It’s not just families who are coping with the consequences of the opioid epidemic, although they undoubtedly are paying the highest personal price. Many others encounter the crisis in the course of their work – physicians, child welfare workers, police officers and prosecutors, to name a few. Once a month for the coming year or so, the Valley News will focus on some of those people to get their perspective on the crisis and how it has changed both their work and their understanding of the epidemic.
White River Junction — Prosecutor David Cahill became acutely aware of the opioid epidemic five or six years ago — not because he was suddenly overwhelmed with drug possession or dealing cases, but rather because of the death certificates handled by the state’s attorney’s office. It used to be that the office would be called out in the middle of the night because an elderly person had died of natural causes or a middle-aged person had died of a heart attack or during a motor vehicle accident. Starting around 2011 or 2012, however, Cahill and his colleagues were more frequently asked to sign death certificates for people in their 30s, 20s or even in their teens. The cause of death was drug overdose.
Cahill, 38, has been doing prosecutorial work since 2005 and has been the Windsor County State’s Attorney since January 2016. The arrival of the opioid epidemic has changed the work he does in ways he could never have imagined. Yes, his caseload has changed — many more drug-related cases get referred to his office than before (which means fewer of other types of cases, such as DUIs, because police are spending more time dealing with the explosion of opiate use). But the real change has been how the epidemic has forced him to rethink the role a prosecutor plays.
“If you asked me when I started working as a prosecutor at the end of 2005 if I was going to know anything about medical insurance billing codes and Medicaid expansion and what it takes to get into residential treatment, I probably would have told you … that I (had) no expectation of having to know that as part of my job. I now know that because fundamentally opiate addiction is a medical problem, that (it) requires a partnership between the criminal justice system and the medical system.”
When Cahill discusses how the law enforcement system handles the opioid epidemic, he tends to break it down into two categories — the supply side and the demand side.
“We do not pretend that at the county level when we prosecute drug dealers we are affecting the supply and availability of drugs. All we are hoping to solve is a quality-of-life problem for specific neighborhoods and specific people who have to live day in and day out in a drug-dealing environment. It is a much more modest goal than the original goal of the war on drugs … which was to solve the problem of drug addiction by eradicating drug supply. Supply is simply too robust, and the supply is controlled by factors that are outside our geographical borders.”
Addressing the demand side, though, seems more attainable, although it is hardly a simple task and, in fact, requires him to shed the conventional role of a prosecutor. Rather than focusing exclusively on holding people accountable for drug-related criminal behavior, Cahill hopes to figure out how to help those people get the services they need to overcome the addiction that is driving that behavior.
“One of the weaknesses of the adversarial criminal justice system where we prosecute and the defendant gets a defense attorney is that we never get to really be face to face and have an encounter like normal human beings with the defendant to discuss what is going on with them and what is driving their behavior.
“One of the things we have done is to take certain classes of offenses and offenders out of the criminal justice system, or at least give them a chance to stay out.”
One way the Windsor County State’s Attorney’s office does that is through its Windsor Rapid Accountability Program, or WRAP, which handles addiction-driven crime by assigning defendants to case managers for screening that determines what array of services might help them overcome their substance abuse problems. If the accused person abides by the conditions and recommendations, the charge is dropped.
Rough statistics show that WRAP, which was launched in 2016, has been successful.
In the third and fourth quarter of 2015 when WRAP wasn’t yet in place, Cahill’s office filed 230 charges in court under the categories “drugs” and “property crime.” In the third and fourth quarters of 2016, his office filed 119 charges in those two categories. Those stats aren’t perfectly comparable, he noted, for a few reasons, including that not all property crime is drug-related.
One of the challenges of making that program work is simply finding the resources to do it properly, which requires finding out enough about the accused person to devise a customized program.
“It is always a challenge to have enough man hours (in) the day so that our case manager can actually go out into the community and talk with defendants, their relatives (and) potential employers, as opposed to being stuck behind a desk writing reports to me and others.”
“I can’t tell you how many meetings I have sat in on where the solution to us was clear that this person needs a certain level of treatment, and the answer from an insurance company was that they did not believe that that level of treatment was required. And as a result literally some people have gone on probation and to jail because an insurance company did not approve them for the level of care they needed.”
While Cahill has had to rethink the role of prosecutor, he says he’s entirely comfortable with an approach that doesn’t necessarily insist that people who have committed crimes be punished.
“Each person who takes advantage of our alternative justice program has to work hard to earn that nonconviction outcome. No one is getting a free ride. And frankly I am amazed at how many people are able to graduate our pre-charge program recognizing the hurdles that they face in terms of just meeting basic needs — shelter, transportation, nutrition and medical care.”
An approach that focuses on treatment makes sense for a prosecutor who has concluded that law enforcement alone is ineffective in fighting the opioid epidemic.
“A medical approach is paramount because the individuals who come to us have a medical disorder. They are the individuals who are truly the tough nuts to crack because their family hasn’t been able to successfully wrestle them away from addiction. Their primary care provider, if they have one, hasn’t been able to do it. Oftentimes residential treatment hasn’t been able to do it. And our role in the criminal justice system, frankly, is to give individuals who are addicted to opiates and opioids a nudge in the direction of using the medical supports that are available to them.”
Jordan Cuddemi can be reached at jcuddemi@vnews.com or 603-727-3248.