MEGAN THOMPSON: It’s 8:30 in the morning at the jail in Louisville, Kentucky. For these prisoners, every day starts with something called a morning meditation.
They’re part of the jail’s voluntary drug treatment program called “Enough is Enough.” Like most in the program, Shanna Sermon is struggling with an addiction to opioids like pain pills and heroin.
SHANNA SERMON: The more painful something is to talk about, the more important it is to bring it out for discussion.
SHANNA SERMON: It’s the– my most favorite part of the day. I’ve never been much of a morning person. And we have goals. We say what we’re grateful for. It gets use to being up early. It gets us use to becoming a habit of what we’re supposed to be doing.
MEGAN THOMPSON: Sermon says she started drinking and taking pills when she was only ten-years-old, and eventually became addicted to heroin. She tried going to a treatment clinic, but kept using anyway.
Arrested for burglary, this is Sermon’s 16th time behind bars — but she says this time, jail saved her life.
SHANNA SERMON: I didn’t really think I would ever find this kind of help. But to find it in a jail – you know, when I try to explain to the new girls that come in that you know, there’s hope.
MEGAN THOMPSON: The Enough is Enough program lasts at least 90 days, and participants are housed in four dormitories — one for women and three for men. They’re kept separate from the general population where contraband drugs are more common…Because in here, the inmates hold each other accountable for their behavior.
There’s a strict daily schedule of meetings and therapy and classes… on changing the way you think and act. Some taught by the prisoners themselves.
MEGAN THOMPSON: And like a growing number of jails across the country, the Louisville jail now offers inmates the option of a vivitrol injection at the end of their sentence. It’s a medication – heavily marketed to jails and drug courts – that blocks a person’s ability to get high.
MEGAN THOMPSON: This is a corrections facility. It’s not a healthcare facility. So, I mean, is this the right place to be doing this work?
STEVE DURHAM: It’s not a detox center. It’s not a mental health facility. It’s not an emergency room. But it is.
MEGAN THOMPSON: Steve Durham is the jail’s assistant director.
STEVE DURHAM: It was a challenge that was given to us by what was happening in this community. And what we said is we’re not gonna do nothing. We’re gonna do something.
MEGAN THOMPSON: Kentucky is one of the states hit hardest by the nation’s opioid epidemic. In 2015, it had the third highest drug overdose death rate, driven by opioids.
In the Louisville area alone, the number of opioid overdose deaths increased by 40 percent between 2015 and 2016.
Durham blames the opioid epidemic for the jail’s population surge in recent years. The jail has 1,800 beds but there are 2,300 people here now, so many sleep in cots on the floor.
STEVE DURHAM: It’s the same old crimes, but it’s really driven by substance abuse. And if we look at it, we drill into it, we’re really seeing the impact of heroin use.
MEGAN THOMPSON: Durham says 85 percent of his prisoners are struggling with substance abuse.
MEGAN THOMPSON: And 60 percent of those who go through this jail’s detox program arrive addicted to opioids.
KENNETH WRIGHT: Jail’s supposed to be punitive, so to speak, but we don’t come from it, from that approach. We look at people as humans, not as inmates.
MEGAN THOMPSON: Ken Wright runs the jail treatment program. Wright says addressing drug issues in a jail setting just makes sense.
KENNETH WRIGHT: Well, first of all, you have a captive audience. They can’t go anyplace. Everybody wants to change. They just don’t know how to change.
MEGAN THOMPSON: Despite the high levels of drug abuse among the jail population nationwide, few U.S. jails offer drug treatment programs. They don’t allocate the funds or have the physical space. And jails that do provide treatment struggle to meet the demand. In Louisville, there are only 64 beds dedicated to the program.
Doctor Joshua Lee studies opioid addiction in jails and says providing prisoners treatment is essential. That’s because when people confined to jail for weeks or months withdraw from drugs, their tolerance is lowered — which increases the chance of an overdose when they leave.
JOSHUA LEE: They go usually right back to using heroin. The weren’t offered enough treatment or any treatment. And when that happens, their tolerance has been decreased and the risk of overdose is quite high So, if you’re not doing anything to mitigate that risk or to treat the disorder itself, you’re kind of blowing it in terms of a public health opportunity.
MEGAN THOMPSON: In Kentucky, 23 of the state’s 80 jails offer drug treatment.
