For small-town Tennessee judge, opioid crisis is personal

DANDRIDGE, Tenn. — Judge Duane Slone has observed the arc of the opioid crisis firsthand since painkiller addiction began taking ahold of lives in the rural northeast Tennessee counties he serves.

Serving as a drug prosecutor in the 1990s before becoming circuit judge in 2009, Slone routinely jailed addicts who committed petty crimes to support their habits, including pregnant women. "How in the world could someone who has a child in her be addicted to drugs?” he remembers thinking.

But as the number of addicted people grew to include some he had known all his life in Jefferson County, where his hometown has a population of just over 2,000 people, the crisis grew personal.

Related: IUDs for inmates seen as tool to combat opioid crisis

Then when a family friend asked Slone and his wife in 2011 to adopt a baby born with withdrawal symptoms, the crisis reached his home. He and his wife, Gretchen, watched as the 6-month-old boy struggled with night terrors, ADHD, violent outbursts — lingering effects of his birth mother’s drug abuse.

“When Joseph came to us, I knew about addiction and I knew about neonatal abstinence syndrome, but I wasn’t really dialed in,” he said. “It changed my perspective completely.”

Slone shifted his approach to justice; at times, his methods are controversial.

• When any pregnant woman on probation fails a routine drug test, regardless of her initial crime, officers must report it immediately to Slone.
• If they don't have a prescription for the drug, the women are immediately sent to a county jail to detox in often uncomfortable surroundings, a process Slone acknowledges is painful for mothers and distressing to fetuses. It also is contrary to recommendations by obstetrician groups and the national guidelines for drug courts.
• Female inmates in county jails are offered a free trip to get long-acting reversible contraceptives — such as intrauterine devices, or IUDs — at local health clinics.

Nearly 70 percent of all babies born addicted in the state are in East Tennessee. Slone said his community can't wait for public policy officials to debate the best practices to prevent babies being born with neonatal abstinence syndrome or for the government to send help.

“If I don’t intervene, then both the mom and fetus could be dead before the child is even born,” he said. 

Terrence Walton, a longtime addiction treatment specialist, said national drug court officials discourage any practice that would put a woman in jail and not in treatment. 

Local civil liberties and reproductive rights groups have questioned whether jailed women may feel coerced by the offer of long-term contraceptives.

But with a dearth of treatment options for pregnant women in northeast Tennessee, Slone said he has to use the only tools he has available. His son, Joseph, is always a reminder that every addicted pregnant woman means a child’s future is at stake, and his Christian faith tells him that justice must be meted out with a measure of grace. That, and results, ultimately are what matter to Slone.

In a nine-month period in Sevier County in 2015, for example, where Slone worked with local health officials to introduce the jailhouse contraceptive program, the Tennessee Department of Health reported a 92 percent reduction in babies born with neonatal abstinence syndrome, the clinical term for babies born addicted to drugs taken while their mothers were pregnant.

“We can’t wait for government or anyone else to act,” Slone said. “We have to deal with this now as a community.”

Speaker Beth Harwell launches task force to fight opioid crisis

His day in court

On a Thursday afternoon, about 40 people are in drug recovery court to give regular updates to Slone.

It is one of 11 recovery courts in Tennessee, created to provide an alternative to incarceration for people with addictions. The two-year program sets strict standards for participants: Take regular drug tests, stay clean, attend weekly recovery meetings, get a job, pay court fines, don't break the law. 

The first woman tells Slone she has gotten her driver's license back and is working toward paying off court costs. She had just opened her first bank account. 

"That's awesome," Slone said. "Someone who didn't know your journey might not think that's a big deal, but I can't tell you how proud I am of you."

The woman had failed to show up for a drug test, saying she couldn't get transportation after work. But she didn't show up again the next morning to take it either.

"If you'd even called us, that's the problem," Slone admonished her. "There is a sanction — 24 hours (in jail) for credit for time here today." She could serve the time on her day off from work, he said.

"That's the least impact on you as possible. That's the grace in this. I promise you we hate to impose this sanction on you when you've been so great. So, clean slate now."

One woman told Slone, "I finally got promoted to general manager. I started premarital counseling. It's taken me a long time to get here."

