Hope they don’t send me to jail today,” said one man as he entered the courtroom. “I missed court last week.” The man, who is required to attend court each week as part of a drug court program, told his peers that he had a relapse Monday.
“I ran into an ex-girlfriend and got into a situation I wasn’t prepared for. She had powder; it was stupid.” As Judge Dominick Motto entered the courtroom, everyone rose, then the dozen members of the program returned to their seats in the jury box.
It was a Thursday morning in Courtroom 1 at the Lawrence County Courthouse. Drug court was in session. Motto turned to the participants, knowing he couldn’t sugarcoat the news he was about to give. Mark McGinnis, who was part of the program, had died from a drug overdose. “He always had a smile on his face,” Motto said. “It is hard on me — it is hard on the program and everyone involved.”
McGinnis’ death was the first in the drug court’s three-year history. Those who came to the courtroom that day are the lucky ones — they have a support system as they focus on recovery. But sometimes even that isn’t enough.
Pennsylvania has seen a 66 percent increase in hospital admissions related to heroin in the past two years, according to a Pennsylvania Health Care Cost Containment Council report released in June.
The report cites 1,524 heroin overdose hospitalizations statewide in 2016, compared with 919 overdoses in 2014, and 378, going back to 2003. Each county may have a different story, but the national Centers for Disease Control and Prevention has declared opioid use an epidemic in the United States.
In Lawrence County, misuse of opioid painkillers results in drug overdoses — and sometimes death — every day.
Many across the country trace the crisis back to 1996 when the American Pain Society introduced the phrase “pain is the fifth vital sign,” making pain assessment as important as blood pressure, heart rate, respiratory rate and temperature. The other vital signs can be measured objectively, but pain can’t.
“Fifteen years ago, the AMA (American Medical Association) was suggesting the use of oxycodone to subdue pain, the fifth vital sign,” said Motto, who presides over the Lawrence County Court of Common Pleas. “The medical community was very generous in prescribing this heroin in a capsule.”
“Teens get their hands on it and think, ‘how could it be that bad if a doctor prescribed it?’ They just didn’t — and don’t — understand the dangers,” said Motto.
His drug court allows an individual who has been charged with a nonviolent crime to plead guilty, but not be sentenced.
Motto is more than a judge in the fight against addiction — with his passion, he has gathered a team of professionals to coach and mentor participants in their fight toward recovery.
Drugs move in
“In the 1980s and ’90s, crack was the drug of choice around here,” said Lawrence County District Attorney Joshua Lamancusa, who was elected as district attorney in 2010. In the mid-2000s, drug dealers from Detroit moved into New Castle to sell crack. A raid in February 2006 resulted in the arrests of 28 dealers linked to two organizations from Detroit.
These major arrests put a dent in the crack cocaine trade in Lawrence County, but soon prescription pain medications, most of them oxycodone-based, emerged as the most prominent street drugs in Lawrence County, Lamancusa said.
Doctors part of problem
The pill addiction problem erupted initially with three doctors who ran a pain clinic in Union Township and dispensed thousands of prescriptions for oxycodone-based drugs during 2002 and 2003, addicting hundreds, Lamancusa said.
Following an investigation by the state Office of the Attorney General and the Lawrence County Drug Task Force, the doctors were arrested in September 2004 and sentenced with multiple felonies. Continued investigations resulted in the prosecutions of chiropractor Thomas Wilkins and pain doctors Philip G. Wagman and William Mangino. All three are serving sentences in state prisons.
By 2010, the CDC had declared prescription pill abuse to be an epidemic in the United States.
Locally, continued investigations led to Dr. Van Edward Scott, a pain doctor who ran an office in New Wilmington. Scott was sentenced in June 2013, to 9 1/2 to 19 years in a state penitentiary. Similar issues surfaced nationally and, as a result, federal guidelines became more stringent for physicians dispensing prescriptions, and doctors became more conservative in writing them.
“Those addicted to opioids want it more than a starving man wants food,” said Motto. “It changes their brain composition to want more and more, to get the same feeling.”
With pill availability decreasing, it was harder for dealers to get prescriptions, so users turned to heroin because it was cheaper, and it gave them the same high. “You can get a hit of heroin on the street for less than 10 bucks,” said Lamancusa.
Now, 90 to 95 percent of the county’s drug cases are heroin-based. And 80 percent of the heroin has fentanyl mixed in, said Motto. Fentanyl is a synthetic opioid that can be more than 50 times stronger than heroin. There are also traces of carfentanil found on the streets today — 100 times more potent than fentanyl.
“That is one of the dangers — users never know exactly the strength of what they get,” said Motto.
The county is orchestrating all of its resources to continue the war on opioids, targeting the drugs and dealers primarily coming from Detroit, Youngstown and Pittsburgh, said Lamancusa. “We have four interstates that go through here, making it easy access.”
The county drug task force has done nearly 200 drug raids and collected $987,000 in cash in the past seven years. Fifty percent of the cash collected comes back to the department, Lamancusa said.
“We are now dealing with more drug ODs than car accidents.”
(Reporter Katy Mumaw welcomes feedback by phone at 330-337-3419 or by email at firstname.lastname@example.org.)