Tag Archives: addict

Louisville: Jail Among The Solutions

In Louisville the other day, I wanted to see how jail was changing in America.

This epidemic of opiate addictions  calling on us to reexamine a lot about how we live, our values, culture, ideas and institutions we’ve taken for granted.

One of them is jail. Jail has always been a crippling liability in our fight against drug abuse. Jails are usually places where humans vegetate, sit around, argue, learn better criminal techniques, then get out weary and stressed and, if they’re addicted to drugs, they head straight to the dealer’s house.

This epidemic is forcing new ideas. One of them is jail turned into an asset, a place of nurturing, of communion as addicts learn to help each other.

That’s a bizarre concept. I never thought I’d write “nurturing” and “jail” in the same sentence, but it’s happening.

The state of Kentucky seems furthest along in all this. I wrote an Op-Ed column for the NY Times about a visit I paid to the jail in Kenton County, Kentucky. Yet what’s being tried in Kenton County – and a couple dozen other county jails in Kentucky — began in Louisville – in Metro Jail.

Why jail?

Well, if “we can’t arrest our way out of this,” as is so often said, then we need more drug-addiction treatment. Yet this epidemic has swamped our treatment-center infrastructure. New centers are costly to build, politically difficult to site, and entering them is beyond the means of most uninsured street addicts, anyway.

I know that jailing addicts is anathema to treatment advocates. But opiates are mind-controlling beasts. 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 street addict is willing to occupy it. With opiates rock bottom is often death.

Jail can be a necessary, maybe the only, lever with which to encourage or force an addict to seek treatment before it’s too late. In jail, addicts first interface with the criminal-justice system, long before they commit crimes that warrant a prison sentence. Once detoxed of the dope that has controlled their decisions, jail is where addicts more clearly behold the wreckage of their lives. The problem has been that it’s at this very moment of contrition when they have been plunged into a jail world of extortion, violence, and tedium. It’s a horrible waste of an opportunity, and almost guarantees recidivism.

With this epidemic, though, we’re seeing new approaches – jail as a place of rehabilitation, a place where recovery can begin.

Several years ago, as heroin began to grip the area, the Louisville jail saw inmates dying from overdoses.

Mark Bolton, the jail’s director, said the spate of deaths forced new ideas.

“We modeled a pod on outside treatment (centers),” he said. “It became a matter of taking the resources we had and repurposing them. We sent people [to drug rehabilitation centers on the outside] and found out how they run their peer detox program. We learned from them.”

Louisville Metro began with female inmates. Those who were just off the street and detoxing, and who normally were spread across the jail, were placed together in one pod, christened Enough is Enough. This allowed more focus on their needs, and got them away from other inmates who were angered by their withdrawal symptoms, which included vomiting, diarrhea, screaming, insomnia and more.

Jail officials began allowing people in recovery into the detox pod as well. These recovering addicts mentored the new arrivals – washing and soothing them. Officers preferred it, as they no longer had to clean up vomit and diarrhea.

In addition to bathing and caring for those in withdrawal, inmates take classes in relapse prevention, understanding criminal thinking, accountability, parenting, and more; they run their own 12-step groups.

As the Enough is Enough pod began to function, there were fewer fights, less contraband. “Inmates into their recovery and into their sobriety are self-policing. The wear and tear is less,” Bolton said. “After we worked out the bugs, we began to see some of these people show progress. The inmates into their treatment appreciated the fact that they were caring for a human being that was at a place where they had been once.”

When they leave jail, they’re given a Vivitrol shot, which blocks opiates, and they were connected with housing and follow-up Vivitrol shots.

The jail now has the one women’s pod and three pods for men: 56 detox beds and 64 recovery beds, total.

I visited the pod – with about 30 women, four of whom were detoxing. The walls were covered with art work.

(Click here to hear the end of the pod’s afternoon meeting that day.)

It seemed, finally, a nurturing place in jail – far more about recovery than its connecting pod, where fights and loud noise were common until the early morning.

I spoke at length with a woman named Kara, whose addiction was more than 20 years old. This was her 17th time in jail. She had come from washing the vomit off another woman who had just arrived in the pod.

Here’s our interview:

The Louisville jail experiment isn’t a cure-all – no one thing is for this opiate-addiction epidemic. And the jail has difficulty tracking inmates who leave, so it’s unclear how well they do on the outside. What’s more, inmates by this time face a daunting uphill trudge to sobriety, hampered by family dysfunction on the outside, shredded personal relationships, a private sector wary of hiring them, and on and on.

And of course, there isn’t nearly enough in available treatment options.

“I would love to shut some of these programs down,” Bolton said. “This shouldn’t be the jail’s responsibility. [Addiction] is a public health issue. Our job is detention, protection of the public, to get people to court. When we have to become the quasi mental health facility for people who are poor and don’t have access to services, or for people who are drug addicts and who’ve created these chaotic lifestyles for themselves and can’t get treatment in the community — then we become this de facto fallback place for everybody. That’s not what jails are designed to do, nor should they be.”