He replied: "You're right on time."

Another woman who relapsed taking drugs in a grocery store bathroom with former longtime friends got three days in jail.

"You're not a failure," Slone assured her. "But this failure is just going to be part of your story."

Small-town life

Slone, 54, grew up not far from Dandridge, a town 20 miles from the North Carolina border that local tourism officials promote as the second-oldest city in Tennessee. The courthouse looms as the largest building in a small, historic downtown square. Right across Main Street from Slone's chambers is the Tinsley Bible Drug Co., which has been serving old-fashioned soda fountain drinks at its lunch counter for more than a century. Slone recommends the milkshakes. 

The first addict Slone ever met was his younger brother, who spent his youth getting high on paint and battling mental illness. He lives in a group home nearby. Slone has served as his guardian for most of his life and has seen firsthand the misery wrought on whole families because of addiction. Their mother was devastated, he said.

Slone's colleagues say the judge has influenced their own view of addicts in the criminal justice system. 

"I send so many people off to jail," said Jeremy Ball, an assistant district attorney. "Because when you only have a hammer everything is a nail. We have other tools here."

Some of the people who come through Slone's drug recovery program see him as a father figure.

"I remember going to court after a relapse," said Tesla Smith, 27. "He had tears in his eyes. It's a good feeling when you know that a judge knows you and cares about you. I feel like I'm somebody." Smith paused. "Not that I should base my self-esteem on who I'm with ... ."

Home

After work, Slone heads to his sprawling property in White Bluff, where eight horses roam the grounds and a cat and two dogs greet his car.

Inside he gets on the kitchen floor to sit beside 6-year-old son Joseph, who is playing Chutes and Ladders. Oakland, his 14-year-old son, sits at a kitchen counter. His daughter, Estella, 4, plays another game beside Slone's wife, Gretchen.

Joseph's mother had two other children born addicted to drugs. When the Slones adopted him at 6 months old, he could not sit up. At 15 months, he could not walk. It was a challenge to get him to sleep. When he did, he would wake up shaking with night terrors, not recognizing his mother or father. He still has challenges ahead. He has been held back in school. He lashes out at times, trying to claw and hit his parents. He has tried to jump out of a moving car. 

"If the epidemic keeps going, at some point everyone here is going to have a connection to someone impacted by it," said Gretchen Slone, whose conversation is interrupted as Joseph loses interest in the board game and runs in and out of the room. "I know the results Duane gets, the drug-free mothers who have been helped, and it's worth all the time he doesn't get to be with us."

Duane Slone remains focused on the work yet to be done. At least four or five times a week someone he knows or grew up with calls asking for advice on what to do with a loved one with a drug problem. There aren't enough resources, he said. 

He is now working with other judges, doctors and counselors to urgently expand efforts to address the crisis.

Tennessee is in line to get $27 million in federal funding to combat opioid abuse, but the funds won't cover the cost of transitional housing that keeps recovering addicts away from the people they abused drugs with.

Slone, a Republican, hopes that Gov. Bill Haslam authorizes additional funds for transitional housing. Lawmakers on the legislature's criminal justice committee failed to persuade Haslam last year to appropriate that funding in the state's budget.

Tennessee needs millions more for opioid treatment, commissioner says

He wants to see women's-only recovery courts. He wants jails to expand their capacity to treat addiction. Ultimately he hopes the state takes a five-year approach to addressing individual drug addiction, connecting recovering addicts to peer support groups or church-based efforts to ensure that all the effort put into the first two years of recovery doesn't fail once the support ends. 

Reach Anita Wadhwani at awadhwani@tennessean.com or 615-259-8092 and on Twitter @AnitaWadhwani.

Babies born addicted in Tennessee

2013: 936

2014: 1,031

2015: 1,039

Source: Tennessee Department of Health

Resources for help with substance abuse

• The Tennessee REDLINE from the Tennessee Department of Mental Health and Substance Abuse Services offers information about resources and guidance about abuse for those who are dependent or a loved one.
• www.tn.gov/behavioral-health
• www.recovery.org
• www.nashvillerecovers.org/treatment-and-detox