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The Daily Signal
How a Family
Doctor Works With Police to Combat a Rural County’s Opioid Epidemic
Josh Siegel
June 07, 2017
COLEBROOK, N.H.—Bruce Latham, a lanky, self-employed doctor, occupies a
unique position in the depths of rural New Hampshire’s opioid drug
addiction crisis.
As part of his practice in Colebrook, a town of 2,300 in Coos County,
Latham responds to pain by prescribing opioid painkillers. He says he
empathizes with patients’ propensity to become addicted to pain
medicine because his own son is a recovering drug addict.
“I don’t judge these kids because I understand addiction and understand
what dopamine does to your brain,” Latham says, describing how opioids
target the brain’s reward system by releasing dopamine, a chemical that
regulates feelings of pleasure.
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Part 4 of 5: Police Assault on Opioids Gets Boost From a Family Doctor
Latham, 63, is also ruthlessly committed to stamping out the illegal
use—and spread of—opiates as they decimate Coos County, which has the
highest combined death rate due to drugs, alcohol, or suicide in all of
New England.
On a recent April afternoon, Latham, a measured, religious man with
heavy bags under his eyes, is downright gleeful as he unveils a wad of
note cards, bound with a rubber band. Embellishing, the physician says
these cards contain the identities of “every opioid drug dealer within
100 miles of Colebrook.”
For the past 10 years, Latham has reported to law enforcement anybody
he comes into contact with or knows about who he suspects to have sold
or otherwise illicitly misused drugs, including prescription
painkillers.
Some of these people are his patients, he says, and others are
individuals who patients notified him about.
“The cards are kind of like a monument to say maybe we are doing
something—maybe we are stopping some of this,” Latham says, slapping
the stack of note cards against his lap to reflect the urgency of this
region’s opioid addiction epidemic. “I am a good Mormon kid. I just
don’t like to see people who have problems taken advantage of.”
Latham’s dual role—prescribing pain medicine and helping to secure
punishment for those who he suspects don’t use it properly—is unusual
in Coos County, the poorest, most northern, and least populated of New
Hampshire’s 10 counties.
His position is also informal, although Latham doesn’t hide his
cooperation with law enforcement.
Latham’s office, which looks like a house and is decorated as a private
residence, with framed images of Jesus hanging from the walls, is
located down the road from the Colebrook Police Department—the agency
he principally works with.
Patients who receive prescription pain medicine from Latham must sign
an agreement that plainly authorizes the doctor to “cooperate” with law
enforcement and waives the normally sacred right of confidentiality for
patients.
Latham says he will stop serving a patient if he suspects he or she is
not handling medication responsibly—by using a higher dose than
prescribed, selling the drugs, or diverting them to family and friends.
“My patients sign a drug agreement,” says Latham, who notes that about
20 of his 2,000 patients are on chronic pain medication. “If you sell,
I turn you into the police. I can’t have one person destroy the
program.”
Latham says patients who are misusing drugs, or know of others who do,
are eager to share information because he isn’t a law enforcement
official.
“The kids know what is happening,” Latham says, adding:
They will give me a name and tell me how much the heroin is going for.
They just volunteer it. A lot of these kids have been in trouble with
the law. It’s almost like they think, ‘I can’t go to the police with
this because I had a problem one time.’ But they can trust me. This
marriage between law enforcement [and] physicians has never been made.
I am the only one doing this up here.
‘Need to Do Something’
While Latham’s actions may seem out of place, local law enforcement
officials here—burdened by limited resources—welcome any form of help
they can get.
Colebrook Police Chief Steve Cass jokes that this town, and others
around it, are so small that he “pretty much knows everybody,” and if
he doesn’t, “then I know somebody who does.”
Cass, 43, memorizes phone numbers—as he demonstrates to a reporter who
tests him—and can recite most residents’ first and last names just by
looking at them.
“I am a nut like that,” says Cass, who was born in Coos and intends to
remain here because he loves living in a rural area where he can “step
out on the back porch in my drawers and shoot my shotgun off.”
Colebrook Police Chief Steve Cass sometimes does patrols to supplement
his nine-officer force. (Photo: Josh Siegel/The Daily Signal)
The chief says his agency is the only full-time police department in
the area. Many of Coos County’s towns are unincorporated, and don’t
have police departments.
The Coos County Sheriff’s Office, meanwhile, doesn’t handle criminal
cases and focuses on civil services such as transporting inmates to
various correctional facilities and providing security in state and
federal courts.
Cass says he uses information provided by Latham just like any other
tip he might receive, as a supplement to tactics the police department
uses to combat drug crime, including enlisting confidential informants
and doing undercover drug buys.
“I am willing to listen to anybody who wants to provide information,”
Cass tells The Daily Signal in an interview, adding:
I’ve been around here long enough to know if someone wants to talk to
me, I am going to listen. While Bruce [Latham] definitely has a finger
on the pulse of the region, what he tells me is like anything you hear
on the street about someone who is dealing pills or a narcotic. I have
to make a case. I can’t just take what you say and go and do a search
warrant. The information in itself doesn’t mean you can take down
somebody.
Cass says Latham isn’t employed by, nor does he have any formal
relationship with, the police department. The partnership has
limits—the department does not share information with Latham about
active investigations.
Latham says he first offered assistance to the police department about
10 years ago in response to a rash of opioid overdose deaths. Latham,
who is originally from New Jersey, had just moved to northern New
Hampshire to respond to a need for physicians.
“I remember the chief saying, ‘You see the smile on my face? You are
the first doctor ever to walk into my office and be willing to help
us.’ I said, ‘Chief, we have a major problem in this town. Every year
we are losing 10 kids from drug overdoses. We need to do something. We
have to work as a team on this.’”
