Examining the Lingering Consequences of “Law and Order” Approaches to Addiction in Correctional Facilities – The Mercury News

Renuka Rayasam | (TNS) KFF Health News JASPER, Ala. — Megan Dunn, who has struggled with addiction since her teens, points to the moment her life went “deeply downhill.” After dropping out of high school, she gave birth at age 19 to a son she named Preston. Six weeks later, Dunn said, he died of sudden infant death syndrome. “From then on, I went into this, like, PTSD, depression,” said Dunn, now 28. Megan Dunn visits Jasper Mall in Alabama. Dunn has been arrested on charges related to illicit drug use. While in Walker County’s jail, she says, she was once placed in a holding cell known as the “drunk tank,” a concrete room that lacks water, a bed, or a toilet. (Renuka Rayasam/KFF Health News/TNS) Shortly after the baby’s death, Dunn said, she started using pain pills again. Eventually, she said, she was arrested on charges related to her illicit drug use, such as trespassing. She said she has had more than 30 stays in Walker County’s jail, a brick building in downtown Jasper. And each time, Dunn said, she was forced into drug withdrawal in her cell without medical care. “I was literally praying to God to end me,” Dunn said about the pain and despair she felt. People with drug addictions fill U.S. jails and are often left to endure withdrawal in concrete cells rather than in medical facilities. That’s especially true in Alabama, which has some of the toughest drug laws in the country. More than 5,000 people were arrested in Alabama on drug charges in 2021, and more than 90% of those were for possessing drugs rather than selling them, according to state data. Dunn survived her stay in a holding cell in Walker County’s jail that’s known, she said, as the “drunk tank,” a concrete room that lacks water, a bed, or a toilet. Others have not. In January, Anthony Mitchell, 33, allegedly froze to death after spending 14 days in the tank, according to a federal lawsuit his family filed in February against Sheriff Nick Smith, his deputies, and other jail employees. Mitchell had “spiraled into worsening drug addiction,” the lawsuit said, and his cousin called 911 to send an ambulance to his home because Mitchell “appeared to be having a mental breakdown.” Instead, sheriff’s deputies arrived and then a SWAT team, the lawsuit said. On Facebook, the sheriff’s office posted that “Mitchell brandished a handgun” and, from the scene, a deputy published a photo of his arrest, the suit said. In jail, Mitchell was “denied access to medical treatment,” the suit said, citing video footage from the jail, and he died in custody. His death has sparked a debate in Walker County about the treatment by law enforcement of people with addiction and mental illness. Crime and Punishment: ‘People Are Scared to Say “I Need Help”’ Walker County, nestled in northwestern Alabama’s Appalachian foothills and dotted with coal mines, has one of the nation’s highest nonfatal overdose rates. The county was among the communities that pharmaceutical companies flooded with millions of pain pills in the 2000s. Addiction rates soared. Over time, people moved on to illicit drugs. Walker County Sheriff Nick Smith, first elected in 2018, campaigned to keep his job in last year’s election, in which he was unopposed, by saying he’d “confronted the drug epidemic head on” by “taking criminals off the streets and putting them in jail where they belong.” He also touted his drug arrests in a paid political announcement published in 2021 in the Daily Mountain Eagle, a newspaper in Jasper. He has deployed resources to boost the number of narcotics officers from two to five, and his staff has made about 2,500 drug arrests to date, Smith told KFF Health News. Smith also said that his office helps people with addiction. It gives people a list of treatment resources when they’re released, he said, and has doubled medical supervision in the jail from eight to 16 hours a day. Drug possession and distribution, Smith said, are crimes he’s tasked with enforcing. “We are going to do our job,” he said. With so many people addicted to illegal drugs in Walker County, the power of the sheriff’s office and threat of arrest loom large. Kayse Brown is a certified peer support specialist in Jasper, Alabama. “People are scared to say ‘I need help,’” says Brown, who faced down her own addiction then decided to help others. (Renuka Rayasam/KFF Health News/TNS) “People are scared to say ‘I need help,’” said Kayse Brown, who added that she faced down her own addiction and then became a certified peer support specialist to help others. According to the lawsuit, a sheriff’s deputy allegedly told Mitchell’s cousin words to the effect of: “We’re going to detox him and then we’ll see how much of his brain is left.” No one checked his vitals or gave him the medication he needed, the lawsuit said. Within days, Mitchell was without a mat or blanket and “had to lie naked on the bare concrete floor,” the suit said. When Mitchell arrived at Walker Baptist Medical Center two weeks after his arrest, his internal body temperature was 72 degrees Fahrenheit, the lawsuit said. That’s more than 20 degrees below what is considered “dangerously low,” according to the Mayo Clinic. In response to the lawsuit, Smith and other defendants said that Mitchell was a “drug addict” who was “arrested in a psychotic and delusional state.” Court records show they don’t dispute what doctors reported about Mitchell’s condition in the medical records. But they deny most of the lawsuit’s other claims, including any liability for Mitchell’s death. They asked that the lawsuit be halted while the FBI and the state of Alabama consider filing criminal charges in the case, according to court records. A judge denied the request in June. Anthony Mitchell, who would later die in the custody of the Walker County Sheriff’s Office, is shown in a photo provided by his family. (Margaret Mitchell/KFF Health News/TNS) After Mitchell’s death, community activists called for Smith’s resignation, circulating a petition that has more than 4,000 signatures. Ryan Cagle, a pastor who started the petition, said the sheriff’s office doesn’t see addiction as a chronic condition. Instead, Cagle said, its officials shame people who use drugs by posting their mug shots and arrest details on Facebook. “The people who are elected, the people who have the power, they do not see people suffering under substance abuse as human or worthy of dignity,” said Cagle, who runs a food pantry. Cagle’s brother is married to Brown. His father dealt with addiction, and earlier this year he lost a 20-year-old cousin to an overdose. Smith wouldn’t comment on the Mitchell case because of the pending lawsuit and said that Dunn’s experiences happened before he took office. But, he said, “the burden of mental health is put on every sheriff in Alabama.” The shortage of mental health treatment and lack of early intervention means people who need help land in jail instead. In one case, he said, a person with mental health disorders faced an 18-month waiting list for space to open at the secure medical facility in Tuscaloosa. Systemic Change Is Not Easy Walker County’s challenges are indicative of those faced across the country. People with addictions often end up incarcerated, and Stephen Taylor, a Birmingham-based doctor and president-elect of the American Society of Addiction Medicine, points to a failure of the public health system to create a sustainable and robust addiction care infrastructure. “We know what to do to treat addiction,” Taylor said in written testimony to a Senate subcommittee in May. But systemic change and disruption of the status quo is “exceptionally difficult,” he acknowledged. Sources inside the system say that more than half of the people placed on the Alabama Department of Mental Health’s waiting list for residential substance abuse treatment either die, drop off the list, or end up incarcerated, according to a 2020 report from the Alabama Appleseed Center for Law & Justice, an advocacy group that says the state’s “prison system is broken.” In Walker County, at least 2,800 people with a substance use disorder are not receiving treatment and existing treatment is limited, according to a September 2019 assessment conducted through a federally funded planning grant that helps rural communities respond to opioid overdoses. Jasper is the county seat of Walker County, Alabama. A death in the county jail in January sparked…

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