Between 2012 and 2016, the number of inmates here detoxing from opiates tripled – from around 2000 to 6000. Authorities say the numbers are on track to be even worse this year.
On any given day, as many as 120 new prisoners are identified in need of detoxing. After being searched, they’re sent to one of the drug treatment dorms. A key part of the “Enough is Enough” program is that participants monitor and care for those going through withdrawal.
MEGAN THOMPSON: Todd Lega helps monitor the new inmates. He’s a recovering heroin addict who’s been to jail 14 times.
TODD LEGA: It’s definitely changed me. I actually care about people now. It will never let me forget that that’s where I was at. I can relate. So I have a lot of empathy and sympathy toward the newcomer.
MEGAN THOMPSON: Before jail on the outside, had you ever tried to seek help?
TODD LEGA: I was court ordered one time. I didn’t want no help, I didn’t think I needed help. I didn’t take it seriously. I was high in the meetings, groups.
MEGAN THOMPSON: While people like Lega have been able to get clean here in jail, Ken Wright says sobriety is a challenge when the 24/7 safety net is gone.
MEGAN THOMPSON: Have you seen people complete the Enough is Enough
program and then come back in?
KEN WRIGHT: Yes. Unfortunately, relapse is a reality.
MEGAN THOMPSON: What are the biggest challenges implementing this treatment in jail?
KEN WRIGHT: Well, there’s not enough resources in the community once they leave. That’s the biggest challenge. So if those needs are not met immediately, they will revert back to what’s familiar to them. They live very destructive– type of life. They cry out for failure. And sometimes, we just don’t have ’em long enough for them to be successful.
MEGAN THOMPSON: The Louisville jail doesn’t collect follow up data on participants in its drug treatment program once they leave the jail.
But the Kentucky department of corrections reports that, statewide, half the people who went through a substance abuse program in jail say they stayed off illegal drugs for at least a year following their release. Three-quarters say they regularly attended alcoholics and narcotics anonymous meetings.
Since Bridget Wilder got out of the Louisville jail a year ago, she’s stayed clean and attends a-a meetings every week. She has a steady job to support herself and her two kids and is also pursuing an associate’s degree.
BRIDGET WILDER: You know, I can’t wait to wake up in the morning, because I’m just ready to live, you know? Like, it’s never been like that.
MEGAN THOMPSON: Where do you think you’d be today if you hadn’t had treatment in jail?
BRIDGET WILDER: I’d probably be dead.
MEGAN THOMPSON: Wilder says medication was a crucial part of her recovery. Before leaving jail, she received two injections of vivitrol. Then, outside the jail, Wilder had seven more monthly injections at a free community health clinic.
In Louisville, jail officials educate the inmates about vivitrol with videos and reading materials. But some experts worry about the growing use of vivitrol in jails.
ANDREW KOLODNY: We’re seeing a treatment that doesn’t have strong evidence supporting its use being over-promoted.
MEGAN THOMPSON: Doctor Andrew Kolodny directs the Opioid Policy Research collaborative at Brandeis University. Kolodny would rather see doctors prescribe two other drugs that have been around longer – buprenorphine and methadone. They have much more data supporting their effectiveness for treating opioid addiction.
ANDREW KOLODNY: We have effective medicines that could be saving lives. And not enough people are accessing them. We should be giving them the treatment that we know will give them the best shot at survival and at a good quality of life. We know what works. And we shouldn’t be gambling with vivitrol on that population.
MEGAN THOMPSON: Joshua Lees thinks differently.
JOSHUA LEE: Is vivitrol better than nothing? Absolutely. I think all the three medications should be used routinely, commonly, and with as little barriers to access as possible in community treatment and criminal justice systems.
MEGAN THOMPSON: Vivitrol is not an opioid, but buprenorphine and methadone are. And that concerns Steve Durham. He doesn’t want narcotics in his jail.
STEVE DURHAM: So they have the potential for abuse. They have the potential to be used as contraband, they have the potential to become barter inside a detention facility. And most detention facilities are hesitant to do that.
MEGAN THOMPSON: Shanna Sermon wants to get the vivitrol injection before she leaves. She also hopes the jail’s social worker can find her a spot right away in a residential treatment program, because she knows staying clean is going to be hard.
SHANNA SERMON: I’m really nervous, but I’m excited. I’m excited because I’ve seen what this has done for me in here. I can’t wait to get the real aspect of it outside.