Drug Court

An Ian Collins Case

Twenty-five Court was the final destination for anyone in Toronto charged with a drug offense, and my current client was a regular customer.  I was sitting with other defense attorneys, watching the parade of shady characters present themselves before the Judge and offer outlandish excuses for why they were in possession of various illicit drugs.  Some excuses were sheer fantasy, while others were convoluted, hard to follow, and always presented the offender as an innocent victim who was unlucky enough to be somewhere near the drugs in question, but never conceded they were the owners.  The only consistent story was that whatever drugs were involved somehow magically appeared in their car’s trunk, in their pocket, or under their mattress.  Whatever the excuse, the Judge wasn’t playing along; in 1973, Possession of pot was considered a bad offense, and hefty sentences were quite common.  Waiting for my client, I kept checking my watch, hoping he’d show, and show soon.  While another victim was led away to jail, the rear doors opened and a walking side-show staggered in.  There was my client, Zach Forrest, his arms around two supporting women, being effectively dragged into the courtroom.  Zach looked like he was so high he was almost in orbit.  I cringed as the Judge recognized him and interjected some sarcasm which made the whole court laugh and got some hoots and comments from the defendants in the box.   At least the two women were extremely beautiful, and the blond was wearing quite the sexy outfit, something every male in the court appreciated and noticed immediately.  Before they descended into cat calls and comments to the girls, I had to reassert the formalities the court was expecting.

 

“Mr. Forrest,”  began the Judge, “nice of you to drop by and say hello…you can say hello, can’t you?”  The comment didn’t register on Zach, and the ensuing laughter made him join in, thinking he was at some weird party in his mind.  He mumbled some incoherent statement, which must have been a joke, as he broke out laughing again.  I jumped up and introduced myself as his lawyer, and said Mr. Forrest was extremely ill and on his way to the hospital.  One guy yelled out overdose time, and the defendant bench broke into a new round of laughter.  I had to get this under control while the Judge appreciated the highly unusual situation and the obvious comedy of errors he was witnessing.

“I hope that hospital is the Addiction Research Foundation, Mr. Collins, as your client seems to be suffering from the effects of the drugs he’s currently charged with possessing…some fairly strong barbiturates, according to this arrest report.  It looks like the police missed a few.”

Howls and laughter followed his comments, and I could only smile, hoping the mood of levity would work in our favor.  This was perhaps the only court that frequently dealt with moments such as this, as every defendant who suspected they would go to jail always took some last minute handful…trying to time it so they kicked in at the jail, but often that timing wasn’t too exact.  One of the women tried to get Zach on the other side of the swinging doors, but let him down on one of the benches where he promptly stretched out, casting his legs atop the back of the next bench.  His slouch and insouciance were apparent, and disrespect for the court was written all over him.  Thankfully, the girls realized this, and tried to pull him into a more respectful position.  I hated to think how many pills he took to stone him out this much, as even when I knew he’d been medically prepared for court, he was usually able to stand and state his name.  I imaging he might have just injected something, as the effects were immediate and powerful.  His shooting gallery arms were nasty looking…red and inflamed abscesses ran up and down both arms.  He should have thought of a long-sleeved shirt, but that was beyond helping at this point.

His two aides quickly dragged him to his feet, and managed to get him into the proper position to face the Judge.

“Once again Mr. Forrest, I can tell why you are in this court, as it’s apparent you’ve taken too many of something they missed when confiscating your stash…I think a hospital would be a good idea.  I’d hate to be deprived of your antics due to an unfortunate overdose.”  At least the Judge liked him and felt pity…in any other court, hard-ass Judges might slap him with contempt of court.

It was summer, and Zach was wearing jeans and a tie-dyed T-shirt.  His exposed arms were red, inflamed and impossible to ignore.  They looked like hell.  His right arm had three massive red and inflamed abscesses, while his left had a few of its own…whatever he was shooting didn’t make it into the vein, and wasn’t something you could absorb inter-muscularly.  He’d mentioned to me how he injected barbiturates…he’d get a large syringe, add some water, pour in several pills, and then add more water and shake it up…not the cleanest way to prepare an injection.  Despite his obvious talents and intelligence, he could pull off some dumb-ass moves, and often didn’t give a damn what sort of damage he caused himself.  I considered him a shaky train about to derail at any moment.

