Stimulant Summit Spotlight: Ky. Court Turns Tide with Treatment Over Incarceration

Judge Kevin R. Mullins of Kentucky’s 47th district has seen first-hand, both in his courtroom and in his preceding years as an assistant commonwealth attorney, the damaging effects that illicit substances have had on Letcher County in the eastern part of the state. He has also observed the powerful impact that guiding defendants into treatment instead of prison can have on those individuals’ long-term prospects for recovery.

In 2010, Mullins began allowing inmates with substance use disorders enroll in inpatient treatment as a condition of pretrial release. He later helped develop a program that incorporated peer support into his courtroom to help facilitate referrals to treatment.

At the upcoming virtual Cocaine, Meth & Stimulant Summit, Mullins will identify the components of a successful community-based treatment team and share lessons learned from Letcher County’s community model. Ahead of the Summit, he spoke with Addiction Professional about treatment vs. incarceration, the importance of community support and how an infrastructure developed to respond to the opioid crisis made Letcher County better prepared for the methamphetamine crisis that followed.

Editor’s note: This interview is edited for length and clarity.

In 2010, you began allowing inmates with substance use disorders to enroll in treatment as a condition of pretrial release. What were you seeing and what was your thought process behind that decision?

In the nine and a half years prior to becoming a judge, I was an assistant commonwealth attorney, which in Kentucky means you’re the person in charge of prosecuting all felony cases. With that, I primarily focused on prosecuting drug-related offenses. To understand what we’re doing, you have to understand the history of Letcher County. We had a problem with opioids long before than the 1999 date that everybody looks at as ground zero for opioid deaths with Oxycontin. … When Oxycontin and the opioid epidemic got full blown, it hit here first. That plays a big part in where we are today. Kentucky, like a number of states, had a knee-jerk response to try to incarcerate our way out of this problem. We enacted lightning-fast legislation to increase penalties on even drug possession charges and classify new materials as illegal. I was on the prosecution side at that time when there was no literature [on opioids]. The first major literature that came out was major newspapers criticizing judges on their handling of different drug cases if they thought they were too lenient. … I’ve always considered myself a normal guy and pretty approachable. While I was prosecuting, it was pretty common for people to come to me and say, “You have my son or daughter in jail. Is there way you can recommend to the judge that they lower this person’s bond so they can get out of jail?” That was pretty common. There’s nothing inappropriate or wrong with that. The biggest thing that took me back was when I became a judge late in 2009. In that period, it was common to bring someone up from jail on a drug-related offense and maybe they had a family member in the audience who would stand up and say, “Judge, can you increase this person’s bond?” That made me think, “Why are they asking for this? What are they really after?” I came to the conclusion that these people were asking for an increased bond or for their family member to stay in jail because they became frustrated. They had seen the 10 years of us trying to incarcerate our way out of this problem with no real success. In their mind, it was better for their loved one to be in jail than for them to continue spending sleepless nights wondering if they were going to get the 4 a.m. phone call that their loved one has overdosed and died. It was just a matter of trying to save someone’s life and this was the only way they knew how: to keep the person in jail.

With that, I understood what they were after. I wasn’t trying to cater to these people, but I said the real goal is to try to save these people’s lives. We tried putting them in jail and saw that does not, did not and will not work in the future. I thought let’s try something different. Let’s send them to treatment. In 2010, getting someone into treatment was completely different from today. At the time, there were very few facilities open for substance use treatment. The ones that were, you had a hard time paying for it because most people’s insurance wouldn’t pay for it. The first lady we sent to treatment, we had to send 4 ½ hours away. At that time, looking back, if we could get someone into treatment in 30 days, we thought we could move them out. We went down the process, and it was a slow, meticulous and time-consuming process, but why we started it was the underlying goal of trying to save people’s lives.

Why are community-based initiatives so important? With regards to your work in recent years, can you talk about the importance of collaborating with community partners and getting everyone to push in the same direction?

