SAN DIEGO — Imagine the Grinch as a porch pirate, stealing to feed a drug habit. After he’s shunned by fellow thieves, he has a change of heart and returns one of the stolen packages. Another Grinch answers the door — the father he thought had abandoned him.

This was the retelling of the classic tale that was staged last month in the Vista, California, jail by the men in its medication-assisted treatment module. Their story reflects themes that surface often in addiction recovery: accountability, acceptance and what a second chance can look like.

Like the Grinch, Eric Klein, who co-wrote and narrated the play, was at a crossroads when he entered what’s known as the MAT module. Years of opioid addiction had cost him everything.

“I lost my wife, my house, all the cars. Everything just went, and I hit bottom,” he said.

Earlier this year, Klein was arrested near the San Ysidro trolley station selling stolen sneakers to pay for drugs. He had completed treatment programs before and even worked as a counselor, he said. But he’d reached a point where he was done trying.

Before he was transferred to the MAT module in September, Klein planned to return to his old life after his release. “I was angry that they arrested me,” he said. “But in all reality, they saved my life, because I was probably going to kill myself out there.”

Medication-assisted treatment has existed for decades, but it has only been introduced in jails in recent years, driven by the fentanyl crisis and a sharp rise in overdose deaths behind bars.

Suboxone, the medication most commonly used in MAT programs, reduces cravings and withdrawal symptoms without producing a high. Because it binds tightly to opioid receptors in the brain, it also blunts the effects of drugs like heroin, meaning people on Suboxone feel little to no euphoria if they use.

Experts caution that medication alone is not enough. Suboxone can provide stability, but therapy and peer support are what help people change long-standing habits.

The Vista jail’s MAT module, which opened in 2023, was built around that model. It houses up to 30 men at a time, each spending three to six months in an intensive, structured treatment program anchored by a morning dose of Suboxone.

Jeff Warren was one of the program’s first participants. He’s now out of custody; the program helped end a nearly 30-year cycle of homelessness and jail.

“It’s the first time in decades I wasn’t sick every morning,” he said. “My cravings dropped way down. My brain could actually focus.”

Warren, like Klein, says the program saved his life.

“I didn’t believe I’d ever get clean,” he said. “Part of me didn’t even want to live anymore. That program changed everything.”

‘Tired of seeing people die’

Before 2019, fatal overdoses in San Diego County jails were uncommon — usually one or two a year, most involving methamphetamine. That changed on Aug. 3, 2019, when Michael Hossfeld, 41, died from a fentanyl overdose at the Central Jail.

Over the next three years, 13 more people died. Hundreds more were revived with the overdose-reversal medication Narcan, often just in time.

“I remember doing CPR and thinking to myself, ‘We’re doing something wrong,’” said Cpl. Dustin Mattox.

When Kelly Martinez ran for sheriff in 2022, she vowed to expand medication-assisted treatment in San Diego jails. The pledge caught Mattox’s attention. He began researching the approach and volunteered when the Sheriff’s Office put out a call for deputies to staff the Vista jail’s new MAT module.

“I was tired of seeing people die,” he said. “We had to do something different.”

The approach, however, challenged long-standing beliefs about addiction and punishment.

“For most people in law enforcement — and I think for a lot of people in the general public — the idea is, ‘Why are you giving drugs to drug addicts?’” Mattox said. “’How is that going to fix the problem?’”

The program started as a pilot with just five people and gradually grew to 30. Since its launch in January 2023, more than 300 people have completed the program and been released from jail.

Early data point to lower rates of re-arrest among participants. Among people who complete the MAT module 19% return to custody, compared with a 33% recidivism rate across the county jail system overall.

“We know the program works,” Mattox said. “Our philosophy has been since day one, when we had our first five people, ‘I’m going to treat you with dignity, I’m going to treat you with respect, but you got to put in the work.’”

People who might be eligible for the MAT module are screened shortly after booking.

“Day one, we identify if they’re going to be detoxing, and that immediately puts them on on my radar,” Mattox said. “They get flagged as being someone who’s a potential candidate for this program, and from there, they’ll see a provider who will determine if they have an opiate use disorder, and then they’ll be put on the medication for a long-term period.”

Participants are transferred into the module once they’ve been sentenced and have at least three months, and up to six months, left to serve. This allows staff to start working on a plan for their release — including a plan for housing and continued treatment — from the outset.

“They’re here from beginning to end,” said Diana Kathol, a licensed mental health clinician who has worked in the program since its early days. “They graduate, and then they go back to the community.”

Kathol meets individually with each participant weekly and runs several therapy groups, including dialectical behavioral therapy, or DBT, which focuses on emotional regulation, distress tolerance and mindfulness. Yoga is offered once a week.

She also leads art therapy sessions.

“These groups are hard,” Kathol said. “We’re talking about trauma, addiction, grief. We need something that lets them express themselves differently.”

The environment itself is part of the treatment, participants said.

“It’s way better than other modules,” said Jason Eisenhart, who has cycled through custody for years, mostly on drug-related charges. “More freedom. Less lockdown. You actually have space to do homework.”

This is Eisenhart’s second time in the MAT program. He’d finished it earlier this year and was released from jail, but he relapsed after his girlfriend died. He ended up back in custody and decided to give the program another try.

“With her passing away, I think it’s — I want to live for her,” he said. “I don’t want to use drugs anymore. I’ve been homeless for 13 years, and it’s been tough out there. There’s just no future.”

