The battle against South Jersey’s surging heroin epidemic is one the local addiction treatment infrastructure is ill-equipped to fight.
Even as state agencies, advocacy groups and individuals band together to address opiate addiction, many factors — from a lack of treatment capacity to the stigma of addiction — undermine their efforts.
“We’re doing the best we can,” said Dr. James Manlandro, a longtime addiction specialist based in Woodbine. “But we really can’t keep up with the number of patients that need treatment.”
Few know the addiction struggle as well as Linwood resident Michelle Bacon, a recovering heroin addict who spent two months trying to get her brother into rehab before finally succeeding in late March.
The biggest issue Bacon and many others in the area face is a lack of “beds,” or capacity, in inpatient rehabilitation and detoxification facilities. Cape May County does not have a single bed listed in the Division of Mental Health and Addiction Services’ treatment directory. Cumberland County has no facilities, either. Atlantic County has about 180 beds between the Lighthouse in Mays Landing and the John Brooks Recovery Center in Atlantic City, while Ocean County has 38 beds at Sunrise Detox in Toms River.
Years ago, when she still used drugs, Bacon had little trouble finding treatment. But the number of opiate users has swollen due to a glut of cheap, pure heroin, and treatment demand has outpaced capacity.
“I have brothers and sisters that both struggled, and I’ve found that over the years, trying to get them into places, it’s taking longer and longer to find beds available,” said Bacon, who said she has been clean for three years.
For Bacon, this meant cold-calling rehab facilities across the state every day, only to be told they were full and to call again later. And while the state has an addiction hot line, it serves to put callers in touch with already-packed facilities rather than help them find an open bed. Cape May County offers placement services and covers at least three weeks of inpatient treatment through a group called Cape Counseling, but as an Atlantic County resident, Bacon’s brother was not eligible for this service.
Bacon’s search for treatment for her brother was tough, but it would have been even more difficult without her brother’s insurance, which was available to pay for his care. Out of pocket, detox and a three-week stay in a residential facility can cost $5,000 or more, said Pat Devaney, director of human services for Cape May County. Medicaid is accepted at relatively few facilities, and many insurance companies do not cover treatment because they deem opiate withdrawal “nonlife-threatening,” Manlandro said, whereas alcohol withdrawal is covered.
Tonia Ahern, of the Cape May County chapter of addiction advocacy group Parent-To-Parent, does not dispute the insurers’ assessment — at least not on its face. Unlike alcohol withdrawal, opiate withdrawal alone will not cause death. But because it’s such a challenge to face alone, many addicts who attempt to go clean fail to do so and ultimately succumb to addiction.
“Technically, it’s not life-threatening, and alcohol is life-threatening,” she said. “But the problem is that when they don’t detox, they’ll go out and use, and there’s a possibility they’re going to die.”
Meanwhile, the overdoses keep coming. Ocean County, which had 112 deaths last year, had 15 by mid-March, said Al Della Fave, spokesman for the county Prosecutor’s Office. Cape May County, which was among the state leaders in drug-arrest rate in 2010, has seen just one death, but its 26 verified opiate overdoses through April already are outpacing last year’s numbers, Prosecutor Bob Taylor said.
Of those lucky enough to find treatment, few receive the duration of care they need. Medicaid typically approves only a week to two weeks of inpatient treatment, Manlandro said, while most addicts need stays of at least three to four weeks to be most effective. Often, patients need months of treatment.
Kristy Heym, of North Wildwood, was in and out of treatment for years before finally receiving long-term care as part of the state’s Drug Court program, which places nonviolent drug offenders in treatment as an alternative to prison.
She would be covered for a five-day detox and two weeks in rehab, but each time she’d enter, she would fail to break her addiction. The rehab carousel, she said, was more disheartening than it was helpful.
“It was kind of, you know, a conveyor belt,” said Heym, now two years sober. “Get them in, push them out — there never was really that feeling of hope. You would see the same people.”
Drug Court, which got a $4.5 million boost from Gov. Christie in his latest proposed budget, is one of several pushes by state and local leaders to fight the growing drug problem. The Prosecutor’s Offices in both Cape May and Ocean counties have stepped up prosecution and teamed with municipal and school leaders to educate kids and parents on the dangers of heroin and prescription opiates.
The opiate fight also has become a legislative priority. Last year, the state implemented what’s known as the “Good Samaritan Law,” which gives immunity on minor drug possession charges to those who in good faith report an overdose.
State Sen. Joe Vitale, D-Middlesex, was one of the major proponents of that bill and has continued to keep the drug issue on the legislative agenda. Addressing it, he said, requires a comprehensive approach including five “pillars” of policy: prevention, maintenance, treatment, education and reform. Anything less, he said, is sure to fail.
“You’re playing Whac-A-Mole,” he said. “You hit it here, it’s going to pop up somewhere else. You have to address every angle, and that’s the danger in rushing to throw out legislative ideas we think will work.”
Vitale said he and some Senate colleagues are readying a package of bills for the coming months that will attack the epidemic from all angles.
The Governor’s Council on Alcoholism & Drug Abuse in March released its action plan to address the growing number of adolescents and young adult users, laying out a series of guidelines on how to address the problem. Among them are raising awareness of the dangers of prescription opiates as a path to heroin, eliminating the stigma against heroin that leads residents to oppose the construction of treatment facilities and creating more channels to help those in need find treatment.
Still, the fundamental issue in the addiction fight is that treatment capacity and availability have remained more or less static, while the number of heroin and opiate addicts has grown statewide. Simply put, the state needs more beds in more places, and more ways to pay for them.
Manlandro has spent the past 33 years of his career treating addiction and knows well the scope of the problem. The state needs as much firepower as it can muster, he said.
“We need all the help we can get,” Manlandro said. “There are a lot of people dying of addiction.”
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