72 hours in Louisville's relentless struggle to stop drug deaths

She comes into the emergency room on a gurney, hair matted, left arm bruised and track marks visible from shooting up. Norton Audubon Hospital staff lift her into Bed 9.

She crashed her car while high. First-responders at the scene had immediately noticed her confused demeanor and slow responses. Pinpoint pupils confirmed their suspicions.

Overdose.

Quickly, they revived her by spraying a heroin and opioid antidote into her nostrils.

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Now, in Bed 9, she's antsy and restless. A pale curtain mostly obscures her from view as Dr. Robert Couch, the hospital’s medical director for emergency services, eases over for his first introduction before heading off to order blood tests.

She's an admitted heroin user who may have taken a mix of drugs. Couch is concerned.

Besides hidden injuries from the crash, she could have HIV or hepatitis C. She may overdose again once the antidote, naloxone, wears off. For all Couch knows, she could end up at another hospital tonight. Or the morgue.

But he never gets to finish his workup. When his staff checks on her a few minutes later, all they see is a mess of sheets on the bed.

She’s gone.

“Typical,” Couch says.

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The adrenaline-fueled frenzy of trying to bring overdose victims back from death’s grip is a weekly, sometimes daily, challenge for Louisville's doctors, nurses, ambulance and fire crews and police officers. They’re on the front lines of a heroin and drug crisis that won't let up. Their quick actions save thousands each year, but they’re still losing more men and women to overdoses than homicides and car crashes combined. Last year, drug overdoses killed 362 people in Louisville, the U.S. attorney's office says, up from 270 just one year earlier.

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Couch says he hasn't seen anything like it in 30 years and calls it "the new normal." Most mornings, he scans obituaries looking for anyone he's treated for drugs. "My life's work is trying to prevent deaths like this."

The doctor, other hospital staff and first responders know they need help. Their reinforcements come from a second tier of workers, kind of like second-responders, who fight to free addicts from the pull of addiction. They do this in the city jail, hospitals and treatment centers like The Healing Place.  A 72-hour period over Easter weekend, observed by five Courier-Journal reporters and four photographers, provides a close-up picture of the seemingly-endless fight in a city awash in addiction.

For all involved, trying to reach addicts dominated by the disease can be daunting, especially when many who need help the most drop out of programs, refuse to go to the ER or make it to the safe space of a hospital only to crawl out of a bed and sneak away.

ERs 'canary in the coal mine'

On this Friday night in the ER, there’s little time to consider each patient’s fate. Within the span of a few hours, Couch and his team deal with young and middle-aged OD patients all while juggling a steady stream of non-drug-related problems like broken bones and pneumonia.

"The emergency department is really a window into the health of the community — the canary in the coal mine," he says.

Minutes before the patient in Bed 9 disappears, staff nurse Matt Pearson stops by Couch’s office to give him a quick update about another opiate overdose victim in Bed 4, a woman who shows up frequently in their ER.

He calls her “a hot mess.” Not a technical diagnosis, for sure, but a descriptive shorthand roundup for all her health issues, drug-related and not.

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Less than a half-hour later, nurse practitioner Amy Pippen takes a bite from her Qdoba bowl and rolls her chair closer to Couch in the doctor’s office to give him an update about the patient in Bed 11, who is suffering from acute tooth pain. He doesn't appear to be an addict or drug-seeker but needs painkillers like the ones that often start addicts on their path toward heroin.

“He’s legit,” she tells Couch. “He’s trembling, crying.”

Pippen has already checked that the man has a clean report on KASPER, a database that Kentucky health workers use to see if patients have been prescribed potentially addictive drugs from other doctors.

Although Couch doesn’t like prescribing opioids, the toothache patient, who lies on his side moaning, is an exception. Couch prescribes just enough opioids to get the man through the weekend and urges him to go to a dentist first thing Monday.

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Couch knows he can’t fix the opioid epidemic in Louisville by simply prescribing fewer opioids. People need to stop thinking they have a right to be pain-free, he says, and instead view medications as a way to ease pain. In the past 90 days, state data says, Couch prescribed opioids only 15 times, compared with an average of 72 among all Kentucky ER doctors.

“These can be very addictive, so we don’t want to cause more problems,” Couch tells the man with the toothache. “Save that pill we prescribed as a last resort.”

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Twenty minutes later, the emergency department gets a call from an incoming paramedic team: another overdose. It’s nurse Pearson’s fourth one today.

