First Appeared in CSAM NEWS - Spring 2004
Death and Drugs in Oklahoma
An Addiction Medicine Perspective
By David Smith, MD
I was recently asked to participate in two death penalty
appeal cases in the state of Oklahoma. This request
was related to epidemiological and behavior research
conducted out of the Haight Ashbury Free Clinics. The
experience gave me a great deal more then I bargained
for. Part of my motivation for participating was that both
sides of my family were born in Oklahoma in the early
part of the 20th Century and came to California during
the great Oklahoma migration around 1930, in classic
Grapes of Wrath fashion. (The maximum security prison
for individuals on death row in Oklahoma was in
McAllister, Oklahoma which is just one hour from where
my mother was born in 1914, in Huglo, Oklahoma.)
What I learned in my Oklahoma travel was both illuminating
and alarming. The rise of drug abuse in rural
Oklahoma is substantially greater than in urban areas.
The big increase in rural areas is methamphetamine
abuse and methamphetamine manufacturing in illicit laboratories.
This was validated not only by law enforcement
in Oklahoma, Texas, Mississippi, and Arkansas, but also
by such leading addiction experts as Dr. Lloyd Gordon,
head of COPAC (Conducive Outpatient Addiction Center)
in Jackson, Mississippi where I recently lectured at a
medical school. He indicated that there has been a huge
increase in methamphetamine labs in rural Mississippi.
Law enforcement officials I interacted with confirmed that
a good deal of the drugs and violence that they
encounter is methamphetamine-related. In particularly
this rise in speed in rural America is a growing major
force in domestic violence.
There is a link between the rise in methamphetamine
use, black market speed labs, and domestic terrorism.
One of the memorable and chilling aspects of my travel
through Oklahoma City was a visit to the Oklahoma City
bombing site where Timothy
McVey blew up the federal
building which killed hundreds
of men, women, and children.
There is evidence that McVey,
Nichols, and his cult of conspirators
were both financed
and deeply involved in
methamphetamine. One only
has to interact with "speed
freaks" to learn where such
bizarre and irrational ideas
such as blowing up a Federal
Building can come from.
Oklahoma law enforcement and public defender legal
establishment confirm that the majority of the 150 people
on death row in Oklahoma have a history of substantial
substance abuse problems. In fact, up to 80% of the
people in the criminal justice system in both Oklahoma
and Texas have significant substance abuse problems,
but very few get
a per capita
basis, of all the
the number two
In one of the
cases that I
was involved in, a vigorous public defender raised the
accused killer's serious substance abuse history. It was a
mitigating factor in her getting life with parole instead of
the death penalty. However, in the second case despite
the fact that the accused, a black man, was deeply
involved in drinking over a fifth of alcohol a day, smoking
two PCP joints, and using crack cocaine he was still convicted
of first degree murder with the death penalty.
My involvement was to raise the substance abuse
issues during both the appeal and clemency process. In
the second case, the man who did the killing was a
chronic substance abuser, intoxicated with alcohol and
PCP at the time of the crime. The victims also had blood
alcohol levels of .14 to .15 and blood PCP levels of .03
micrograms per liter at the time of the crime. The killer
was operating under a very elaborate delusional system.
The prosecution emphasized that some of the observers
said he walked in a normal fashion, rejecting the whole
concept of physical and behavioral tolerance. They said
that this level of PCP would have minimal impact on the
individuals' thought process and behavior.
By the time this is published he will have been executed
in the state of Oklahoma, as I'm sure will several
others who have had a history of substance abuse and
committed heinous crimes. In my opinion, some who had
substantial substance abuse problems should have gotten
a lesser penalty or even an opportunity for diversion
to treatment. As a result of their disease progressing and
the resulting crime, they will get the death penalty. Some
of those who are executed will be innocent.
The New York Times reported that Texas has executed
300 people since 1977. More defendants from Harris
County near Houston, Texas have been executed than
anywhere else in the country. If it were a state, Harris
County would rank third behind Texas and Virginia in total
executions since 1977. A review of the Houston forensic
laboratory found that technicians had misinterpreted
data, were poorly trained, and kept shoddy records. They
mishandled all available evidence, while defense experts
were barred from refuting or verifying the results. The laboratory's
building even had a leaky roof that contaminated
A recent retest of DNA found that an individual
judged guilty was in fact innocent. William C. Thompson,
a professor of criminology at the University of California
at Irvine, who had studied the Houston police laboratory's
work stated, "The likelihood that there were more innocent
people convicted because of bad lab work is almost
David Dowel, the University of Houston law professor
who represents death row inmates in capital appeals, has
indicated that these lab errors leading to convictions are
probably the tip of the iceberg. He stated that there were
two different problems in the crime lab: "scientific incompetence
Professor Dowel said, "That's a deathly combination.
Once you have corruption there is no reason to think that
this is limited to DNA cases or any scientific evidence of
any sort. Without appeal an individual in question may be
executed by now."
It is clear that there is great variability in laboratory
testing in the United States. Some are regulated by
agencies such as the Department of Transportation that
invokes a medical review officer with very high standards.
Otherwise, particularly in the criminal justice system,
unless the defendant has a good lawyer and an independent
laboratory test, a medical expert is not required.
ASAM's Forensic Addiction Medicine Sciences
Committee, chaired by Robert DuPont, MD has organized
forensic science training seminars to raise the standards
of addiction medicine physicians in forensic issues. The
Medical Review Officer (MRO) Committee, chaired by Ian
McDonald, MD, has organized MRO training courses
which focus on the requirements of the Department of
Transportation (DOT) and role of the medical review officer
in that context, but have evolved as a laboratory urine
testing course for doctors in addiction medicine.
Just as ASAM and the Department of Transportation
have pushed to raise the standard of testing in safety
sensitive positions, we should push to raise the standard
for all substance abusers in the criminal justice systems.
Each should have an adequate substance abuse evaluation.
More importantly this would make available earlier
intervention for such individuals and diversion from the
criminal justice system. The lack of treatment of people's
addictions prior to the progression of their disease, often
results in costly and damaging crimes in our society.
David Smith is the Founder and Medical Director of the
Haight Ashbury Free Clinics and is Medical Director of the
California Department of Alcohol and Drug Programs. He
is a member of both the ASAM Forensic Addiction Medicine
Sciences Committee and the Medical Review Officer (MRO)