Oswego’s Intervention Court saves lives of those suffering substance use disorder

From left, Mark Raymond of Farnham Family Services, Oswego County Surrogate Court Judge Spencer J. Ludington, and Samantha Cleveland of Oswego Opioid Intervention Court stand before the Oswego County Courthouse, home of Oswego’s Opioid Intervention Court. Randy Pellis/Oswego County News

OSWEGO — Intervention Court, formerly known as Oswego’s Opioid Court, is a testament to the power of compassion rather than an example of the power of the law. It’s not a court that locks you up. It’s a court that sets you free, free from substance use disorder.

Originated in Buffalo in 2017, it arrived, paid for completely through a federal grant, in Oswego in January 2019. Presided over by Oswego County Surrogate Court Judge Spencer J. Ludington, with support from numerous community organizations including Farnham Family Services and Case Manager for the court, Samantha Cleveland, the Intervention Court exists to stand against the opioid crisis in this county and to stand for and provide help to those who have been affected by that crisis. Simply put, it exists to save lives.

And it seems it is doing just that. In a lengthy interview with Judge Ludington, Samantha Cleveland, and Mark Raymond of Farnham, the goals, methods, philosophies, and hopes of the remarkable people and agencies that have dedicated themselves to this humanitarian effort were discussed in detail. The following is some of what they had to say.

“In January, February 2019, we commenced the program,” Judge Ludington began. “We were the very first rural county to have such a program in the state of New York. We’re pretty proud of that. And, I’ve got some statistics here. We have so far had 54 people participate in the court program, notwithstanding the effects of the bail reform, which we believe reduced our numbers and the coronavirus pandemic. We’re fortunate thus far, no overdoses within any of our participants, which we’re very proud of, and essentially, these are for non-violent offenses. If it’s a violent offense, you’re not going to qualify. It’s a 90-day program designed for the person to attend each and every day here. Since the pandemic started, they’re calling Sam (Samantha Cleveland) every single day. I meet with them virtually via Microsoft Teams. The real success of the program is early intervention, and that’s where Mark Raymond comes in. He’s from Farnham. We’ve found, and statistically it’s shown, if you’re able to get someone initiated in a program as soon as possible, your likelihood of success is greater. Some people might be surprised, many of these individuals are all classes, professional classes, working classes. These addiction issues reach all people from all backgrounds for a variety of reasons. And many of them sincerely want to get clean, and we’ve really been able to turn around a lot of individuals, get them clean, they go get jobs, they’re productive members of society, they’re working, pay taxes, and hopefully, continue to live clean lives. I don’t know if we have any statistics on recidivism, but we believe that we’re not aware of any recidivism. It appears we’re having success with people getting on the straight and narrow. My job is to sort of try to do what’s called motivational interviewing to keep them focused, to listen. You’d be surprised how individuals are willing to discuss their issues, because they want help, they want to get help. And so, part of my job is to encourage them to participate in the program, to stay in touch with Sam, stay clean, and to a degree, I find out who they are. And like I say, they’re regular folks which you’d run into at the grocery store, everyday people. And we encourage them to do what’s called medical-assisted treatment, and that’s where Farnham comes in. Most of them are going to Farnham every day. They’re either on Suboxone or a Methadone treatment program, and those programs are proven over the years. But, I’m on the court end of things, a volunteer judge. I was asked to participate and volunteered to do it in addition to my other duties. The goal is getting these individuals into either, perhaps, Liberty Resources, which is mental health services or certain behavioral health services, and there are different people to help them get clean. It’s amazing to watch individuals come to the courthouse looking like they need some help, and it’s dramatic to see how quickly their improvements are made. Their color comes back, they start gaining weight, they’re more engaging, they’re more talkative. It’s really a remarkable thing to watch.

“I’ve indicated to people,” he continued, “that if someone comes off the street, I’m going to take them in. Our grant is focused on individuals who have committed low-level misdemeanor crimes, but if someone shows up, I’m going to make the time to do what needs to be done to try to get them services and get them on the straight and narrow. They would come here (to the Oswego County Courthouse, 25 E. Oneida St. in Oswego), and then we’d figure out a way to communicate with them. Most of them have phones, and they can download the Teams app, which is free, to communicate with the court. It’s beyond the grant, but, we’re here, we want to help people. I’m convinced that it works. I couldn’t possibly turn anyone away.

