INDIANAPOLIS — Up until a decade ago, drug-using criminals probably didn't want to face Marion Superior Court Judge William Nelson.
"Ten years ago, if you were a drug addict appearing before me in court you were a junkie who made the conscious decision to pop that pill or stick a needle in your arm," Nelson acknowledged. "You were a criminal committing offenses to support your habit, and you deserved to be punished."
But 10 years ago, Nelson's stepson died from an opioid overdose.
On Wednesday, Nelson invited other judges and law enforcement officials to alter their approaches in dealing with people who are ordered into Indiana courts. To emphasize his message, Nelson played the 90-second frantic 911 call made by his wife when she found her son had overdosed.
About 1,000 justice professionals attended Wednesday's statewide opioid summit sponsored in part by the Indiana Supreme Court and the Indiana Family and Social Services Administration (FSSA). Attendees were urged to consider options in helping Hoosiers with substance use disorders or mental issues, including medication-assisted treatment.
"For trial judges particularly the idea of giving medicine for addiction is a difficult concept to accept. Getting over that barrier of crime versus addiction is equally difficult," Nelson said.
"That's exactly what I thought 10 years ago ... That all changed the day that 911 call was made," Nelson said.
On average, there were 84 opioid prescriptions per 100 Hoosiers in 2016, officials said. Some counties go well above that average. Howard County averaged 123 prescriptions per 100 residents; Madison County averaged 110 and Clark County averaged 105.
In 2016, there were 1,518 drug overdose deaths in Indiana. Opioids accounted for 12 percent of the deaths.
Opioid prescription rates in Indiana rose from 103 per 100 population in 2008 to a peak of 112 per 100 population in 2012. They have been dropping since 2012.
"We're starting to see a few counties reporting to us a plateau or a decrease in overdose deaths," said Dr. Jennifer Walthall, FSSA Secretary.
"We've had two in the last few weeks that report almost a 30 percent decrease in overdose deaths. We take that very seriously as a potential positive but there are so many things that are folded into that. ... The plateau is not enough. We need to see decreases that are sustained," she said.
But many Hoosiers with substance abuse disorders are arrested and then face the judicial process.
"The No. 1 referral source for getting people to treatment, other than self referral, is the criminal justice system," Indiana Chief Justice Loretta Rush said.
In Kokomo, Howard County has an adult court offering treatment services for non-violent drug offenders. About 84 percent of offenders have substance use problems.
"We need to figure out how we can expand those principles in the way we're dealing with addicted individuals out in the rest of the criminal justice system," Howard Superior 1 Judge William Menges said.
His 1,300 cases a year include repeat offenders.
Menges said, "This is a part of what we have to look at as well, what are we doing with people pending trial. How do we start dealing with their addiction issues early? Because the sooner the better, and break that pattern."
From Lebanon, Boone County Superior 1 Judge Matthew Kincaid said he was encouraged to hear about medication-assisted treatment as an option to address the opioid crisis. "This is a conundrum and a social problem ... It's a debilitating crisis. It's destroying families, ending lives. It's something like a Korean War every year in the United States in the number of people that are dying from overdoses."
As an option to avoid being held in jail, offenders can receive a shot of the anti-addiction drug Vivitrol.
"Anything we can do as judicial officers and professionals in the criminal justice system to work on this problem I think is a tool we should listen to," Kincaid said.
The most common drugs involved in prescription overdose deaths are methadone, oxycodone and hydrocodone, according to the CDC.