By Sam Quinones
The New York Times
Sunday Review/Opinion
COVINGTON, KY. — Not long ago, I visited a Narcotics Anonymous meeting where men with tattoos and short-cropped hair sat in a circle and talked out their errors.
One had lived under an overpass, pimping his girlfriend’s daughter for cash to buy heroin. As the thought brought him to tears, his neighbor patted his shoulder. Others owned to stealing from grandparents, to losing jobs and children. Soon, most in the room — men with years of street addiction behind them – were wiping their eyes.
What made the meeting remarkable, however, was not the stories, but where it was taking place.
Unit 104 is a 70-man pod in Kenton County Detention Center in Northern Kentucky, across the Ohio River from Cincinnati. The unit, and an equivalent one for women, is part of a new approach to jail made necessary by our nationwide epidemic of opiate addiction. Drug overdoses are now the leading cause of death among Americans under 50.
As the country has awakened to that epidemic, a new mantra has emerged: “We can’t arrest our way out of this,” accompanied by calls for more drug-addiction treatment. Yet the opiate epidemic has swamped our treatment-center infrastructure. Only one in 10 addicts get the treatment they need, according to a 2016 surgeon general’s report. New centers are costly to build, politically difficult to find real estate for and beyond the means of most uninsured street addicts, anyway.
So where can we quickly find cheap new capacity for drug treatment accessible to the street addict? Jail is one place few have thought to look.
Jails typically house inmates awaiting trial or serving up to a year for a misdemeanor crime. Many inmates are drug addicts. They vegetate for months, trading crime stories in an atmosphere of boredom and brutality. Any attempt at treatment is usually limited to a weekly visit by a pastor or an Alcoholics Anonymous volunteer. When inmates are released, they’re in the clothes they came in with, regardless of the weather, and have no assistance to re-enter the real world. This kind of jail has always been accepted as an unavoidable fixed cost of government.
But the sheer dimensions of the opiate-addiction epidemic are forcing new ideas. One of them, now being tried extensively in Kentucky, is jail not as a cost but as an investment in recovery. Jails as full-time rehab centers — from lights on to lights out.
Jailing addicts is anathema to treatment advocates. But as any parent of an addict can tell you, opiates are mind-controlling beasts. A kid who complained about the least little household chore while sober will, as an addict, walk through five miles of snow, endure any hardship or humiliation, to get his dope.
Jailer Terry Carl
Waiting for an addict to reach rock bottom and make a rational choice to seek treatment sounds nice in theory. But it ignores the nature of the drugs in question, while also assuming a private treatment bed is miraculously available at the moment the addict, who is usually without insurance, is willing and financially able to occupy it. The reality is that, unlike with other drugs, with opiates rock bottom is often death. (Drug overdose deaths last year most likely exceeded 59,000, the most ever in the United States, The Times found in an analysis of preliminary data this month, up about 19 percent over 2015.)
Jail can be a necessary, maybe the only, lever with which to encourage or force an addict who has been locked up to seek treatment before it’s too late. “People don’t go to treatment because they see the light,” said Kevin Pangburn, director of Substance Abuse Services for the Kentucky Department of Corrections. “They go to treatment because they feel the heat.”
Jail may in fact be the best place to initiate addict recovery. It’s in jail where addicts first come face-to-face with the criminal-justice system, long before they commit crimes that warrant a prison sentence. Once in custody and detoxed of the dope that has controlled their decisions, it’s in jail where addicts more clearly behold the wreckage of their lives. And it is at that moment of clarity and contrition when they are typically plunged into a jailhouse of extortion, violence and tedium.
“Imagine your most stressful day at work, multiply that by two or three, then imagine that every day,” a Kenton County inmate said. “Having to be on your guard. Always tense. Then you’re released from that. The first thing you’re going to take up is heroin” again.
In the red state of Kentucky, a relentless opiate-addiction epidemic is changing long-held dogma about how to deal with addicts. Families who once supported a “throw away the key” approach to addiction are thinking differently now that their loved ones are strung out. Kentucky is also the only state that elects its jailers. This gives them more autonomy than their counterparts elsewhere. It also inspires more budgetary accountability to voters, and thus an acute awareness of the costs of cycling inmates in and out and back in again.
Kenton County is among the latest of two dozen Kentucky county jails that have started full-time “therapeutic communities” aimed at rehabilitation within their walls, providing inmates the services that private treatment centers offer on the outside. Much of the impetus has come from the state’s Department of Corrections, which a decade ago began transitioning its prisons away from pure lockups to providing drug treatment.
With the state’s epidemic of addiction, and $3 million that state legislators approved for substance-abuse treatment in 2015, Kentucky has become a center of experimentation in a new way of doing jail.
Terry Carl, the Kenton County jailer, is a Vietnam veteran, Navy reservist, former operations manager for a local utility and a Republican — hardly a wild-eyed social experimenter. . .
READ MORE: A New Kind of Jail for the Opioid Age
