The Equal Opportunity Disease

Chief District Court Judge Tom Jarrell (Guilford County, NC) died suddenly last August in his bedroom.  His colleagues were stunned at his sudden passing at age 56.  They went from stunned to shocked when his autopsy results were revealed last week showing his cause of death as an accidental overdose of fentanyl and heroin.  One of his colleagues said, “It was a shock. It wasn’t the person that we all knew.”  A group of supporters don’t believe the police report nor the medical examiner.  “They cannot see Tom Jarrell as a drug user, let alone a candidate for an OD.”

According to his biography, Judge Jarrell’s 20-year judicial career began with his appointment to the Guilford County District Court bench in August 1999. He served in that capacity until 2016 when he was appointed Chief District Court judge for the 18th Judicial District. Prior to taking the bench, Judge Jarrell was an attorney in private practice and an assistant district attorney in Guilford County.

He was president of the North Carolina Association of District Court Judges Association, was a Commissioner on the North Carolina Governor’s Crime Commission and a member of the Criminal Justice Information Network.  He also served on the Sentencing Commission of NC. Ironically, as Chief Judge he created a DWI Court focusing on treatment over incarceration for those convicted of impaired driving.

 Judge Jarrell was married for over 25 years and had three sons.  A more conventional path to judicial leadership is hard to imagine.  An editorial in his local paper said, “…[A]mong the journalistic set, his reputation was as something of a boy scout: tough, fair, rigorous, thorough.”

The road to an overdose

Then how in the world did he die under such conditions?  According to his widow, the only medication the judge took regularly was one for atrial fibrillation, a condition that causes an irregular heartbeat.  It is not an opioid.   Did he have an opioid prescription that had run its course?  How did he get hold of heroin?   Was the fentanyl-laced heroin what he was expecting or was its adulteration with fentanyl unknown to him?  Fentanyl, the synthetic cousin of heroin, is up to 10 times stronger than heroin and 100 times stronger than morphine. It takes about 30 milligrams of heroin to kill an average adult male but only 3 grams of fentanyl.

Speculation on how it happened

Further investigation may reveal the answers to these puzzles but, meanwhile, we’re going to speculate that it happened this way:  The judge had an old football injury that was acting up due to a combination of the natural aging process, a weight gain while on the bench (a too frequent phenomenon among the judiciary) and the stress and pressure of being not only Chief Judge but president of the District Court Judges. He went to his doctor who prescribed Vicodin. The medication provided relief not only from the physical pain but also the calm and peace missing from much of his busy life.  He kept taking the medication until his doctor wouldn’t write any more prescriptions.  Instead of tapering him off the opioids, his doctor, who had no training in addiction medicine, as is frequently the case, just simply refused to give him any more pills. 

The part that’s hard to imagine is how the judge then scored either bootleg opioids or heroin.  Between being a prosecutor in the county and presiding over criminal cases he certainly knew where the drug hot spots were in the county.  Did he drive down and buy it on the street?  Did he have a surrogate do so?  We hope he didn’t use current defendants or otherwise taint the criminal justice process although the county prosecutors are ready to investigate any cases that may have been tainted by his opiate use. 

Did he ever come to work under the influence?  Did his family notice anything going awry?  One of his colleagues said, “Why didn’t we see some signs of something that would have let us know that something was wrong?” 

How opioids work on the brain

Opioids work so well and are so addicting because we have natural opioid receptors in our brains.  We need them for pain regulation.  We’d die of shock if there were not some barrier between severe pain and our consciousness.  Opioid use disorder (OUD) is a spectrum condition that goes from mild to severe.  When a user crosses the line from recreational use to what used to be called addiction, there is no going back.  As they say in Alcoholics Anonymous, once you’re a pickle, you can never be a cucumber again.  The substance use becomes a compulsion and withdrawal from opioids is not pretty.  A person is no longer using for pleasure but, rather, is using to keep from getting sick.  The gold standard of treatment for OUD is Medically Based Treatment that includes medications. 

Shame, stigma and pain

Once the judge realized there was a problem, the combination of stigma and shame overcame his desire to address the situation.  What was he going to do?  Take a leave of absence and go to treatment?  Go to NA and take the chance of running into attorneys or, worse, criminal defendants who may recognize him?  How does the “boy scout” everyone saw him to be address an OUD?  Asking him to do so would be almost impossible.  So, he died.

Stop stigma now

What do we learn from this sad story?  Substance use disorders are equal opportunity diseases.  Anyone from affluent white men with responsible jobs to returning veterans with battle related PTSD can fall prey to them.  They are cunning, baffling and powerful and, once you have one, the only way out is treatment or death.  If we all recognize that substance use disorders are a brain disease, the stigma would be reduced or stop.  And someone like Judge Jarrell might be more likely to seek out treatment.  We wish he could have found the support he needed.  May he rest in peace.