“We are blessed in the county of Oswego with an incredible amount of stakeholders: Farnham, Liberty Resources, the district attorney’s office, local justices in the county, towns, and villages, lawyers, Judge Metcalf and Oswego City Court, Judge Hawthorne in Fulton City Court, Oswego County Probation Dept. and the Oswego County Dept. of Social Services. All those individuals know we exist. If they know of someone they believe has a problem, they call Samantha.”

“We find an increase of individuals referred to us,” Samantha (Sam) Cleveland said, “that had misdemeanor and non-violent felony charges who were using illicit drugs off the street, not knowing what’s in them, possibly having overdoses in the past, thinking that they had maybe cocaine, and it turned out there was fentanyl in there because fentanyl is cheaper and cut with many of the substances that people are using now. So, we wanted to expand the criteria to encompass everyone that was at a high risk of drug overdose, whether it be IV drug use, using multiple substances, etc. And another thing we should be mindful about is people with a history of opioid use, maybe they’re even in jail, and they’ve had a period of sobriety, now they’re at a greater risk of overdose, because if they use their original dose, they’re going to overdose, and it may possibly be fatal. So, we do make sure we keep an eye on that, and Judge Ludington does a great job of reminding people when they’re released from the jail. We get them connected to Farnham within 24 hours, because we know they’re in a crisis situation where they need the services.

“We have a bunch of people that reach out to us,” she continued. “They cold call me and say, ‘I was just arrested, and I received your phone number.’ So I screen them for the program. We’re seeing an increase of self-referrals, people calling in, but if someone does not fit our criteria, I will help them transition to another facility and whatever services they need. And we do let the police departments know that they can give out our phone number. That way, the person could just reach out to us directly.

“If they are facing charges in Fulton City Court, that case will stay in Fulton City Court. It does not get transferred to us. We are focussed on them being a patient first, getting into treatment, getting stabilized. We don’t want to talk about their court case or anything like that when we’re meeting every single day. We do want to make sure they’re staying in contact with their attorney throughout the process, but we really want to make sure they’re focused on the treatment and their sobriety. So, we do not make promises on their case because we do not have their case, but we can give the court a letter when they complete saying this individual completed the 90-day program.”

“We have nothing to do with the case itself,” Ludington added. “That’s solely in the province of the judge and the court of jurisdiction where the individual was arrested. We make no determinations on the guilt or innocence, or have anything to do with it. We have no jurisdictional powers at all. It’s of no consequence in terms of for them to come here as far as the criminal case. That being said, there’s two reasons someone might come here. One is to get clean, drug-free. The defense attorneys, I’m assuming, are encouraging their clients to assist, perhaps gaining some favorable resolution with the district attorney’s office. We don’t know if that happens or not. That’s entirely up to the district attorney’s office and the defense attorney. The defense attorney and the DA agree on their own as to deferring prosecution. For instance, if someone after 30 days is unsuccessful in engaging with us, they’re not cooperating, we notify everybody that we’re letting him go, and that the criminal court should just take over the case and proceed. So, it’s purely a volunteer program. We play no part in the normal criminal procedure process.”

Those who’ve been arrested and incarcerated awaiting trial may be released while they participate in the 90-day Intervention Court.

“Some individuals were released on their willingness to participate in the program,” Ludington said. “If they failed to participate in the program, the local judge would issue a warrant for their arrest, and they’d be reincarcerated. If they qualify, the Probation Department might recommend them, the district attorney might not have any objection, the defense attorney made the request, it was all in consent with the district attorney, and/or in combination with the district attorney and the Probation Office whether or not to consider releasing him. More often than not, it’s driven by an agreement between defense counsel, the district attorney’s office, who I believe relies on Probation for their information, and their own information on the defendant as to whether or not to authorize a release. They may condition that they release on condition that they participate in the program.”