Yet until a massive investment in community drug rehab and medically assisted treatment takes place, it’s likely that pods like Enough is Enough will be necessary.

It also occurs to me that with jail rethought and remade — a nurturing place — we have the chance that it will be an asset in the next drug scourge that comes along.

Either way, as with Kenton County, it seems like a better bet of public money than the way jail has been done up to now.

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Dr. Procter’s House

I’m speaking today in a mansion near Portsmouth Ohio built by a doctor named David Procter – known around here as `The Godfather of the Pill Mill’ – whose story I told in Dreamland.

A reader I’ll call Karen, who grew up in Portsmouth, wrote to me a while ago:

“For some reason I feel compelled to tell you that Dr. Procter was the catalyst that destroyed my family.

The house, in South Shore, Kentucky on the Ohio River, has been converted to a procter-2drug rehabilitation clinic run by a company called Recovery Works.

Karen:

“My dad worked at the prison as a guard. He hurt his back, falling from a ladder during some sort of training assignment.

“I only knew that my dad got hurt at work, and [Procter] was his doctor. And that my mom hated him with a passion. I can remember going to his office and my mom coming out so upset. I found later that it was because she would go there and beg him to stop giving my dad pills. Lines out the door. I can still remember my mom and my aunt and my grandmother in the car discussing all the people.

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Pharmaceutical companies and pain specialists viewed the pain-pill revolution that transformed American medicine as a boon to doctors. They sold the opiate painkiller pill as a way of addressing the lack of time doctors had with patients, and pain patients in particular.

That doctors accepted them so readily tells us how serious were the time pressures they felt.

The more you prescribed them, though, the more the pills became a curse – just like morphine molecule they contained. They wore down a doctor. A doctor known as an easy touch was soon overwhelmed with patients who filled his waiting room, waving cash in front of him, insisting. Soon he was accepting only cash – addicted to it, accepting the lies his patients told him, believing too that nothing was wrong.

From this emerged the medical mutation known as the Pill Mill. Nothing showed the corrosive effects of for-profit medicine like the pill mill.procter-1

David Procter was notorious in Portsmouth for prescribing large amount of pain pills to patients, with almost no diagnosis.

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“The day my parents marriage finally ended, was the day my mother threw all of my dad’s pills Down The Gutter and he removed the manhole cover and crawled down to get them. I remember her taking her wedding ring off then and telling him that she wanted a divorce. His head was literally sticking out of the manhole. Sad time.”   Karen

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David Procter was a product of that, I believe.

He had come in 1977, and been beloved. Amid economic decline, doctors held the key to life strategies like worker’s comp and SSI. Procter became the quickest doc around in preparing worker’s comp papers.

In 1988, the Kentucky Board of Medical Licensure investigated him for the first time. Those reports seem to describe a man losing his bearings but still trying to maintain some semblance of medical and moral rectitude, still looking for second opinions and trying to find alternatives to pills for his pain patients.

Ten years later, a second investigation, and that doctor had vanished.

In the interim, OxyContin and the Pain Revolution had come. Jobs were gone, Main Street was an empty shell. Ohio River towns had lost huge population. Dreamland pool had closed.

As a doctor in a desperate place, he had been unaccountable for too long and grown corrupt, the Kentucky public record documents. Now, investigators found a man who extorted sex for pills from vulnerable and addicted women, who preyed on girls tormented about abortions. His waiting room was a corral of drug addicts, all there with eyes downcast, desperate. He stayed open well past his posted business hours. His records were shoddy or nonexistent.

After a car accident, he began hiring doctors with drug and alcohol problems to run his clinics. This is what gave him lasting importance to this story, for those doctors in turn left to start their own pain clinics.

The problem metastasized like a cancer. Procter became the Ray Kroc of the Pill Mill.

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Drugs have hit my family hard. My uncle’s stepdaughter and her daughter were both murdered in Lucasville. They still haven’t found their murderers. The daughter was a beautiful sixteen-year-old girl who didn’t deserve anything that she got. Apparently her mother was selling Oxycontin. My aunt’s step-daughter is doing life right now for murdering another girl in a town near Portsmouth. I have two uncles who both died of heroin overdoses in the last 6 years.

And some of my friends from high school, their daughter has been missing for about 6 years. Due to drugs as well, I’m sure of it. I could go on and on. I’m so glad that I left that area in 1989 and made a better life for myself. However the county that I am living in and have been living in for 27 years is starting to feel the sting. It’s happening.    Karen

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David Procter eventually went to prison for 12 years. He was released in 2014 and, being Canadian, was procter-3deported. He leaves behind a strange painting of a monkey looking into a mirror, with Dr. Procter’s reflection looking back at him, and a seven-bedroom, six-bath, seven-car mansion on 34 acres that is now occupied by 16 addicts working on their recovery.

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My dad OD’d in 2009, but he really died years before. He was a good dad once. I’m glad that I have those happy memories.

I know Procter’s house well. We always called it the house that pills built. Beautiful place. Fitting that it’s now a rehab.   Karen

 

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