“The court demands that Mr. Forrest seek immediate medical treatment for the blatant abuse he’s inflicted on his body, and will remain at the ARF until he is in a more coherent frame of mind to address this charge.  Case remanded three months, and I suggest Mr. Forrest spend that time seeking treatment for a drug problem that is doing far more damage than he can tolerate.  I’d say a jail sentence would save his life at this time, but a hospital is more in line as I can see some severe medical problems without looking any further than what is before my nose.”  He banged the gavel and seemed to fight against the girls who were trying to lead him out of court.  Forrest seemed to remember the laughter, and enjoyed the spotlight on this strange stage.  Unfortunately, he also opened his mouth.

“Thank you, Thank you, you’ve all been so kind…I’d like to offer everyone a beer or something a little stronger if you know what I mean…let’s all remember this and make it a day that will live on.”  Although the words were heavily slurred, we could all hear his devil may care comment.  It seemed even the already detained defendants were shocked by this insane display of drug abuse in the extreme.

The Judge rolled his eyes, and added, “It seems you wish has come true Mr. Forrest…this day is being recorded, along with your behavior, and it will live on…on the record, and able to be re-lived at your next appearance.”  The two gorgeous women that Zach somehow managed to produce finally got him to the door.  The tall blond bowed to the Judge, and said thank you, and managed to get a reluctant Zach through the doors.  He was trying to hang on to the door-frame.  I dropped my pen and hung my head.  After this little performance, I don’t think my initial idea for a defense would have a chance of working.  I discreetly packed up, but caught the Judge’s eye: “Mr. Collins, please convey the concerns of the court to Mr. Forrest.  He’s a train wreck heading for a major disaster, and I’ve actually grown quite fond of him…even reading that first book he published.  He has talent, and it’s a shame to waste what could be a profitable life.  Ensure he is firmly locked away in Detox somewhere, and follows that through with rehab.  At this point it’s a suggestion, but if he doesn’t follow through, I’ll make it a firm bail condition.  All the best and get him some help.”

I assured the Judge my client would be in much better shape the next time we met, and quickly retreated.  Exiting the courtroom, I noticed the girls managed to drag him to the front door, so I went over to see what would happen.

They managed to get Zach to the street, but every taxi they hailed passed them by.  Finally, while the cute blond tried hailing, the other girl sat Zach down so he wouldn’t be so obviously out of it and scaring all the drivers.  Eventually, a bleeding heart pulled over, probably because he liked the blond.  They all tried to push him in the back seat.  I could imagine the taxi driver’s snicker when directed to take Zach to the ARF.

The taxi pulled up to what passed as the emergency entrance…not equipped like a hospital, it was merely the main entrance door.  When the nurses and assorted other personnel took a look at Zach’s arms, they knew they had a major problem on their hands.  They did have an emergency ward on the second floor, and after securing Zach to a restraint supplied gurney they directed him there, a.s.a.p.

The first doctor to examine Zach’s arm was visibly shaken…he’d never seen so many abscesses on one arm, and Zach had them all over.  Requiring immediate attention, they started freezing the surrounding area, getting ready to lance and drain the pus that made them look like massive pimples or boils ready to pop.

The largest abscess was treated first; it produced over an ounce of nasty looking yellow. blood-tinged bile, and took a lot of pushing around the edges to get all the poison out.  It was an incredibly painful procedure, and there were still many to go.  When as clean as they could manage, they stuffed the empty skin pocket with anti-biotic swipes, hoping they’d act like sponges to soak up residual poison.  The rest of the lumps got the same treatment, and by the time they were near the end, Zach was screaming constantly from pain so much the doctor caved and gave him a large shot of Pantopon: 35 milligrams was about double the usual dose, a medical decision that many inexperienced doctors would never consider.  Armed with Zach’s previous history, the doctor knew Zach had been admitted for heroin addiction, prescription opiates that read like a list of hospital-grade high potency painkillers that included the Pantopon he just gave Zach.  On his last stay, Zach listed his drugs of choice as Pantopon, Oxymorphine, Diamorphine, Methadone, Leritine, Hydromorphone, and Numorphan.  He was secretly impressed at the quality of Forrest’s drugs of choice, as most pain clinics would only stock one major pain medication along with the middle and lesser brands.  Doctor Ballard remembered more about this patient, including an overdose from a new drug that wasn’t even in production yet…something called Fentanyl.  For now, it was a laboratory experiment, and finding it was something of a surprise.  He recalled it took three injections of Naloxone to counter its potent effects.  He also recalled Forrest earned the distinction of a drugstore cowboy…but one that had a successful history, but a aftermath of total destruction.  The damage and poison trapped in various pockets showed a total disregard for his life, as these abscesses were the result of injecting pure barbiturates…something that wasn’t absorbed by the body unless it was injected directly into a vein.  The staff had already come up with a nickname for him…”The abscess man of the year.”  He’d seen one or two on some patients, but never five or six on one arm…a total that added up to over a dozen highly infectious wounds.

