It’s Tuesday morning in the Ulster County Courthouse and Judge Donald Williams is doling out justice to a steady stream of defendants accused of everything from drunken driving to murder. Plea deals are ratified, indictments read out and sentences handed down with the rote efficiency of a jurist on the tail end of a 10-year term on the bench.
A young woman stands at the defense table in the baggy orange uniform of an inmate at the Ulster County Jail. She was arrested early this year on a felony charge of criminal sale of a controlled substance. A few months later, she was free on bail when she was arrested in Orange County for driving under the influence of drugs. That charge was upgraded to a felony because she had a child — her own daughter — in the car at the time. Under the terms of a plea agreement, she’s due to be sentenced to three years in state prison, including a stint at the Willard drug treatment program run by the Department of Corrections in Seneca.
But Williams takes a break from the dry legalese of maximum periods of incarceration and DNA databank fees to engage in a friendly back and forth with the prisoner. He asks her about her experience breaking free of drug addiction while behind bars at the county jail. The woman says the time behind bars and the 12-step groups she attended there had helped her get clean and “get some clarity” that she was unable to achieve on the street.
“When you have people coming in [To the jail] who have experienced what I experienced, who have done the drugs and who have worked the [12 steps of recovery] it really makes a difference,” said the woman.
“So you’re saying that the time you spent in jail waiting to be sentenced helped you?” prodded Williams.
“Yes, I’d say so,” she replied.
Following the conversation, Williams pronounced sentence, shaving off two years in recognition of progress.
“I don’t think those extra two years would serve any purpose,” said Williams. “You made the big step with the six months you’ve spent in jail.”
In recent months Williams, who is not known for his warm manner with convicted criminals, has engaged in similar dialogues with defendants jailed while awaiting disposition of drug charges. While he has taken no official position on the subject, the discussions appear to be the judge and former district attorney’s critique of a new bail reform law that, starting next year, will end pretrial detention for virtually all drug crimes.
“This is a real issue in this community and other communities all over,” said Williams from the bench. “People need some period of time to dry out.”
While Williams’ questioning may be the Republican judge’s not-so-veiled swipe at the bail reform bill passed by Democratic lawmakers and signed into law by Gov. Andrew Cuomo earlier this year, it also illustrates an undeniable truth: law enforcement and corrections professionals stand on the front line of Ulster County’s raging opioid epidemic. Now, the Ulster County Sheriff’s Office — the only local agency that combines both functions — is undertaking a groundbreaking effort to change a culture built around arresting and locking up drug addicts to one geared towards prevention, education and treatment.
In recent weeks, Ulster County Sheriff Juan Figueroa has announced a three-phase anti-opioid strategy that combines public education, direct outreach to the addicted and, perhaps most controversially, the introduction of “medically assisted treatment” — MAT for short — bringing for the first time opioid substitutes like methadone and Suboxone to the county jail.
A fatal problem
“I’m going to be straight with you, I have my reservations,” said Figueroa, whose office at the Ulster County Jail is adorned with pictures of him standing next to tables loaded with guns and narcotics; mementos of a 25-year career with the state police. “But what we’re doing isn’t working. We have to try a new approach.”
Ulster County is a hotspot in New York’s opioid epidemic. In 2018, Ulster led the state’s 62 counties in opioid deaths per capita. Between 2015 and 2018, opioid-related overdose deaths rose by 93 percent. County Executive Pat Ryan has made combating opioid abuse as one of his top five priorities and has set a goal to reduce overdose deaths by 50 percent over the next two years, aided by a three-year $2.5 million grant to improve coordination between county agencies and implement more anti-drug programs.
For law enforcement, the opioid epidemic has become part and parcel of the job. Sheriff’s deputies respond to overdoses and drugged driving accidents and investigate crimes fueled by addiction at a rate that shocks the most seasoned cops.
“I didn’t think anybody was playing around with heroin anymore,” said Ulster County Undersheriff Eric Benjamin who has served with the agency since the 1980s. “But then it came back, it came roaring back.”
Figueroa’s strategy, dubbed Opioid Response as County Law Enforcement (ORACLE), involves a three-phased effort built around education, outreach and treatment. The first phase was unveiled this summer at the Ulster County Fair with the ORACLE trailer. The trailer contains a living room, kitchenette, bathroom and bedroom. To the uninitiated, the trailer looks like an ordinary living space. But hidden in plain sight are the markers of opioid addiction. A pair of workboots in the corner are missing the laces, which addicts often use to tie off before injecting heroin. Little tufts of cotton pulled from swabs, used to draw up liquefied heroin into a syringe, are scattered around. In the sink, a tablespoon has been bent to serve as a heroin cooker.
The trailer travels around the county to farmers’ markets, schools and other public events, accompanied by an education team that includes the family members of overdose victims who share their stories, along with the telltale signs that a loved one may be struggling with opioids. The team hands out cards with referrals to treatment services and tries to establish a rapport with those in need of help.
“We want to reach out to people and we want to establish a level of trust so that they’ll come to us” said Sheriff’s First Sergeant Chad Storey of the ORACLE program. “But the biggest thing is the follow up, so that people are not walking out of jail with no support.”