To me, the only way you can have community success is with community involvement. Without that, you have nothing. The major thing we’ve focused on is an effort to educate our community as to the problems and the treatment options. The more people you can get on board, the easier it is to get other people on board. One of the great benefits we’ve had is that our medical community was on board from the onset with treatment as an option. When I say medical community, I mean general family practitioners. That made it so much easier for us to attract others to get involved and to get referrals to treatment for people we might not otherwise see in the court system. We also have a lot of support from our local churches.

When we first started sending people to treatment in 2010, one of our first great moments was in 2013 when our governor at the time opted for the expanded Medicaid. With that going into effect, that allowed a lot of other providers to open up and access to treatment became daylight-and-dark different. We started sending more people to treatment because there were more facilities closer and it was easier to get it paid for. We continue doing that. Another benchmark moment was February 2018, a local doctor here named Van Stanley Breeding, who treats about half the county, decided he wanted to do something to fight the opioid epidemic. He, along with Joe Grossman, the CEO of Appalachian Regional Healthcare, the largest employer in eastern Kentucky, and Tim Robinson, CEO of Addiction Recovery Care, started HEAL – Help End Addiction for Life. With that, they had meetings twice a month where people involved in treatment could explain what they were doing and what they had to offer. That created networking opportunities, including me becoming familiar with Addiction Recovery Care.

Another big event for us was in August 2018. Kentucky has a Casey’s Law mechanism where a family member can petition the court asking for someone to be placed into treatment involuntarily. We had a Casey’s Law matter on Aug. 14. That case involved a lady who was dating a methamphetamine dealer. The methamphetamine dealer had been arrested. Her access to meth went with him. She developed a condition [where] she was still addicted to the process of injecting herself. She started injecting herself with Gatorade for a placebo effect. I spent 45 minutes in court talking to her and her attorney trying to plead her into going to treatment because I hate to force anyone into treatment. You have better results if you can allow a person to have some control over their future by educating them. … We went outside to continue the conversation—me, her and her lawyer—and by chance, there were three ladies I recognized coming to pick up someone from jail to take them to treatment. The three ladies spoke to this lady, and within 5 minutes, they talked her into going to treatment. The way they did that, in my opinion, was when she was able to talk to someone who had been in her shoes, it gave them more credibility than I had. She went to treatment that same day.

That set off a lightbulb in my head that I needed to have someone in my courtroom who has been in these people’s shoes and can talk about what treatment is and what it has done for them. I contacted a gentleman with Addiction Recovery Care and asked for them to send me somebody. They sent a peer support worker for the courtroom to answer questions about going to treatment. By virtue of having that person stationed in the courthouse, it lets other people in the community know they can come to ask questions about treatment.

Where that turned out to be beneficial was we had seen an increase in methamphetamine cases. We could see it coming. It hadn’t peaked yet. In 2019, it became wide-open. We had a lucrative market because we had all of these people in addiction or in recovery from addiction. Plus, eastern Kentucky had always been dependent on coal and coal mining jobs. We have only a handful now. So, we have all these factors and in 2019, methamphetamine just took off. But we had a system in place where we could get people referred into treatment. We were able to help 256 people from Letcher County, which has a population of about 23,000, and six other out-of-county people who came through our court system get into treatment.

So, the work you had done in responding to opioids put you in much better position to respond when methamphetamine use started rising.

Yes, with the number of cases we saw for methamphetamines in 2019, there is no way possible that we would have been able to address that problem by keeping people in jail. Our jail isn’t big enough to house that number. From January 2019 through February 2020, we were able to get 199 people released from the Letcher County jail to go straight to treatment. Of those 199 who went to treatment, they stayed in treatment for an average of about 39 days. Absent having a system in place, I don’t know what we would have done. Our numbers this year have been affected by COVID, obviously. Today, we’ve physically placed 133 people into inpatient treatment [this year].

What we started here in Letcher County, what ARC refers to as the community liaison program, they’ve taken what we’ve done and the newest numbers have it in effect in 50 counties in the state. Collectively, they are averaging 75 people into treatment per week. For a year, that’s 3,900 people. All of that is based on a girl who was shooting herself up with Gatorade. It’s been successful here and in other parts of the state. And the best part about our program is that it costs my county zero dollars, only some effort and determination. … You can do this absent grant funding or any kind of corporate sponsorship. You can do this anywhere you can get your community behind you.