He now meets regularly with Kathol and a jail chaplain to work through his grief.

Participants say deputies assigned to the module treat them differently than deputies elsewhere in the jail.

“They actually ask how you’re doing,” Eisenhart said. “You’re not just a name and a number.”

Klein described a similar shift.

“In other places, it feels like just a job,” he said. “Here, you can tell it means something to them. These guys are on our side, you know — they’re going to bat for us. And that just doesn’t happen when you’re in jail. Normally, we’re on opposite sides.”

Deputy Luis Meraz said he asked to be assigned to the unit. “It’s changed my mentality,” he said.

Meraz looks for motivational videos to share with participants, and he bought pizza for the group after the Grinch performance. He tries to lead by example. “Hopefully that’s making a difference,” he said.

Mattox said he trains deputies assigned to the unit to approach addiction as a disease, not a moral failing.

“They’re already here,” he said. “We don’t need to keep punishing them over and over. The goal is to make sure they don’t come back.”

Participants earn commissary items for completing homework and attending group sessions. They’re also afforded greater access to phones and the television — privileges that can be revoked for rule violations.

“One thing that works really well is incentives,” Klein said. “We do homework, they give us a bag of Doritos. It might be small, but it motivates people.”

Violence, alcohol use or selling or trading prescribed medication results in removal from the housing unit, though not from treatment entirely, Mattox said. Those participants keep receiving services and may be allowed to return later.

“It happens,” Kathol said. “People have setbacks. We’re not going to turn our back on them.”

Some men ask to join the MAT module; others are placed there in the hope that they’ll engage in programming. At first, not everyone wants to stay.

“We tell them, ‘Give it a week. If you hate it, you can go,’” Kathol said.

About 98% choose to remain, she said.

“I’ve seen guys come in like, ‘Yeah, OK, whatever,’” Kathol said. “And by the end, something clicks.”

‘A warm handoff’

Because everyone in the unit has already been sentenced, staff know each person’s release date and begin planning early. Participants work with reentry counselors to secure critical necessities like government IDs, Medi-Cal, housing and a plan to continue treatment.

“My philosophy with this program is, we don’t just want to kick you out on your butt. You get out of here, we want to give you a warm handoff,” Mattox said.

As of mid-November, about 97% of participants chose to continue treatment after release, often through community providers that offer housing and support, he said.

Still, gaps remain. Kathol wishes there were more long-term recovery programs available outside of jail.

“Three months of sober living isn’t always enough,” Kathol said. “Addiction is a lifelong journey.”

After spending 15 months in the program — far longer than the typical stay — Warren moved into residential treatment, then outpatient care. He enrolled in college, earning top grades, and now works full-time at a downtown San Diego hotel. He’s training to become a certified peer support specialist to help others in recovery.

“So many times I’d tell myself, ‘This time is going to be different,’” he said. “And then I’d get out, and the cravings and the thoughts would just take over.”

Through counseling and group therapy, Warren said he began to understand his addiction as much more than a lack of willpower.

“I learned it wasn’t a moral failing,” he said. “My brain was wired to respond to any kind of discomfort by reaching for something — drugs, alcohol, instant relief.”

The program, he said, taught him to slow down.

“I never really understood the idea of hitting rock bottom,” Warren said. “But I got to a place where I was ready to surrender and let the process work.”

He credits classes rooted in cognitive behavioral therapy and dialectical behavioral therapy — along with mindfulness and yoga — with helping him build new habits.

“I didn’t think yoga would be my thing,” he said. “But it actually clicked.”

Eisenhart, who is scheduled for release this summer, is focused on securing housing and staying off the streets for the first time in years.

“It’s hard to do anything positive when you’re just trying to survive,” he said.

For Klein, who entered the program after years of addiction, homelessness and repeated probation violations, just having housing lined up has changed his outlook.

“Just releasing someone back out to the streets after six months of incarceration who doesn’t have any plan, nowhere to go, they’re gonna go back to the streets,” he said.

Once he’s released this month, he plans to return to restaurant work and keep attending recovery meetings. He wants to be able to return to the module as a visitor — and a success story.

Vista is currently the only jail in San Diego County with a dedicated MAT housing unit, though people in other jails receiving Suboxone can participate in therapy and groups like those offered at Vista if they choose. Over the last two years, there has been only one confirmed fentanyl overdose in county custody.

The MAT module’s results have convinced Mattox the model should be expanded beyond one jail.

“They’re almost never getting into trouble. They’re almost never getting into into fights — we have almost zero incidents in this module versus everywhere else,” he said. “You treat people with dignity and respect, and they start acting the way you treat them.”

The goal, he said, is to replicate the model in other San Diego jails, starting with the Central Jail and the Las Colinas women’s jail, though space constraints have made expansion a challenge.

For now, he’s trained deputies at each jail about how MAT works. Anyone in custody who’s taking Suboxone has the option to participate in classes and one-on-one counseling.

“I’ve been here for 11 years,” he said. “Being in jail is very negative for everyone, like not just these guys, it’s a very negative place. And seeing something like this, it’s like turning on a light in a dark room.”

Kathol agrees. The program works, she said, because multiple pieces are in place at once: medication, therapy, structure and human connection.

“There is no gentleness in jail,” she said. “So when people experience it here, it matters.”

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