WYNC News, 12/21/17
By Mallory Moench & Clarissa Sosin
Kelly was 18 years old and driving to her high school graduation when she was rear-ended on a highway in southern New Jersey. She walked away unscathed, but three weeks later while getting a tattoo on her lower back, her leg went numb. The doctor told her she had two herniated discs and prescribed a mild painkiller. She was quickly hooked.
For the next ten years, Kelly worked the system to get prescription drugs. When it wasn’t enough anymore, she turned to heroin and cocaine. Thirteen years after her accident, she found herself pleading before drug court, facing prison or rehab. She said she begged for all the help she could get.
Kelly eventually landed at Integrity House, the largest treatment provider in New Jersey, where she went through long-term residential treatment. After her therapy was completed, she found a job as a waitress, got engaged to someone she met at Integrity House and had a baby girl. But, like many opioid addicts, she relapsed and is now back in treatment.
“I don’t feel like I’m ready to go back home,” said Kelly, now 35, who asked not to publish her last name because of the stigma. “I have a one-year-old daughter who needs me and it’s hard enough to be here without her, but I know that I’m not ready to go home and if I go home now and I relapse again, I could die.”
The opioid crisis claimed more than 64,000 lives in the U.S. last year – more than gun violence and car crashes. It’s the same as an airplane with 179 people on board going down every day.
And while much attention has focused on rural and suburban areas, where the epidemic has spread more recently, metropolitan areas like New York and New Jersey have long had some of the nation’s highest numbers of patients in opioid treatment. In the state of New Jersey, there were 76,509 treatment admissions for opioid addiction last year. This year, there were 38,000 New York City residents in treatment.
Yet treatment centers like Integrity House still struggle to meet a skyrocketing demand in recent years. Along with other major local treatment providers, officials at the center are hoping that President Trump’s response to the crisis will help meet the crushing need.
Robert Budsock, CEO of Integrity House, says that despite the 420 beds he has available for residential services, there is a daily waiting list of 50 to 100 people seeking treatment.
“It would be ideal if we had treatment upon demand,” said Budsock.
Dr. Timothy Brennan, head of Mt. Sinai’s Addiction Institute in New York City, said his facility is also unable to keep up with the influx of people who need treatment. The hospital is operating almost at full capacity, with 45 patients currently in residential treatment and 320 coming in daily for medication.
“We’re inundated with patients. Facilities around town, around New York State, around the country, are inundated with patients,” Dr. Brennan said. “Clearly we need more beds.”
In addition to more beds, addiction treatment providers are hoping for funding that would allow them to offer what they term “holistic” residential programs that would allow them to hire more addiction medicine specialists, and to be able to give patients long-term aftercare including housing and job training.
In October, Trump declared the opioid crisis a national public health emergency and appointed a commission to tackle it. The commission’s report, released in early November, recommended 56 major reforms, including expanding residential treatment, cracking down on traffickers and establishing drug courts to help offenders get treatment.
All of those ideas were welcomed by treatment providers in the New York metro area. But they are still waiting for a funding commitment and a strategic plan to carry out the recommendations.
“The Trump administration declared it a public health emergency, but it hasn’t mobilized any substantial resources or fundings to create beds or finance new treatments that are desperately needed,” said Dr. Aakash Shah, an emergency room doctor at Rutgers Robert Wood Johnson Hospital in New Brunswick, N.J., where he tends to opioid overdose patients.
In the meantime, New Jersey Governor Chris Christie increased the number of available in-patient psychiatric beds in the state by around 900 beds.
“That is a 40 percent increase and a major step in the right direction,” said Dr. Shah.
A spokesperson at the U.S. Department for Health and Human Services would not comment specifically on the treatment providers’ concerns, but said the agency and the White House are reviewing the commission’s recommendations. The spokesperson also said that the proposed replacement for Obamacare includes increased funding for opioid response.
The House of Representatives passed legislation in May that allocated at least $15 billion to the crisis, a figure that advocates say falls far short of the need. The GOP bill pending in the Senate calls for three times that amount, $45 billion, an amount that some critics say is still too low.
This year, the federal government has made just a modest increase to the budget for drug treatment, from $10.6 to 10.8 billion. About half goes towards Medicaid and Medicare services. And at the same time, Trump has called in his 2018 budget proposal for $1 trillion in cuts to Medicaid and Medicare. The new tax bill is likely to increase pressure even more for Medicaid and Medicare cutbacks.
Most patients at Integrity House, including Kelly, are covered by Medicaid. “I hope they don’t cut the funding,” she said, “because I don’t know what I’m going to do if they do. I can’t afford it on my own. My family can’t afford it.”
Budsock said one key reform called for by the president’s opioid commission would repeal a 1960s law that limits use of Medicaid funds for substance abuse treatment in facilities with less than 16 beds. While federal officials have recently made it easier for states to get waivers of the law, many operators, including Budsock, support a full repeal.
Other providers caution that residential treatment shouldn’t be viewed as a total remedy. Dr. Brennan, at Mt. Sinai, said there’s no strong evidence that in-patient programs are more effective than out-patient.
“We don’t want to make a system where we’re warehousing people for 28 days at a time and spitting them out into the same problematic communities where they came from,” Dr. Brennan said. “Aftercare is the most important part when people come in to see us — what happens after discharge. The truth is, it’s really easy to keep someone sober for 28 days.”
All the treatment providers interviewed said holistic aftercare that addresses psychological and social issues, like housing and employment, on top of drug treatment is one of the most crucial needs in combating the opioid crisis. They want more funds to develop longer treatment programs with therapy, transitional housing and job training.
“The ugly truth is that it’s very rare that someone is going to enter treatment and then live their life without picking up another substance along the way,” Budsock said.
James Hollywood, head of residential treatment at Samaritan Daytop Village, one of New York City’s largest non-profit treatment organizations, said patients need longer stays to address psychological issues. Recovering addicts often have co-occurring disorders, he said, such as mental illness or trauma on top of drug abuse.
“Folks who stay engaged in residential treatment beyond 90 days tend to have better outcomes earlier on,” Hollywood said. “Severe trauma, co-occurring mental illness, homelessness, profound addictions, are continued beyond the typical 28 day cycle.”
Hollywood would said added federal funds would allow him to expand programs to include psychiatrists, nursing staff and social workers, as well as prevention centers and aftercare services. He also wants to open more recovery centers that would tackle awareness and prevention on the community level.
For patients like Ryan, a former marine combat veteran who suffers from PTSD as well as an opioid addiction, a holistic approach has been necessary for his recovery.
The 29-year-old, began experimenting with drugs in high school, but he spiraled out of control in 2013 when his father died of a massive heart attack in his kitchen while the two were snorting cocaine. He already suffered from PTSD from his four years in the Marines, but he said watching his father die was the final straw. He started taking prescription pills to numb the pain and when they got too expensive, he switched to heroin. By the time he ended up in treatment for the first time, in 2014, he’d lost his job, his apartment and his car, and had completely cleaned out his bank account.
Now he’s back in treatment for the second time at a Samaritan Daytop Village center, where he’s receiving care for his opioid addiction and getting help for his PTSD and other mental-health issues. He has access to a variety of group therapies including anger management, and sees a therapist at New York University. He said that without treatment his addiction would have ended his life.
“It wants me dead,” he said, referring to his drug craving. “It wants me dead and I’m really trying to do it right this time.”