If they didn’t get massive doses of pure Penicillin into his blood-stream to fight the infection, sepsis could set in and only amputation of his right arm could save him.  That was something he didn’t want to cripple an immature 22-year old with merely due to lack of caution and a personal destructive tendency that only time would cure.

After wheeling Forrest back from the operating room, his arms were taped to his body, as the barbiturates he’d been ingesting for over six months had produced an addiction that produced one of the worst withdrawal setbacks that made heroin withdrawal seem like quitting sweets.  The symptoms produced vivid hallucinations, violent shakes, and total disorientation…a horror that would take over a week.  He was still sleeping from the Pantopon injection, something a younger colleague was worried about due to the large levels of barbiturates already flooding his blood system.  His only response was that the relatively small doses they gave where nothing compared to what this client put his body through on a regular basis, and the intense pain he suffered had to be put under control.  Leaving him to suffer the pain of lancing 12 abscesses would be barbaric and not in the Hippocratic Oath.  Besides, the pathetic screams grated on his nerves, and repeatedly inflicting severe pain was something he couldn’t tolerate.  He knew Zach would inject over 100 mg of Pantopon when he did a hospital…some of this was mentioned in his chart.  The objections had stopped when he told his assistant to read the history, something many doctors forget to do before they begin radical surgery.

Leaving orders for one more shot of Pantopon if Forrest showed extreme pain, he left for the day and would return in the morning.

Forrest woke up around midnight, screaming out in pain.  The hard-boiled doctor put off the order for additional pain meds until Forrest screamed for a full hour, his body bucking and shaking so much he threatened to expose his wounds and cause even more trouble.  He ordered the large dose and Forrest spent the rest of the night resting.

Morning arrival, and Doctor Braid looked in on his patient.  Now clear of last night’s meds, he wanted more, along with barbiturate to control the shakes…the first symptom of withdrawal.  Instead of narcotics, they injected him with 3 milligrams of pure penicillin…a rather thick and painful injection pushed into his fatty rear end.  He’d have to endure that shot for the next four days, and every four hours.  He had a battle ahead, and they had to be careful with him or this could end up costing him an arm or even his life.

By the second day of pure antibiotics, Forrest’s blood work showed some sign of responding favorably to the drugs.  By the third day, he was in full blown withdrawal from the barbiturates.  After hearing the high doses he took, it would be amazing if his body managed to pull through.  Hallucinations were part of the ordeal, and he had to have Forrest strapped to the bed to stop the violent thrashings.  He was also screaming spiders were crawling all over him.  Against my better judgment, I have him a strong dose of Valium to control the shakes, and redressed his wounds…a very painful procedure.  After the first two, he fought us at every turn.  There was no choice but to give him another shot of Pantopon…in most cases like this, a patient would be totally knocked out, but with the help of the Pantopon and Forrest’s otherwise healthy condition, he tolerated the rest of the bandage changes…this included removed the antiseptic swabs we stuffed into the surrounding areas of the wounds, a painful procedure I knew what hard to take.  With a stoic resolve, Forrest bucked up and let us do what we needed to do to save his arm.

I doubled the Penicillin shots, and watched as it took five minute to push the syrupy medicine into his fatty tissues, and additional pain I watched in horror.  Day four was the peak of the barbiturate withdrawal, and we had to use extra straps to keep him still.  Another shot of Valium helped somewhat, but he kept screaming for something stronger…after being on barbs for so long, the Valium wasn’t having much effect, but it was the only treatment available.  We redressed his wounds again, and began to see definite signs of healing.  It looked like we removed the poison from his arm, and the antibiotics were cleansing his blood system.  The withdrawal symptoms were being taped for research, as not too many people made it through such a violent course, and it would help others if they were in his position.

Day six of the withdrawal found him believing the walls weren’t bending back and forth, the spiders were gone, and his arms were beginning to look moderately healthy.  After several more days and bandage changes, his treatment had lasted 8 days…8 days of sheer torture and pain.  I wondered if the video we took could be used as a shock value film to show other addicts how bad things could get when they put drugs before life.

After ten days, there was still one abscess that emerged on his left arm, but the right arm was healing nicely and the withdrawals were mostly over.  I discharged him to our resident rehabilitation unit, had nurses check on is arm every four hours, and gave him 20 mg of Valium four times a day…but only for the first week.  The drugs was chemically different than the barbs he’d been eating like jellybeans, so all they did was make him hang on to reality without losing his mind.  I didn’t want a violent outburst, something that post-barbiturate withdrawal patients could produce.  It was for his safety and the rest of the group.