“I think it might be worth revisiting the original motive of the opioid courts,” Mark Raymond of Farnham said. “There were a lot of people being incarcerated with opioid use disorder who were addicted to opiates and committing crimes. This goes back a long way. And what we found is, a lot of people who were being released from incarceration were actually committing more crimes again, because they’d relapse and go back to their addiction. A lot of them were small, lesser-degree crimes, and before they can even get back to court for their initial court, now they’ve got additional crimes that they need to face. We also saw, in examining the large number of people who died from overdoses of opioids, if you look at their history, many of them had periods of abstinence and specifically, periods of incarceration. And the reason for that is if somebody’s not using for a while, their tolerance goes down, and if they go back to using without treatment, without support, then when they relapse with their tolerance down, that’s enough now to kill them. So, what we saw in so many of our overdoses, there was a high rate of people with a period of abstinence prior to their fatal dose. So, adding this combination of court and support was bringing people this balance of support and accountability and is beneficial to that participant. The whole premise is to save lives.”

And there’s a specific method Farnham recommends to accomplish that. It’s called medication-assisted treatment, meaning a prescribed, therapeutic dose of Methadone or Buprenorphine along with counseling.

“What we know is that people who are addicted to opioids, there’s true pharmacological changes in their brain chemistry,” Raymond said. “We know this from probably over half a century of information, data, studies. Without medication-assisted treatment, an opioid-addicted person is going to be in a constant use-withdrawal cycle, use-withdrawal cycle, and when they’re in withdrawal, it’s so agonizing for them, it’s like the flu times 10. They’re not going to be able to function as a member of society very well because they’re very sick and drug-seeking to try to alleviate that withdrawal syndrome, which is a very expensive habit to afford on a daily basis, and leads to crimes. So many people have had over the years sort of a negative stigma towards people who are taking medication as part of their recovery program, even though we know that nine out of 10 people who are addicted to opioids without medication-assisted treatment will relapse. And it doesn’t really matter how long you’ve been well for, in fact the longer they go, the more at risk they for a fatal overdose if they do relapse. And when you think about post-acute withdrawal, people who are addicted to these opioids and they’re not using them, even if they do well, could have moments of depression, sensitivity to pain, a lot of cravings, a lot of difficulty. And what happens is, by having that medication plus therapy the patients are more stable. And what the judge has seen with many of these folks is that combination of counseling plus medication is helping that patient stabilize so that they don’t need to go out and continue to pursue the use of illicit substances. And we have people like the judge who are seeing these really positive changes that are actually working. They’re helping people not use heroin, fentanyl. They’re helping them not die. They’re helping them become more presentable to court. They’re taking more responsibility for their actions. They’re obtaining employment. Then all of a sudden, they love that experience. When you start to experience positive gains, you get positive feedback from a judge in your life, you are going to treatment and you’re not feeling in constant withdrawal. You’re on medication and going to counseling. These things have a really nice progressive approach to helping that person believe in their recovery, that it’s possible. So, for me, I can say that the biggest thing I see is the difference in success of our patients is when the have a true opioid use disorder, is the combination of medication and counseling.

“I think they need to realize there up against a really – it’s not impossible – but they’re up against a really, really big fight that I wouldn’t wish upon anybody,” Raymond continued. “The chances of success when you’re looking at eight or nine out of 10 relapsing over decades, that’s not great success. But it is possible, and so, at Farnham, we also talk about that. And whatever the patient wants to do, we’re going to try to do what’s most important to them. Whatever route they take, we want them to do the most educated, careful, safe, smart way. So, if they’d like to do it without medication and with counseling and some other wrap-around services, we will most certainly try that. But we will explain to them the risks. So, let’s ask people to not try to manage their addiction completely on their own. And let’s not make them feel bad about choosing whatever they need to choose, whether it’s medication-assisted treatment or another method. Let’s just encourage them to get help that they need.”

As far as the court’s future?

“If statistics prove out we’re successful,” Ludington said, “I think we’re in for a long run. The federal government’s committed to it. We’re committed to it. There’s definitely a need. It’s all about helping people. That’s what it’s about. That’s the bottom line. I think helping people help themselves is what we all should be doing.”

To contact Samantha Cleveland call 315-207-7579. To contact Mark Raymond at Farnham call 315-622-0323 or Farnham at 315-342-4489.

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