FONDA -- Sometimes the best place for someone addicted to drugs is neither a courtroom nor a jail cell.
“Anybody who's going through withdrawal, it's not a fun situation,” said Montgomery County Sheriff Jeff Smith.
Montgomery County has a protocol in place for when individuals who are addicted to drugs, particularly opioids, are arrested and placed in the county jail, Smith said. Despite their best efforts, the sheriff said, these detentions are often problematic. They’re exceptionally stressful for the inmates and they strain law enforcement and correctional officers at his Montgomery County Correctional Facility.
"It creates medical problems,” Smith said. “We have medical protocol, and we have nurse practitioners who provide the medical care that's needed, but, still -- you're in a jail cell going through withdrawal and that's not an easy task -- there is no specific inpatient or outpatient counseling.”
“We have counseling programs, but nothing really on a regular, daily basis, so there's nothing that's helping the person to stop," he said.
Until now, that is.
To address the issue of opioid-addicted people flooding the justice system, the New York State Unified Court System has begun establishing special Opioid Stabilization Courts, and Montgomery County has been chosen to be the seat of the first pilot Opioid court for New York's 4th Judicial District.
Montgomery County Court Judge Felix Catena said he's been asked to preside over the new court, which he has been in the process of setting up over the last several weeks.
"Essentially, what this is is like an emergency room for the court system,” Catena said in an interview last week with The Daily Gazette. “In a nutshell, the way it works is, because of the problem of heroin abuse and opiate [and opioid] abuse and opiate overdose and heroin overdose and fentanyl -- we have people who are affected by this and people who are dying; around the country, they're coming up with different treatment courts in an attempt to come up with a solution for the problem, to at least, at a minimum, save lives.”
“Once somebody is stabilized, they would go through the typical system," Catena said.
The Buffalo Opioid Treatment Intervention Court, launched in Spring 2017, was the first of these courts in the U.S., and then Rochester opened one in November 2018.
According to a news release from the New York State Unified Court System, the stated purpose of these new Opioid Courts is to provide immediate intervention, treatment and supervision to high-risk defendants with severe opioid use-disorders. Cases considered appropriate for the Opioid Courts will be flagged for screening upon the consent of the defendant’s attorney. Defendants who opt to undergo screening and are found to be at high risk will have their case proceed in the Opioid Court, with the local district attorney suspending prosecution of the case during the stabilization process.
"Once clinically determined to be stabilized and no longer at risk of overdose, the defendant may be referred to drug treatment court, for longer-term treatment, judicial diversion or other adjudication," reads the news release.
Catena said Chief Judge Janet DiFiore has made it a priority to establish an Opioid Court in each of the state's judicial districts and Montgomery County will host the one for the 4th District, which includes 11 counties stretching all the way to the Canadian border.
While Catena said the new court will technically have jurisdiction over eligible Opioid cases in all 11 counties, during its initial stages it will only handle cases in Montgomery County. He said he is in the process of circulating a Memorandum of Understanding with Montgomery County District Attorney Kelli McCoski, the county public defender's office, local law enforcement agencies and the court clerk's office -- all necessary for the Opioid Court to function.
Catena said the way the Opioid Court will work is every morning at about 8 a.m. the drug court coordinator in Fonda will call the Montgomery County Correctional Facility and the Amsterdam City Jail to inquire whether anyone arrested overnight has experienced any of the effects of heroin use or opioid overdose.
"Then it kicks in, and that person is immediately brought to Fonda, appears before me, and then treatment is notified, treatment comes to the courthouse, picks the person up and gets them into treatment, where they are stabilized. Then, they are brought back into the criminal court, and it's handled like any other case," he said. "Basically in the Opioid court there is a stay of prosecution, a hold on prosecution, to get the person stabilized. That's essentially how it works."
McCoski said there is a huge need for this type of program in Montgomery County.
"When I started my position, I did not realize how much heroin there was in Montgomery County. You think of it as a big city or a big county thing, and we're not a big city or a big county, but it's here, and it's rampant right now," she said. "This is almost like a triage. We try to nip it in the bud immediately. With Drug Court, you don't get Drug Court until your attorney has negotiated with my office, you get brought into court and there's a plea, there's a presentence investigation report, and also there's sentencing. There's a period of time when nothing is going on, and with heroin -- [treatment] needs to be immediate."
McCoski said preserving people's lives needs to be one of the top priorities of the court system, including the lives of drug addicted witnesses, some of whom may be vitally important to drug prosecution cases.
Montgomery County Public Health Director Sara Boerenko, who's also the county mental health director, said the latest statistics from the New York State Department of Health show Montgomery County has a rate of opioid overdose death of about 6.1 per 100,000 people since May of 2018, which adjusted for Montgomery County's population of about 50,000 people would equate to about 3 deaths over that time period, none of them from heroin. State Department of Health figures show Montgomery County's rate is down from 10.1 per 100,000 in 2015.
"We have to look at a few factors, our hospital, St. Mary's, is the emergency room provider for a three-county area," she said. "When we're looking at our opioid instances, we're tracking where the person was when the incident occurs."
While Boerenko said she thinks the Opioid Court may be a great idea, she hopes that the treatment programs in her county will receive the funding support they need to handle patients from it.
"We know this is a growing epidemic, but my fear is if we build it, they will come, and the question is do we have enough infrastructure, staff and economic support to continue opening the doors [of treatment] without additional funding," she said.
Smith cautioned that although he supports the creation of the Opioid Court, anyone in it who skips out on treatment will be brought back into the regular justice system.
"A warrant will be issued for their arrest immediately," he said.
According to the New York State Department of Health, among state residents, the number of overdose deaths involving opioids increased from 1,074 in 2010 to 3,009 in 2016. The age-adjusted rate of deaths involving all opioids in New York state approximately tripled between 2010 and 2016, from 5.4 to 15.1 deaths per 100,000 people. This included a large increase in the rate of deaths involving synthetic opioids.
Opiates are drugs derived from opium, including morphine, codeine or heroin and opioids are synthetically made like fentanyl. The term opioid can apply to either.
Many people addicted to opioids are arrested for illegal possession of drugs or selling drugs or other crimes.
Smith, the Montgomery County sheriff, said he's seen cases of drug overdoses directly linked to recent jail inmates who did not receive any treatment.
"The 'repeat customers' and recidivism is out of control. We're continually going through this cycle, when they get out of jail -- they were doing a certain amount of heroin when they went in and then they aren't doing it in jail -- but then when they get out they think they can do it at that same level, and that causes them to OD," he said.