He was excused from the daily activities, and spent the first week showing up to get a meal and then returned to bed.  The rest of the ward must have wondered, as his arm were covered in bandages, and when the smaller boils appeared, he could be covered in bloody pus at any given time.  I heard the worst instance was during supper…the large abscess on his left arm popped and sprayed a noxious mix of blood and poison across the table.

After that, we had his meals delivered to his room.

 

After two weeks, a weak and barely alive Zach Forrest started sitting in on group therapies.  The initial reports indicated Zach scared other residents by graphic descriptions of what happened to him, plus other instances when he’d exceeded the borderline and again put his life in danger.  I allowed him to continue…sometimes the truth can work…especially when the horrors of what can happen to anyone is demonstrated for all to see.

His second week on the ward was better, and I stopped his Valium.  He had a mild dependence, but nothing compared to the hell he’d lived through.  Week four had him almost back to normal, and helping the newcomers with the reason they were there.  He certainly didn’t mince words, and others seemed to be somewhat scared of him.  I noted this would pass, as I knew Zach, and predicted his happy go lucky attitude would return, along with his quirky sense of humor.  Week five bore me out, and Forrest was almost back to normal.  Whatever had pushed him to select such a powerful and dangerous drug to use puzzled me…I knew he’d been suicidal, and it seemed he played fast and loose with his life, like he didn’t care if he lived or died.  Unless we restored a proper sense of life, it would be something that would endanger him, and I recommended an extended stay and full course of personal counseling.

Despite Zach friendly and helpful attitude, other patients were scared by the obvious close call he’d just survived.  Most of the inmates were in for booze or soft drugs, and the hard core nature of an arm covered in severe injection misses put him in the dangerous hard-core junkie category, and there weren’t too many around.  He scared them.  In some was that was taught them a lesson to avoid dangerous drugs, but it didn’t do much to help him ingratiate himself with the group.

He felt bad for Zach.  With all kinds of addicts moving through the program, he happened upon a group of young rookies; he was only 22, but probably scared the hell out of them.  One thing I had noticed was a friend dropped off his art supplies, and he was currently working away in his room…creating some dark pieces that seemed to match his latest dark incident, but his portfolio was there, and had a beautiful sketch of a young woman that dazzled with light and dark contrasting strokes, and I’d noticed a few people showed interest.  Perhaps his talent would break down barriers, for who could be afraid of someone that drew such beautiful subjects?

Another week fly by, and many of the younger residents checked out.  Zach was now working in a corner of the dayroom…better light and more room made it an obvious choice, and he had a slew of observers watching his sure and steady hand produce beauty.  He did some portraits and gave them away, a sure way to become accepted.  The replacements we got were older junkies, and Zach was soon forgotten as an object of terror.  Alf checked in, and his mean and grizzled face could scare anyone…with two lines of tracks on each side of his neck, he usually wore long sleeves to hide the junction rails that ran up and down both arms.

I knew Zach had a lot riding on our report for the courts, so I kept him for the three months he had before his next appearance.  I wrote a glowing report, and recommended him for long term therapy at one of the park-like facilities that bordered Toronto.

He left for court with a therapist for support, and returned in the afternoon, slightly happier and with a better attitude towards his recovery.  The court made a deal with him—if he stuck out a six month program, they’d drop the charges and let him move on.  That’s the sort of motivation he needed…I knew if he’d been released before his court date, he’d be back on drugs as soon as he got home.  I’d found out he had a stash of barbs at home, and that worried him…he knew he wasn’t strong enough to dispose of them, and that was worse than releasing an alcoholic to work bar in a busy nightclub.

Then one night we let him fill the store orders.  Once or twice a week, a select person would take orders from everyone, get the money, and buy what they needed from the store: pop, candy, cigarettes, Tampons, chewing gum…just about anything a person wanted from the store and had the money to pay for it.  The trip usually took a couple of hours, as it was often a long list.  Within an hour or two of Zach’s return, the staff started to notice odd behavior.  The resident haircutter at the time left a person half finished, people were using the side balustrades to help steady their walks, and the living area was an endless source of gleeful laughter.  This wasn’t that unusual, but when dinner was served, many people dropped their trays and couldn’t even navigate to their table.  Someone had brought drugs on the unit, and based on their reactions, it looked like they were bombed on heavy-duty barbiturates…exactly what Zach had demonstrated he had easy access to.  When I started my shift at 6:00 P.M., the staff brought this to my attention, but believed some visitor had smuggled in drugs during the afternoon.  As the doctor on duty, I recognized the effects of sleeping pills, Quaaludes, or barbs, and couldn’t help but make the connection to Zach.  I was slightly disappointed but not surprised…he was an addict.  We gave some of the more obvious offender urine tests, and using the quick results strips, found they showed positive for large quantities of barbiturates…probably the 200 or 100 milligram variety Zach had been strung out on.

