The gash in Tammy Paris' arm was wide and deep.
The abscess had grown with every poke of the needle — and there'd been plenty.
She'd inject heroin every day, in fact, sometimes six times a day.
Staying high kept the sickness at bay.
Paris ravaged the fold of her right arm as she satisfied the addiction that would eventually cause her to lose much of what she loved — her home, her dogs, her friends — and force her to rebuild her life at 63-years-old.
"I hit rock bottom," she said.
And she's not alone.
In Louisville and in cities across the country, heroin use is surging — taxing local resources, tearing apart families and leaving many, like Paris, reeling in the battle against addiction.
At some homeless shelters the effects of the addiction are particularly potent. There are more than 6,000 homeless people living in the Louisville Metro area, according to data from the Coalition for the Homeless. Many deal with addiction or mental health issues, experts say.
And with limited shelter space, homeless residents that seek shelter must jockey for space in shelters that are often packed near capacity.
These days, Paris lives at Wayside Christian Mission on the east side of downtown Louisville. She sees plenty addicts, like herself, taking refuge inside the shelter during the sweltering summer months and many others outside, beneath the nearby overpass.
Though no staff members at the mission were available to discuss the effect heroin is having on the shelter, officials at other shelters across the city recognize addiction as a true epidemic.
"It's something we are faced with every day," said Linda Romine, spokeswoman for St. Vincent de Paul, which operates an emergency shelter for men at their facilities in Shelby Park.
Romine said to address the issue, staffers from kitchen workers to case workers are regularly trained on how to deal with an overdose situation. What's more, the staff keeps the overdose antidote, naloxone, in stock.
Other area shelters do the same — St. John Center for Homeless Men, Salvation Army's Center for Hope, and Volunteers of America.
Yet, as the cases of fatal overdoses in Jefferson County are on the rise, the number of beds in shelters dwindles.
A review of the Kentucky Office of Drug Control Policy’s annual reports from 2011-2016 show the number of people dying from overdoses in Jefferson County is increasing every year.
In 2016, the office reported 311 people died from drug overdose – up from 147 in 2011.
The number of available beds in emergency shelters or transitional housing programs across the city has dropped by nearly 600 in the same time.
The trend concerns Jennifer Hancock, chief executive officer of Volunteers of America.
"This is not a time for our community to be reducing capacity," she said.
Instead, Hancock wants to see shelter capacities expand. But only if people suffering with an addiction can be welcomed and treated, she said.
Not doing that, she said, is a disservice to those residents.
Still, some shelters turn people away who may be under the influence or who fail a drug test. Hancock said this can run counterproductive to the larger mission of addressing addiction.
Many of these organization, however, are "simply not equipped from a capacity point of view of an organizational competency point of view," she said.
"That speaks to complexities of dealing with this disease."
However, agencies across the state that focus on addressing homelessness are beginning to take a harder look at addiction services, said Adrienne Bush, who heads the Homeless & Housing Coalition of Kentucky.
The Kentucky Interagency Council on Homelessness will meet next week and Bush expects the group to examine what's missing from it's addiction services portfolio.
"Because it is so prevalent," she said.
Tammy Paris knows this to be true. She got hooked on heroin after her supply to pain pills ended.
She's deleted the phone numbers of her old dealers, but is confident she could find a fix "in a split second."
But she doesn't want to. She wants to stay clean and sober — which she's been for nearly two months.
Though she liked the feeling of the high, she didn't like the sickness or the helplessness that can come with addiction.
And she certainly didn't like the gaping hole in her arm.
"That's what heroin done to me," she said. "Heroin wasn't worth all this."
