Pain Killer

A fatal overdose from a prescription pain patch
leads to a murder charge in Westerly

11/2005 - Last spring, 48-year-old Elfreida Cook, diagnosed with colon cancer and awaiting surgery, was using a powerful prescription pain killer, a fentanyl patch, which, once it is applied to the skin, slowly delivers, over the course of three days, a medicine that can be 100 times more potent than morphine.

When some of the patches disappeared from her home on Bowling Lane, one side of a decrepit duplex in the old mill village of Bradford, on the rural outskirts of Westerly, she went downtown to the police station to report them stolen, according to her niece, Derlyn Scott.

"I drove her there," says Derlyn Scott, 37, who was raised by Elfreida Cook in the house on Bowling Lane. "She needed those patches. The police did nothing."

About two weeks later, on the morning of April 23, Wayne Snyder, a 33-year-old man who grew up just a few houses away from the Cooks in Bradford, was found dead on the living room floor of his downtown Westerly apartment.

According to police, he was the victim of an overdose from one of Cook's fentanyl patches, which they say she sold either directly to him, or to a friend of his, the night before he died.

Three days later, Elfreida Cook was charged under drug statutes with the illegal delivery of the prescription drug fentanyl. Last month, after an autopsy on Snyder was finished, she was charged with murder.

Snyder's death came at a time when authorities across the country were beginning to come to terms with an alarming rise in fatal overdoses from the misuse of fentanyl patches, which have been fast making their way from clinical prescription settings to illegal street use.

In some cases, the drug is extracted from the patch and injected or ingested. Some overdoses occur when more than one patch is used at one time, for a higher sense of euphoria, or when the person using the patch is not tolerant of the drug's opioids.

In June, researchers at the University of Florida presented to the annual meeting of The College on Problems of Drug Dependence the results of a study showing that abuse of the patches had resulted in 115 deaths in Florida alone last year.

Then in July, the U.S. Food and Drug Administration, announcing it is investigating fentanyl deaths nationwide, issued a public health advisory warning of overdoses and recommending strict adherence to the labeling instructions for the use, storage and disposal of the patches.

Cook's prosecution on a murder charge, which has a maximum sentence of life in prison, is based on a seldom-used provision of the state statute, one sometimes criticized by legal scholars, that specifically cites instances in which a death occurs from the illegal sale or delivery of a controlled drug.

"We advised Westerly that we believed that the Rhode Island homicide statute provides the kind of latitude that they would need to charge her with murder," says Michael Healey, a spokesman for Rhode Island Attorney General Patrick C. Lynch.

"It was admittedly a charging decision that was out of the ordinary. That said, though, the fact pattern is increasing, not only locally but nationally," Healey says. "We see more and more cases like this ... drugs making their way to other people and bad things happening. We believe the murder homicide statute supports this."

Authorities are investigating a case in Newport in which someone died after fentanyl was put in a drink. No arrests have made.

Healey also cited a 2003 case in which a West Warwick man was charged with murder after his wife overdosed on heroin he had bought for her. Both the husband and the drug dealer eventually pleaded no contest to manslaughter.

The drug dealer is serving an 11-year sentence, while the husband, against the recommendation of prosecutors, was given a suspended sentence.

"Evidently the judge in this case felt bad for the mess that (the husband's) life had become. He didn't think that serving the time was appropriate," Healey says.

Cook's family, dismayed over the seriousness of the charge, and her failing health "she also has diabetes, asthma and heart problems" contend that the person who took the patches from her, weeks before Snyder's death, has continued to brag about it in the neighborhood.

But Westerly Police Capt. Lauren Matarese, while acknowledging Cook did at one time report to police that patches had been stolen, says Cook also admitted to selling one the night Snyder died.

"We have not yet determined if she sold it to him or someone who was with him. According to her, she sold it to another individual" Matarese says. "I can't say she sold it to Wayne Snyder."

Mary Church, who lived with Snyder at their Chestnut Street apartment and calls herself his common-law wife, "they have an 8-year-old son" says she thinks he was coerced into trying the patch that night.

She says Snyder, who worked construction and landscaping jobs, and sometimes played guitar in a band he and friends called Low Budget, was a heavy drinker, favoring tequila, but not a drug user.

"Maybe he smoked some pot, but he didn't pop pills or do any of the other stuff out there," she says. "There was no way he was going to take this thing he didn't know anything about and stick it on himself."

Church, who is 35, says she and Snyder had an argument about money the day before he died, and she spent that Friday night with a friend nearby. She says she called the apartment Saturday morning and a friend of Snyder's told her she should come right home.

By the time she arrived, minutes later, an ambulance was already there, and Snyder was lying on the floor in front of the sofa.

"He was already gone," she says.

Church says it is her understanding that Snyder was driven that Friday night to Cook's house by an old friend, who also grew up in the Bradford neighborhood with both Snyder and her. Snyder apparently put on a patch while at Cook's house, Church says, because he was so disoriented that he later had to be helped down the street to his mother's house.

Eventually, Snyder's friend drove them back to the apartment on Chestnut Street, where they spent the rest of the night. Church says the friend removed the patch, and possibly a second one, before the ambulance came.

Matarese confirmed that Snyder was not wearing a patch when the EMTs arrived.

Regarding the state's prosecution of Cook on the murder charge, Church says, "I'm glad."

It would be possible for someone to overdose on one patch if it had not been properly prescribed to them and their system was intolerant of the drug, says Bruce Goldberger, director of toxicology and an associate professor at the University of Florida's College of Medicine, who was the lead researcher in study on fentanyl patches.

Alcohol use could also increase the risk of a fatality, he adds.

"It is an excellent medication for what it was intended to be used for," Goldberger says. "But, like with Oxycontin, people are quite clever about how they can misuse the drug."

Cook was released to home confinement this week on a $50,000 surety bond. The attorney general now has just under three months to present the case to a grand jury to seek an indictment for murder. According to her family, Cook lives in the house on Bowling Lane with her sister and an 11-year-old grandchild and collects Social Security disability payments.

She was originally scheduled for the cancer surgery two days after the day she was arrested, according to her family. The home confinement rules could now allow a surgery to go forward if ordered by a doctor, according to a spokesman for the Rhode Island Department of Corrections.

David A. Levy, the public defender who represents Cook, says that Snyder's consumption of alcohol the night he died will make the state's case much harder.

"It's extremely difficult to prove this," he says. "They have to prove that the drug caused the death of the other person."

The use of a murder charge when a death occurs in the course of someone committing a felony has its roots in common law, from a time when felonies might have been typically only more violent crimes, like rape or assault, according to David Zlotnick, professor of law at the Roger Williams University School of Law in Rhode Island.

"But as society evolved, we came up with all kinds of felonies, like the illegal use of narcotics," he says.

Still, the Rhode Island legislature saw fit some time ago to specifically write the delivery or sale of drugs into the murder statute, he says, and prosecutors are within their rights to bring cases like this one, however infrequent.

"My own criticism is that drug dealing is a bad thing and people should be punished, and when people die maybe they should be punished more," he says. "But it seems to me that the right charge when someone dies and you've behaved recklessly is manslaughter."

Zlotnick says the Cook case could well become part of a course on criminal law he is teaching this semester.

"There has to be an exam question, right?" he asks.

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