The second phase of Figueroa’s plan includes a more direct form of outreach aimed directly at addicts. The program, which should be up and running later this year, uses a four-person outreach team consisting of a plainclothes deputy and a “peer advocate” — usually a former addict — plus a mental health professional and a planner. The team will respond to phone calls to a soon-to-be-established hotline as well as to reports of non-fatal overdoses from officers in the field. The team’s goal is to make contact with an addict within 72 hours of an overdose as that’s a time when they may be more receptive to offers of help. The team will meet with the addict, explain treatment options and, if they’re amenable, arrange for their enrollment in an inpatient or outpatient rehab program.
“The job is to get them the help they need by making whatever phone calls, whatever contacts are necessary,” said Figueroa. “And hope that maybe they’ll be willing to listen.”
The final phase of the ORACLE plan includes bringing medically assisted treatment for opioid addiction into the jail. On any given day, Figueroa said, about 200 inmates are lodged at the jail either on pretrial detention or serving sentences of less than one year. (Longer sentences are served in state prison.) Of those, about 10-15 percent self-report an opioid addiction. Other addicts are identified after they begin going into withdrawal while in custody. Traditionally, addicts were forced to withdraw cold turkey with little besides a dose of antacid and Motrin to ease the symptoms. After withdrawal addicts could avail themselves of 12-step groups offered in the jail.
Figueroa’s predecessor, former sheriff Paul VanBlarcum, also introduced Vivitrol, a non-opiate drug that blocks the euphoric effects of narcotics and cuts users’ cravings to treatment options at the jail. But VanBlarcum, like many corrections professionals across the country, outright dismissed the next part of Figueroa’s plan — the introduction of opioid replacement therapies to the inmate population.
Those therapies use opiate-derived substances that prevent users from going into withdrawal but do not provide the quick intense high of street narcotics and some prescription drugs that lead addicts to seek ever-larger doses. Patients in medically assisted treatment programs may use the opioid replacements to slowly wean themselves off of opioid dependence, or they may remain on a maintenance dose for years.
A large body of clinical evidence demonstrates that MAT programs provide better outcomes when it comes to preventing relapse and overdose deaths than traditional abstinence-based programs that incorporate therapy and behavior modification to lead addicts away from all intoxicating substances. But the treatment has long faced stigma in a rehabilitation landscape dominated by the 12-step model, which holds that “a drug is a drug and a drink is a drink.”
County Executive Pat Ryan sees the proposed MAT program as a necessary response to a crisis situation. Ryan said that Figueroa’s approach had “near universal” support. Ryan pointed to MAT’s demonstrated efficacy in reducing overdose deaths. He added that introducing MAT at the jail would allow inmates to remain on their treatment protocol while incarcerated, and transition more easily to community-based programs upon their release.
“It’s a crisis situation, overdoses just keep going up,” said Ryan. “When what you’re doing isn’t working, you do what works and medically assisted treatment works, there’s a ton of studies out there that demonstrate that.”
Keeping it secure
But concerns about MAT in correctional settings are persistent, in part because of concerns that the opioid replacements will make their way out of the treatment program and into the general inmate population. Figueroa said those concerns were evident on a recent visit to observe an MAT program in the Monroe County Jail which serves some 200 inmates. Figueroa said he observed patients awaiting their daily dose while seated on folding chairs on a basketball court in handcuffs. When he asked why the inmates’ hands were cuffed, jail staff told them that it was to prevent them from spitting the pills into the crook of their arm and smuggling the dose back to their cells.
“There are definitely concerns about security,” said Figueroa. “But that’s something we can address.”
Figueroa said medically assisted treatment in the Ulster jail had already begun with a handful of pregnant inmates. The women had been enrolled in a methadone program prior to their incarceration and medical staff judged that withdrawal during pregnancy could be harmful to the fetus. Transporting the women to a medical facility for regular doses posed security risk, so corrections staff arranged to have the women’s medication brought to the jail and administered under supervision.
Going forward, Figueroa said, he planned to implement a more formal program based in the jail that would provide methadone or Suboxone to eligible inmates. The program would be limited to inmates who were already using the treatment prior to being locked up. Inmates bound for state prison, meanwhile, would be ineligible because the state Department of Corrections does not accept prisoners on opiate replacement therapy.
Figueroa said the program would also likely be limited by the fact that once bail reform kicks in next year few, if any, defendants charged with drug crimes would spend time at the jail prior to the disposition of their case. But Figueroa said he believes the ORACLE program had the potential to save lives and give addicts a better shot at staying both drug-and crime-free.
Needing some help
Figueroa is waiting to hear back on his application for a $900,000 grant that would allow him to bring all of the ORACLE components under his auspices, rather than relying on an ad hoc network of volunteers and nonprofit groups. The grant application includes concrete objectives which include public education campaigns and outreach to at least 200 overdose survivors.
“This is not a research paper, this is a hands-on plan,” said Figueroa. “You have a band and you an orchestra leader. That’s the goal, but we need to build that trust with the community to really make it work.”