Sheriff Apple went on the road to meet with other sheriffs and advocate for better MAT programs within correctional facilities. Back home, he gave the Albany County Correctional Facility a new name—the Albany County Corrections and Rehabilitative Services Center—and brought in nonprofits and non-law-enforcement personnel to provide services. Sheriff Apple also made another, more unusual, change: He converted 25 cells into rooms for people who were homeless, including those struggling with substance-use disorder, whether or not they had been accused of a crime. The move represents a growing—and controversial—trend in the United States as communities struggling with issues such as homelessness and substance-use disorder have begun using detention facilities to house people who haven’t been charged with a crime or sentenced to incarceration.

Apple’s idea, which he calls the Sheriff’s Homeless Improvement Project (SHIP), was not only to provide shelter to Albany’s growing homeless population, but also to grant access to the services available at the jail. He hopes this will reduce recidivism among homeless people who have previously served time (in turn lowering costs): “A lot of these folks get out of jail, and they don’t have a home. They don’t have family. They go from one shelter to another … and then they reoffend, and they are back in jail, and we lose.” Another inspiration, Apple said, was that imminent bail-reform legislation in New York State, which will take effect in January, means that he, like other sheriffs, has a “huge jail with a low census”—that is, a lot of empty space to fill. The program hopes to begin accepting participants around the end of November. “We are taking a bad building and making something good out of it,” he explained.

The newly converted cells are not intended to feel punitive. They have doors instead of bars, and amenities such as televisions, and residents can move in and out of their rooms freely. Sheriff Apple said in a phone conversation that the new program is “not a jail,” but more like a drop-in center. “You don’t like it, go do whatever you’ve got to do,” he said when asked whether people can drop out anytime.

While it’s too soon to tell what the outcome will be, Apple’s plan reflects the growing tension between law-enforcement officials and advocates for people with substance-use disorder who believe that drug problems should be managed within communities, not in correctional facilities. (Apple is adamant that SHIP is not a correctional program.) Critics ask, even if people like Sheriff Apple have the best of intentions, should communities rely on law enforcement to lead the response to the substance-use-disorder crisis?

Deaths from drug overdoses have been steadily increasing over the past two decades. In 2017, drug overdoses accounted for more than 70,000 deaths in the U.S.; opioid-related deaths, in particular, accounted for nearly 48,000 of those. Preliminary data for 2018 show a slight downturn so far, though overdose deaths are still much higher than they were 20 years ago. They have contributed to lowering life expectancy in the United States three years in a row—something that hadn’t previously happened in a century, when the U.S. population plummeted because of World War I and a flu pandemic.