American Pain Society introduced “pain as the fifth vital sign,” giving it equal status with blood pressure, heart rate, respiratory rate and temperature.

For many in the U.S., pain is not only uncomfortable—it is inconvenient. And the pharmaceutical industry has made hundreds of billions of dollars off a collective desire to transcend pain. Because pills are cheaper than other therapies, insurance companies have been on board.

Thus began campaigns to push opioids on physicians and consumers as a “safe” means to manage patient pain, whether temporary or chronic, without disclosing these pills were actually addictive.

“I get asked, ‘Why is heroin back?’ ” Wichern says. “Heroin never left. If you look at the history, people go from pills to heroin.

“We don’t need to prevent the next drug; we need to give the kids the tools and power to prevent that first dose. Just about every Drug Enforcement Administration office across America is laser-focused on heroin and fentanyl addiction to save lives.”

As black market demand for prescription pills like hydrocodone, Percocet and OxyContin has increased, these drugs have become prohibitively expensive on the street while heroin has gotten cheaper by the year. According to the DEA, in many hard-hit towns, one 30-milligram OxyContin pill can cost up to $40; a bag of heroin can go for as little as $5.

Opioids have opened the floodgates for heroin; street dealers often mix it with the cheaper—and more dangerous—painkiller fentanyl. Heroin is also sometimes mixed with carfentanil, another synthetic opioid 10,000 times more powerful than morphine. It’s a drug used to tranquilize elephants. In the hands of people with addictions, these mixtures are frequently lethal.

“Eighty percent of new heroin users start with opioids,” Wichern says, whether it’s recreational or prescribed. “Almost all heroin contains fentanyl, or it’s [pure] fentanyl on the streets. Taking heroin now, with fentanyl involved, it’s like playing with a fully loaded gun.”

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