Everyone in Judge Craig Hannah’s opiate-specific court is offered a deal: complete addiction treatment and the charges against them may be reduced
This article titled “‘He’s trying to save lives’: the ex-addict judge on the frontline of the opiate crisis” was written by Edward Helmore in Buffalo, New York, for theguardian.com on Sunday 20th August 2017 04.01 UTC
“You have to want to get help, and you have to want to help yourself,” counsels Judge Craig Hannah from his bench in Buffalo city court 11. “You can’t just keep running away from the treatment bus.”
Hannah, a pioneering jurist who oversees the nation’s first Opiate Crisis Intervention Court in northern New York, is speaking to a man who has flunked out of rehab a second time. A bed in a third facility may not be so easy to find. The addict – a “participant” in the parlance of the court – looks doubtful, and Hannah continues his pitch: “If you get on the bus, I’m going to take off my robe and come down there and shake you by the hand.
“But I also need you to hold yourself accountable,” adds Hannah, who has his own firsthand experience of drugs from earlier in his life.
Everyone who comes through the court is essentially offered a deal: complete addiction treatment, and prosecutors may look favorably at reducing the charges against them.
As the Trump administration sends conflicting signals about its approach to making the opioid crisis a national emergency, Hannah is receiving calls and visits from judges across the US interested in what is happening here.
They’re exploring replicating the Buffalo model of an opiate-specific court that speeds up the arraignment-to-treatment process. His goal here, Hannah says, is “to set up a good working model that can travel”.
When the Guardian visits, we watch as his presentation, a mix of friendly persuasion and a basic reality check for drug users lost in the maze of active addiction, is delivered several times through the day.
The singular requirement is the use of opiate drugs. Many come directly from jail in jumpsuits and shackles; others are days or weeks into detox or treatment programs. Some display defiance, others vulnerability. But each are offered the same deal.
With an average of one overdose death in Erie County each day, Judge Hannah’s court is on the frontline of the spiraling opiate crisis. The stark objective is to keep addicts alive, and under the terms of the scheme that means placing rehabilitation ahead of prosecution.
The addicts in Hannah’s court are from every walk of life. Many, perhaps most, switched to heroin after legitimate prescriptions to pain medications were restricted. But the addition of the super-strong painkiller fentanyl has turned the conventionally dangerous use of heroin into a game of Russian roulette.
Health officials in Buffalo blamed 300 deaths on opioid overdoses in 2016, up from 127 two years earlier. The Erie County health commissioner has already determined this year’s total is likely to double again. At the same time, Buffalo drug court administrators had noticed that potential participants were dying between arraignment and being referred by court treatment coordinators. In one week last year, three overdosed.
The increase in Fentanyl-related overdoses in Buffalo corresponds to national figures. According to the Washington Post, Fentanyl-related deaths in 24 of the nation’s largest cities and surrounding the counties increased nearly 600% from 582 in 2014 to 3,946 in 2016. The number of fatalities this year are expected to easily top last year’s total.
“This particular substance does not allow individuals to make it for any length of time to get to the rehabilitation they need, and we were getting tired of notifications at drug court that we wouldn’t need to worry about defendants turning up because they were already dead,” says project director Jeff Smith.
Smith’s proposal for an opiate-specific drug court was approved earlier this year with a three-year, $300,000 grant from the US Department of Justice’s bureau of justice assistance. The opiate court launched on 1 May.
Now, at 7.30am each day, anyone arrested and detained overnight in Buffalo is interviewed about their drug use. They are asked three questions, says Smith. “Have they ever used? Are they currently using? Have they have overdosed? If any question is answered in the affirmative, they are brought before the court.”
As part of the project, both the Buffalo district attorney’s office and the public defender’s office agree to hold the defendant’s cases in abeyance while the court deals with the addiction issue. “We needed a judge who would see these people right at arraignment and not wait for constitutional rights to be followed and try to intervene then and there on an individual use of opiates.”