Some days, it's "one heroin OD after another,” Pearson says. Occasionally, he runs out to the parking lot to give the opioid antidote to someone who's been dumped out of a car.

That isn’t the case tonight. The man being wheeled down the hall is sitting partially upright, eyes open and alert if a bit watery and unfocused. He goes to Bed 6, changing from his red T-shirt, jeans and baseball cap into a thin hospital gown.

A paramedic tells the nurse manager that others threw ice water on the man in a misguided attempt to revive him.

“Why do they do that?” nurse manager Renee Cecil replies, shaking her head.

The paramedic shares her own exasperation with the night’s calls.

“The overdoses started at 9:30 a.m.,” she says. “Over and over and over.”

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On a bed three floors above the emergency department, a woman is determined to put drugs behind her. She's sought out Norton Audubon's New Vision program, which offers medical help for people who are detoxing.

The woman got hooked on heroin almost two years ago but has been working hard to get clean. For the past nine months, she’s been using methadone, an opioid treatment drug designed to wean her off heroin. But now she's saddled with costs and the daily routine of clinic visits and wants something better — a new job, new home and new life for her 4-year-old daughter.

“She has a really good shot at success. She’s very strong-willed,” says Paige Ross, service coordinator for New Vision.

Ross knows well what her patients are going through. Her own mother died of an overdose in 2006. Her brother is a recovering prescription pill addict 12 years clean.

“I’ve seen the full realm of what addiction can do," Ross says, "from jail and death all the way to recovery and a new life."

'The streets are winning'

As Good Friday turns to Saturday, Christi Embry’s high starts around midnight with a gram of heroin. It ends two hours later as she stammers and totters through the Louisville jail intake area and lands on a blue plastic bench.

In between, authorities say, she got in her car and almost struck a police car head-on.

Embry, a wizened, 34-year-old blonde, starts to shake. Her arm, wildly flailing, is still bruised from the heroin needle. She falls three times, hits her head on the bench and sobs. Within 20 minutes she’s snoring — in the reluctant care of Metro Corrections staff who must keep checking on her labored breathing.

She’s only one of thousands of drug users behind bars.

Metro Corrections — the red brick building on Sixth Street downtown — took in just under 32,000 inmates last year. About 30 percent went through the jail’s voluntary detox program, most of them hooked on heroin and other opioids. On any given day, as many as 120 people crowd the four detox dorms. Nearly half leave without completing the program.

“The streets are winning,” says Corrections Officer Brett Rehm, an 11-year veteran of the jail. “… Every night, same shit.”

Last year, jail was the second most common destination for Metro EMS in Jefferson County — and a significant number were treating drug users.

Once inside the jail, inmates are searched, scanned and fingerprinted by officers and nurses, then questioned by lawyers before they’re sidelined for hours until a bed in the overcrowded jail opens up.

At 9 p.m., 41-year-old John Palao approaches Hour 5 of his wait. He was just released two days earlier after a 20-day stint for stealing.

The affable, articulate heroin addict was back after officers found him unconscious in a car near Dixie Highway and Algonquin Parkway, a hot zone for overdose deaths. A police report says Palao “thanked the officer for taking the heroin from him.”

A former bartender at O’Charley’s, Palao started using heroin after developing an addiction to Percocet and Opana prescribed by doctors. In the five years since, he's been in and out of treatment programs and left friendless, homeless, jobless and absent from his children’s lives.

“Once you get wrapped in it, the biggest thing you want is not to be sick,” says Palao, wearing a long-sleeve plaid shirt to cover the track marks on his right arm. “It consumes your whole days.”

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Another inmate, in a position of trust working within the jail, can't resist sneaking in heroin and meth stuffed in his sock.

It's 10 p.m., and 39-year-old Rocky Smith is being moved from the general population dorm to detox. He had been cleaning the intake area when an officer found two pea-sized white rocks tucked in a folded-up juice packet in his sock. Smith says he was just “passing them along.”

“I’m a drug addict,” he says while handcuffed in an elevator on the way to a holding cell. “It’s not easy to quit."

Smith says he started using drugs in Chicago at age 12. Both his parents were addicts, he says, and he graduated from marijuana to cocaine, meth, heroin, LSD and mushrooms.

“I just hope to get help,” Smith says.

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On the other side of the main intake room, a former University of Louisville student — and a member of the Alpha Tau Omega fraternity — is mopping and picking up trash.

