Paul Coles’ journey to becoming one of the 2.5 million Americans addicted to prescription opioids began with painkillers prescribed for injuries suffered during an IED attack in Iraq. The physical scars healed, but emotionally Coles suffered. He had Post Traumatic Stress Disorder and couldn’t stop using drugs.
“It got to the point I would take three times the lethal dose of heroin and cocaine, load it into a syringe and shoot it up, trying to shut my body down,” Coles said. “I would sit there and say, ‘God if you are out there, just kill me.’”
Time after time, he cheated death. But he couldn’t escape the law. Coles found himself handcuffed, arrested and jailed on charges of felony drug possession. Yet what seemed to be a new low would turn into a lifeline.
From the moment Judge Jeri Beth Cohen looked at Coles, she knew he needed help.
“My feeling is that opioid addiction is a terminal illness: You’re either going to end up in prison or you’re going to end up dead,” Cohen said.
“I’m seeing more and more cases,” she said. “These are young men and women between the age of, I guess, 21-30. It’s a largely Caucasian population,” she added.
One judge, two courts, one team
Coles’ case is one of hundreds Cohen has seen during the unfolding prescription opioid and heroin epidemic in South Florida. Inside her courtroom, with graphic photos of what drugs can do to the body, she surrounds herself with professional caseworkers on the frontlines of how America’s criminal justice system handles the boom in opioid abuse.
Miami-Dade County launched the nation’s first drug court in 1989. Today there are 3,000 U.S. drug courts serving 136,000 people. But a report by Physicians for Human Rights claims few communities have adequate treatment facilities and the criminal justice objectives of drug courts often overrule the medical need of the patient.
Cohen’s drug court gives people the chance to beat their addictions, stay out of prison while eventually getting their felony drug charge expunged from the record if they complete the year-long program.
Like Paul Coles 75 percent of Drug Court graduates remain arrest-free at least two years after leaving the program.
Miami-Dade County launched its first drug court when the community was facing a previous drug crisis. The approach then did not address people’s addictions, rather it was focused on jailing them for criminal conduct.
“There was a crack cocaine epidemic just like we’re looking at this opioid and heroin epidemic right now. People coming into criminal court in large numbers were taking a plea or going to jail, getting out and getting rearrested,” Cohen said.
Today there’s a stream of people in drug court struggling with addiction to a multitude of prescription pain pills and heroin. Cohen, regarded as one of the top drug court judges in the country, uses a holistic approach.
“What I find is if we can get them stabilized on a drug like Methadone or a Suboxone, which blocks a high, then they’re able to start engaging and they’re much more able to focus on getting well.” she said. The goal of the drug court is to get people treatment, steering them away from prison time and hopefully reducing recidivism rates.
“You have to take many variables into account: trauma, untreated mental illness, the chronicity or severity of the drug usage and also what’s going on in the family. If you’re not developing a treatment plan with your treatment team based on an individual’s particular risk and needs, you aren’t going to be successful with that individual,” Cohen said.
The judge bemoans the system’s lack of compassion.
“People are treated really, really poorly,” she said. “In the jails, in the courts, even in treatment they’re treated poorly. If you have money, it’s easier to access care [but] it’s still hard.”
For all her understanding, Cohen shows little tolerance for those not following the rules. She sentences some to community service hours while others go back to jail.
There are frequent drug screenings to make sure people stick with their sobriety. Those who don’t meet the court’s year-long requirements may be returned to a traditional criminal court to face felony drug charges.
“I don’t think that sick people should be in jail. I do the best that I can to help people get well within our system, to divert them out of jail, but yet hold them accountable,” Cohen said “I feel like I do my job and I feel like I do it well.”
“If you don’t go into the program, that’s fine with me,” Cohen tells a young, opioid-addicted mother, handcuffed and dressed in orange prison suit. “I am not going to keep you here and I am going to have the state dependency court file a termination of parental rights. I will order them to do it,” Cohen stressed.
“The children in my court have been removed from their parents because they have severe and chronic drug addiction and have failed to get into treatment,” the judge said. Her formula is to get parents who are struggling with opioid addiction intensive drug treatment so they can regain custody of their children.
She said 60 percent of the parents who go through the program get their children back.
“It’s getting into true recovery, improving your relationships with your family, your spouse, your children and starting that long life-long journey to recovery,” Cohen said.