Smith found a judge in Hannah, who knows what he’s dealing with. He is, he says, a grateful recovering addict 17 years clean from a dependence on marijuana and cocaine. It takes one to know one, and Hannah’s underlying message to participants in opiate court is of identification: “I tell them the only difference between them and me is time.”
So far, no one who agreed to participate in the program has overdosed, though there have been warrants issued for missed appearances.
“I think everyone is coming to grips with this as a health issue,” Hannah says. “Twenty years ago they were locking them to keep them away from the substance. That didn’t work ’cause the second they got out they still had the same illness.”
The self-help, total abstinence approach – “cold turkey and you’re on your own” – has largely been superseded by medication-assisted treatment, with addicts offered a range of opiate substitutes and blockers, or both.
The changes are a reflection of the severity of the opiate crisis, as well as broad acceptance of addiction as a disease. “People are realizing you have to treat this as an illness that needs medical treatment,” says Hannah. “If you have diabetes, you’re not ashamed of going to the doctor, so why should this be any different?”
But the political climate is complicated and not necessarily favorable. Last week, Donald Trump initially pushed back against calls to declare a national emergency over the opiate crisis and spoke instead on the importance of law and order. This position appeared to reflect that of the attorney general, Jeff Sessions, who has called this “the worst drug crisis” in history, and vowed to use “every tool we have” to reverse the trend.
Sessions has said government officials “have mistakenly sent mixed messages about the harmfulness of drugs”. He continued: “So let me say: we cannot capitulate intellectually or morally unto this kind of rampant drug abuse.”
But policymakers taking a high moral or political line on so-called recreational drugs and working, as Hannah does, in the daily grind of opiate addiction and its consequences, are far removed from each other.
Also, Trump’s later comments in which he said would look at calling a national emergency raise the prospect that the administration might take a more nuanced approach.
Hannah informs participants in the program that the court plays by “Vegas rules” –what they say here is not part of any criminal case – but he needs to know what’s going on to be able to help them. The moment an addict comes into his court, he says, it’s his job to give them a chance.
“I’m their biggest friend and cheerleader for the next 60 or 90 days,” he says. “I have to believe that this time he or she really wants treatment as opposed to all the other times they’ve just said anything to stay out of jail.”
Acceptance and participation in opiate court means detox, inpatient or outpatient care. The court runs a counselling session each morning at 9.30am. Those under Hannah’s care accept 8pm curfews, and at least 30 consecutive days of in-person meetings.
Participants who relapse aren’t punished – “relapsing is part of recovery”, Hannah recognizes – but anyone who doesn’t show up is likely to find a sheriff at their home with a warrant. In court last week, one man who’d refused Suboxone, then skipped out of treatment, used fentanyl and was returned to jail until a new place could be found.
“We have to be aggressive in following-up and checking on people,” says Hannah. “Our job is trying to keep them around long enough so they can get better.”
One of those is David Scott, 29, who recently passed 44 days clean after nine years using heroin and shooting cocaine and crack cocaine. He recently lost two former girlfriends to fentanyl. “I was beyond sick and tired and fucked up,” Scott says. Now he’s under care of the opiate court. “He’s empathetic. He isn’t a judge with a constant scowl on his face. He’s trying to save lives.”
A woman who gave her name as Crystal said she’d made 65 days clean. Her addiction started when she was prescribed Lortab for kidney stones. When the prescription ended, she started smoking fentanyl patches. Now a participant the court program and taking Suboxone, she’s been able to become a part of her family again.
It’s still early days for Judge Hannah’s opiate court, but with each turnaround the path out of the crisis may become more apparent.
“We’ve had zero deaths of people who come through the court. I’m proud of that but I’m also a realist,” says Smith. “Science created more powerful pain-managing drugs, but no one was ready for what would happen when it started or after it stopped. That’s what we’re dealing with here.”
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