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American Judges Are Playing Doctor—and Doing Harm

An early look at a Pacific Standard story that's currently only available to subscribers.
(Photo: tlegend/Shutterstock)

(Photo: tlegend/Shutterstock)

Hailed as the most compassionate way for the criminal justice system to deal with addicts, drug courts were designed to balance punishment with rehabilitation. But after 25 years, the verdict is in: Drug courts embolden judges to practice medicine without a license—and they put lives in danger. In this devastating, comprehensive feature, Maia Szalavitz, who has covered drugs and addiction for nearly 30 years, underlines the human cost of a legal institution that enjoys broad bipartisan support, and is beloved by the press.

Maia Szalavitz's Pacific Standard feature is currently available to subscribers and will be posted online on Monday, May 18. Until then, an excerpt:

Rudolf and Judith Lepolszki know all too well what can happen when drug courts deny access to maintenance, because they witnessed the effects on their 28-year-old son, Robert.

Robert had been a much-wanted child. His parents had struggled for seven years to conceive him and then had emigrated from Romania to Long Island in 1996, when he was 11, in order to give him a chance at a better life. “He was such a smart kid,” Rudolf recalls. Unfortunately, Robert got involved with drugs during high school, moving from marijuana to cocaine, then to pain pills, and finally to heroin. A series of arrests and attempts at drug-free rehab didn’t stop his addiction, but he kept trying to recover and eventually entered a methadone program. After a 2012 arrest, he was allowed to continue his medical treatment in jail, while serving an 80-day sentence in Suffolk County. On the day of his release, Rudolf drove him to a community-based methadone clinic, because the drug did seem to help him. Finally, Robert seemed to be turning a corner. For the first time in years, as Judith puts it, he was “doing great,” dutifully submitting to drug tests and attending Narcotics Anonymous meetings three days a week. He had even returned to his work in sales, earning excellent commissions. Like many young-adult immigrants, he lived with his parents, but that was a choice, not a necessity.

One Friday night, however, the police showed up at the Lepolszkis’ home, a three- bedroom house on a quiet suburban street in Farmingdale, New York, with a warrant for Robert’s arrest. Before he’d started methadone treatment, he’d sold a small amount of the anti-anxiety drug Xanax, which he’d been legitimately prescribed, and the police had now tracked him down, about a year after the crime.

Robert’s case now fell under the jurisdiction of the Nassau County drug court, where a judge decreed that in order to avoid more prison time, he would have to stop taking methadone—the only treatment that had ever helped him. Although Suffolk County had allowed him to take methadone even in jail, and Robert had responded well to it, Nassau’s drug court judge was philosophically opposed. A county line—not the data—thus determined his medical care.

Robert decided to taper off methadone rapidly, a more painful detox than is medically necessary, because he faced sanctions in court every time he tested positive for it. “He was suffering,” Rudolf recalls. Describing Robert’s response to the chills that occur in withdrawal, Judith adds, “It was like 90 degrees outside, and he was bathing in the sun, sweating, then taking hot showers.”

As he stopped the methadone, Robert cut ties with his drug-using friends, determined to avoid relapse. “He was frightened that he couldn’t stop,” Rudolf remembers. “He just had this addiction [and] he was fighting it.” He told his parents that he didn’t even want to make new friends at Narcotics Anonymous meetings, having seen how many of those attending were still using. But at one meeting, not long after he went cold turkey, he met a beautiful young woman, and the two soon became romantically involved. She wanted heroin. Soon, so did he.

Because of his recent abstinence, Robert was at extremely high risk for overdose—and, not surprisingly, it happened. One Saturday, after he had returned home from a Narcotics Anonymous meeting with his girlfriend, the two went up to his room and shot heroin. Rudolf had no idea what was happening until he heard the young woman come downstairs and call 911. Robert had stopped breathing.

The ambulance came quickly, and the EMTs were able to re-start Robert’s heart, but, sadly, the damage was done: Robert died four days later in the hospital. He was 28 years old. Because he’d signed an organ donor card, in dying he was at least able to save four lives.

Cases like Robert’s haunt Ellen Sousares, who knows of at least three other families who have lost children after drug courts denied access to maintenance or otherwise failed to take the risk of overdose into account. It’s impossible to know how pervasive a problem this is, however, because drug courts do not track mortality rates. “Nobody has that information,” says Herman Joseph, one of the world’s leading experts on maintenance and a member of the original team that developed methadone treatment. Joseph is convinced that the problem is widespread, and believes that what drug courts are doing is a travesty. “They are destroying lives,” he says, “and it’s horrible.”

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