Since he’d been here under lock and key after his court appearance and didn’t know where he was going to end up, I’m sure he didn’t stash any nearby, and I knew he didn’t have anything on his person when checked in.  It was possible a friend hid them for him to find when he went out on the store run, but that was a random privilege we only allowed residents who were about to be discharged to perform.  I called Zach into my office.  If Zach was high, he didn’t take enough to impair his walk or speech, had such a high resistance it wouldn’t show, or he hadn’t taken anything.  I showed him the test results from the urine screen, and said, “They test positive for barbiturate powders and amytal sodium, the other half of Tuinal, and an extremely powerful member of the barbiturate family.  He saw the results and sort of hung his head, knowing what was coming.  “Zach, this is was nearly cost you your right arm, and possibly might have killed you…I thought you were coming along fine, but you have to admit, this is a very bad situation and it seems to point in your direction.”

Zach nodded and said, “If I did have access to my stash, I’d probably pop around ten…enough to put a tiny stagger in my walk, but not enough to really affect me.  I haven’t been hanging with any of the new guys lately, so I don’t know what might have been happening through the grapevine.  I know I went to the store, but I didn’t bring anything back, and I haven’t taken anything.  Give me the cup and I’ll give you a urine screen right now…believe it or not, all you’ll find is residue from when I first came in, if its there at all.”

Zach looked steadily into my eyes, and I believed him.  He was calm, normal, and never slurred his speech or showed any sign of taking the strong pills.  I knew he’d built up a high resistance, but after 2 months of clean living, even one or two of the 200 mg Tuinals would definitely affect him…that was a knock-out dose, and Tuinals start at 50 mg., which is sometimes enough to knock most people into dreamland.  The 200 mg variety were used for pre-surgery meds, cancer patients to sleep with intense pain, or for the few that had huge tolerances.

I said, “Everything you’ve done has been helpful in getting your life back…after court, I’m sure you fully appreciate how serious it is, and I have the distinct impression you’re telling me the truth.  I don’t need a urine sample, as I don’t think you took anything.  I’m sure we’ll find out who brought them in, but for now, you’re off the hook.  The drugs will be in your system for some time, so we can always test you later, but I think we’ll look over the visitors and patients for today, and see if that offers a clue.  I’m extending trust here Zach, and it would be better for you if you brought them in to tell me now.  Did you bring them in?”

Zach gave me a level gaze and firmly said “No.”

I waved him out of my office and looked at the daily visitor list.  I recognized an old patient visiting his buddy, and remembered some problems we had with him during his last stay.  I phoned the nurse’s station and asked them to bring me the patient, and told them to search his room while I talked with him.

Peter Stark made it to my office and fell into a chair.  He was plastered.  I immediately asked, “How many pills did Andy bring you?  Handing them out to other residents only gets other people in trouble, and makes this situation a problem that affects the whole ward…besides, you know people don’t stand up like in jail, and cough up names as soon as you ask.”  My trick worked…he thought someone he gave pills to ratted him out, and knew it was game over.

He didn’t know what I knew, but guilt can often make someone cave and dispense with lying.

He admitted his friend brought him about 50 Tuinals…the 200 mg, knock-you-on-your-ass with one variety, and reached into his pocket to pull out the ten he had left.  I told him about the rules, and he knew he was getting the boot.  Knowing he was history, he put the Tuinals back in his pocket…why bother pretending now?  Punishing all the other patients for his indiscretion was by the book, but I decided to tell each person to go to bed and sleep it off, or pack their stuff and leave.  About ten people were suspected of being stoned, but there were probably others that only took enough to get a slight buzz or had high tolerances.  I couldn’t empty the whole ward just because someone put temptation right in their lap.  I told him to go get packed, and mentioned he was barred for six months.  As he left, I thought about Zach.  The entire nursing staff convicted him, and basically told me he was the guy responsible.  I was glad I followed my instincts and trusted a junkie…it’s not always a good move, but you have to start trusting someone…sometime.

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