Shane Tucker, 47, works as an aide on the booking floor — earning $3 a day — while serving a sentence for stealing.

Tucker was convicted of theft in 2013, a year after he stole nine cans of Freon from his former employer to pay for a pill habit. He got five years supervised probation but ended up in jail after violating it. He may get out later this month to be transferred to a drug rehab intervention program.

He got addicted to pills after he was in a serious car crash that same year, three days after his youngest daughter was born. His face was bruised and his shoulder shattered, requiring surgery that came with prescription painkillers.

Within a few months, Tucker says his 3.92 GPA at U of L dropped and his relationships with his wife and children frayed.

For months, he used the money from his medical insurance to pay for the drugs, spending as much as $36,000 a month on pills.

His wife left him, but now stays in touch and keeps the kids in his life. Tucker is preparing for a life on the outside. Jail, Tucker says, rescued him.

♦ ♦ ♦

While jail can save some inmates, it's a rough place, too. Almost all corrections officers tell stories about daily fights and drug use. They say they’ve been spit on, yelled at and assaulted — making it hard sometimes to hold back their own aggression.

The jail's bottom floor is the calmest, especially during Easter weekend. Officers pass the time watching TV and playing a question game  — “Would You Rather?” — with inmates and each other.

Would you rather be in a zombie apocalypse or World War III? They pick zombie apocalypse. Stop 9/11 or the Holocaust? Answers are mixed. Know the date or cause of your death? They pick "cause of your death."

After the midnight shift change on Good Friday, a new inmate comes in: 40-year-old Shayne Cecil, a Louisville native who has been using drugs for half his life. He got caught stealing earlier in the day.

Cecil started out his drug use with marijuana and alcohol before moving on to pills, and eventually heroin. He’s done straight fentanyl, a menacing synthetic opioid, and was once given heroin laced with carfentanil — the elephant tranquilizer — which caused him to overdose. Both drugs, much more potent than heroin, have sent addicts across the nation to the morgue.

He claims he’s not an addict — he can go more than one day without using heroin and feels fine — but uses drugs because he’s bored. He says the way to break a drug habit is to get to the root of why people use drugs and then to distract them with hobbies.

He blames the “system,” which he thinks forces drug users to become criminals because they can’t find jobs. As for him, he’ll be fired from a new job delivering pizzas the next morning when he doesn’t show up because he’s in jail.

“The system is not set up for people to survive,” he says. “Society should be set up better.”

Drugs on the beat

Hours later, Louisville police officer Zack Haley rides through the streets of Old Louisville during his usual 7 p.m.-to-7 a.m. shift, describing how the deluge of heroin and other drugs has pockmarked areas of the city.

He also has issues with the system, but for a different reason.

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"The thing I hate about it is if someone ODs, you can’t charge them because they’re calling for help — and they all know it,” Haley says, referring to the state’s Good Samaritan Law, which encourages fellow users to call 911 if they witness an overdose.

Haley recalls one heroin user who overdosed three times in three months. The man had two of his hospital admission bracelets framed on his wall. Maybe the addict considered them trophies — or motivators to get sober after near-death escapes, the officer speculates.

Some heroin users Haley talks with on his beat say they keep taking drugs to avoid dope sickness. Others simply don’t want to quit.

The court system ought to be doing more, the 27-year-old Arizona native says, perhaps holding heroin users in jail for longer  — though he acknowledges the jail is already full. Perhaps more could be done to keep people in treatment and off the streets.

Haley drives by modest apartments-turned-flop houses he's previously entered with dread, repelled by a stench and worried about getting stuck by dirty drug needles.

“That’s a drug house there,” he says, pointing out his patrol car window to a weathered building just south of downtown.

As the two-year LMPD veteran crosses Fourth Street at Oak, he describes it as a popular spot for selling drugs. Haley and his fellow officers note suspected drug dealers, feeding information to narcotics detectives, who work to reduce the supply and punish dealers.

Haley has a street-level role, arresting drug users and dealers, rushing to help one to three users a night who have overdosed in apartments, cars and on the street. He's only used naloxone to rescue someone from an overdose a handful of times, usually deferring to EMS or firefighters if they get to scene first. But he must be ready for those times he is the only one standing between the unconscious person and death. At the start of his shift, he and other officers grab small, red packs of the antidote from Fourth Division headquarters.

Through mid-April, officers used 295 doses on 207 people this year. Some addicts require more than one dose, especially if they intentionally or unwittingly took something more deadly mixed in with heroin or pills, such as fentanyl or carfentanil.