In the view of Cass and Latham, if they could reduce illegal sources of
drugs from the streets, there would be fewer drugs for people to become
addicted to—and potentially die from.
“You don’t know all the things you prevented, but if you save one life
it’s worth it to me,” Cass says.
‘Very Bad Information’
But still, some in the medical community question whether it’s
proper—or effective—for a physician to take an aggressive approach in
working with police.
Before Latham started his own practice in Colebrook in 2007, he was
employed by the Indian Stream Health Center, the largest medical
provider in Coos County.
John Fothergill, a physician there who is also a state representative,
hired Latham. He spent about a year at Indian Stream, the county’s
leading prescriber of pain medication.
Fothergill says patients often report to him potential misuse of
opioids he prescribed to others, but he treats these claims skeptically.
“The problem we have at the health center is the information we get
from the public is very bad information in general,” Fothergill tells
The Daily Signal in an interview. “Frequently, if person A won’t sell
drugs to person B, person B may call the health center and say person A
is selling drugs—just because he’s mad at him.”
Fothergill, 62, says opioid users who become addicts learn to lie to
feed their addiction, and physicians aren’t in a position to determine
the truth.
“I have had patients in the past say one thing, and then they have a
come-to-Jesus moment and say, ‘I was lying,’” Fothergill says. “I don’t
take much of it to heart—or at least I don’t take much of it to the
police. A lot of these people certainly have problems. They are
addicted to drugs, and to expect them to behave like honest citizens is
somewhat unrealistic.”
Indian Stream works with law enforcement only in limited circumstances,
Fothergill says, in situations where medical staff suspects
easier-to-prove illegal activity, such as when a patient tampers with a
urine sample during a drug test in order to be prescribed more
medication.
“We certainly have a relationship with law enforcement,” Fothergill
says. “They talk to us. We talk to them.”
Fothergill argues that it is wrong for medical providers to apply their
own zero-tolerance policy to opioids misuse, because addiction—which
can drive illegal activity—is best addressed through treatment.
Indian Stream requires patients who receive prescription pain medicine
for 28 days or longer to participate in a substance abuse class or
group therapy.
“People have to fail multiple times before we say we are really not
helping you, you need to go some place else,” Fothergill says. “In our
program, we expect them to be honest, but we try to provide increased
help instead of just throwing them out.”
‘Sticky Thing’
John McCormick, Coos County’s attorney and chief law enforcement
officer, appreciates the challenges in approaching a drug epidemic
fueled by both legal and illegal behavior.
McCormick, who has a soft voice and cerebral demeanor, is contemplative
as he discusses the circumstances in which he believes drug-related
crime should be met with punishment rather than second chances.
Reflecting on the nuances of his job, he reveals to a reporter the
number of drug overdose deaths in Coos reported to him in recent
years—12 in 2015, nine in 2016, a few likely already this year,
although it’s too early to know for sure.
“To beat this, I think it’s got to be sort of a multipronged approach,”
McCormick tells The Daily Signal, sitting on a broken desk chair in his
undecorated office. He adds:
I can tell you that some folks I have seen through the criminal justice
system, I almost want to say they are almost in a better place in jail
than outside of jail. I have seen addiction cases where if you let this
person free, they are going to die. It’s that bad.
The county attorney, who has been in his position for nearly five
years, adds that he has seen defendants die of a drug overdose before
they go to trial for a drug-related case.
“We are not here to just throw everyone in jail,” McCormick says. “I
don’t think we can just prosecute our way out of this. Treatment is
worth a try. If they are not ready to receive that help or are not
accepting it, the other alternative is jail.”
At the federal level, Attorney General Jeff Sessions has signaled a
tougher approach to drug crime, recently ordering federal prosecutors
to charge suspects with the most serious offense they can prove. But,
McCormick says, it’s important to see each case for its unique
characteristics.
McCormick says he usually reserves the most severe charges for suspects
selling large quantities of drugs and for out-of-towners who travel to
Coos County to sell drugs—usually from the Boston area—to take
advantage of the demand. Repeat offenders also deserve stronger
punishment, he says:
It’s kind of a sticky thing. I am aware of the addiction aspect, of
course. I think I differentiate between someone who sells to use, and
someone who sells just to profit; however, those lines are blurred.
Every defense attorney will say their client is dealing to use.
McCormick, who knows Latham but doesn’t work directly with the doctor,
says it’s challenging even for law enforcement to confirm the intent
behind suspected illegal activity related to drugs.
“In these kind of cases, credibility is king,” McCormick says.
“Sometimes you have to take what folks say with a grain of salt.
Certainly, if they are serious addicts, we want to make them
rehabilitate. At the same time, sometimes they know how to tell a good
lie and manipulate folks in order to keep using. It’s a tough thing. We
aren’t human lie detectors. It’s hard to sometimes tell whether someone
is genuine.”
‘There Is Hope’
Seeking the proper balance between punishment and treatment, McCormick,
Cass, and Latham all sound hopeful about a potential solution.
Coos County, working with the state, is in the process of creating a
drug court.
In such a specialty court for offenders with substance abuse problems,
defendants are able to access treatment services as an alternative to
incarceration.
As the defendant receives treatment, he or she checks in periodically
with the court, which closely monitors progress and can impose
sanctions if the offender commits a new crime.
In August, McCormick is planning to travel to Lewisburg, Pennsylvania,
a small, rural community, to observe how it runs its drug court.
With state funding committed, McCormick says he expects a drug court to
come online in Coos County within a year.
Read the article with photos, charts and graphs at The Daily Signal
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