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Haley remembers seeing men and women he thought were gone revived by naloxone, usually with no memory of what happened.

“It was weird at first, but now you see it all the time, it’s just normal.

“Which is bad…” he says, trailing off.

The choice to get sober

A day later, on Monday, another week dawns. Inside The Healing Place's men's detox center, a man sleeps slumped against a vending machine, his face mostly covered by a black hoodie, as he waits for an open bed.

He’s already been there a few hours by 6 a.m., when staff members flip on the lights to begin the day’s discharges and make room for new addicts seeking to get clean.

Seven men are approved to leave the downtown detox center this morning, meaning they’ve successfully rid their bodies of various poisons and are ready to take the next step in recovery — or leave and risk a chance of relapsing.

Six plan to walk the 43 steps across West Market Street to The Healing Place’s post-detox recovery program. They joke like old friends as staff members David Clancy and Roger Davis, both program alumni, return their few belongings.

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“They’re detox buddies,” Davis says. “They decided to do it together.”

Not all of the six are expected to make it through the program, though.

At The Healing Place, no doors are locked to stop people from leaving. They can either choose sobriety — or abandon the fight.

Davis and Clancy have families and careers, and both are recovering alcoholics who went through detox and the free recovery program. Now, they regularly volunteer at the center in eight-hour shifts. It helps them remember where they’ve been and where they could wind up again.

It’s been just three years since they finished the recovery program, but they’ve already noticed a change in the men they’re trying to help. They’re much younger. They haven’t had time to gain as much to lose.

“A lot of these young men here and across the street come in here really as children,” Davis says. “Dave and I know how to get out of a place and go find a job, how to pay a bill, how to open a bank account. A lot of these young men don’t have those basic skills.”

♦ ♦ ♦

By 8 a.m., Davis and Clancy finish releasing the seven men and are replaced by staff members Lou Kelley and Austin Baker, also program graduates. Kelley walks over to the corner near the vending machine, shaking the man in the black hoodie awake and asking if he’s still interested in a bed.

The man, eyes bloodshot, shuffles to the counter and gives his name and information before asking if he can use the center’s phone to call his mom. If he commits to detox, he says, she’s told him she would drop off some clothes.

The phone call turns out to be a lie. Within an hour, the man is sitting next to a wall outside the detox center, waiting for a ride to a 30-day recovery program in Elizabethtown.

The six-to-nine month route to sobriety wasn’t for him.

Kelley has been through the detox center several times before finally getting sober in 2009, at the age of 63.

Through the day, he and Baker work across from three nearly-filled corkboards, lined with the names and faces of men who’ve entered detox but who’ve since died.

Baker knows probably 25 men on the board, including a good friend who died earlier this year.

“It sucks looking up there and seeing all the people you know,” Baker says. “But that could have been me.”

♦ ♦ ♦

Later Monday, a familiar face returns to the center, toting a backpack stuffed with clothes for his stay.

The younger man had detoxed at the facility before and had even lasted four months in The Healing Place’s recovery program before getting booted for breaking a rule.

He stayed clean more than a year but eventually buckled to the desire to put money ahead of sobriety, using meth to stay awake for work.

The man’s employer, aware of his past, offered to pay for him to return to a recovery program anywhere. The Healing Place, which is free, was his first choice.

“There’s something about this place; I like it… Here, you got to want it,"  the man says. "If you’re not ready, if you’re not beating yourself up enough to do it, then go on.”

But no matter how many drug users start on the path to healing, others remain caught in the undertow of addiction.

As Haley says, "I don't see it getting better any time soon."

If the latest numbers hold, Louisville EMS will make up to 30 runs for overdoses tonight.

And at least one person will overdose in Louisville and die.

How we reported this story

Drug abuse is epidemic in Louisville, touching thousands of local families and killing a growing number of addicts. Over the Easter weekend, nine Courier-Journal journalists chronicled 72 hours on the front lines of the community’s fight against drug abuse.  Reporters and photographers paired up to follow addicts, doctors, treatment professionals, jail workers and others in their daily struggles amid a growing and deadly epidemic. Because of medical privacy laws and the sensitivity of the topic, some of the subjects’ names could not be used. The team plans to follow up with related stories in the coming months.  For comments or questions about this series, contact reporter Laura Ungar by email at lungar@courier-journal.com or 502-582-7190.