Pubdate: Sun, 04 Oct 2015
Source: Washington Post (DC)
Copyright: 2015 The Washington Post Company
Authors: Marc Fisher and Katie Zezima, in Mays Landing, N. J.


Despite Soaring Rates of Addiction, Treatment Remains Hard to Access 
and Prohibitively Expensive

Ashley Gibbons had been holding it together, or so she told herself. 
Sure, she had sold off her electronics, stolen money from her mother 
and slept with guys who gave her money. But it wasn't as if she was 
an actual prostitute: "I didn't go and find random people. I knew 
them," she said.

She had tried heroin for the first time at 21, four years ago, and 
for a long while, it remained an occasional thing. But she needed 
more and more to get high, and, though she held onto her job, pretty 
soon everything else was falling apart.

Ashley's mother, Alicia Gibbons, tried together daughter into rehab. 
She called at least 20 places, and they either didn't have a bed 
available or didn't take her insurance.

One place said it had room - but then said Ashley wasn't using enough 
heroin to qualify. At another facility, managers accepted Ashley, but 
when she got off the bus, they denied her admission she had used 
heroin in the previous few days and this program was only for people 
who were clean.

There were so many rejections that, at one point, Alicia said she 
handed her daughter "a razor and told her to cut her arm so they 
would put her in the mental hospital because they would detox her" there.

Ashley hit bottom last year. After spending two months in jail, she 
bought four bags of heroin and shot up two. She returned, still high, 
to the three-story townhouse she shares with her mother, her mother's 
boyfriend, her four siblings and her 5-year-old daughter.

Ashley drew a bath inthe upstairs bathroom, the one with an 
inflatable puffer fish dangling fromthe ceiling and prints of 
humpback whales and fish on the walls. She climbed in and injected 
two more bags of heroin. Then she nodded off, her head slipping under 
the water.

Downstairs in the living room, where a mirrored sign reads "Hope," 
Alicia wondered why she hadn't heard her daughter leave the bathroom. 
She bounded up stairs. Jiggled the handle of the door. Locked. She 
banged on the door, called Ashley's name. Silence. Banged again, 
screamed her daughter's name. Nothing.

Alicia raced downstairs and got her boyfriend, Jose Vega, who ran up 
and broke through the bathroom lock. Ashley "was bluegray, no pulse," 
her mother said. Alicia and Vega pulled her onto the tile floor. Vega 
furiously started CPR, although he'd never learned it. "It just 
kicked in," he said. Ashley's sister called 911 while Alicia ran to 
her bedroom and pulled out her naloxone kit, a leopard-print cosmetic 
case containing three needles and a vial of the drug that reverses 
the effects of a heroin overdose. Alicia had taken a course on the 
drug while Ashley was in jail. Now, she trembled as she pushed the 
needle into the vial- and broke the needle.

The sister yelled at the 911 operator, Vega kept trying CPR, and 
Alicia attached another needle. This time, the drug flowed into the 
syringe. The mother plunged the sharp into her daughter's arm. Twice 
more, she filled the syringe and injected her daughter. Finally, 
Ashley started to convulse.

"All of a sudden, I came to and I puked up all this water," Ashley 
said. "I was so high, though. It sounds horrible, but that was, like, 
the best and the worst high I ever had in my entire life. I'll never 
feel that again unless I overdose and die and come back again."

That time, Ashley got into a rehab facility for two weeks of 
treatment and then into a halfway house, where the state paid most of 
her bill through a program for people younger than 25. But Ashley 
turned 25 while she was there and was told she had to leave, in part, 
she says, because she hadn't been following the rules. She now owes 
the facility $3,000.

"I don't have it," she said. "I make $8.75 at Shop Rite, and that's 
$150 a week. I'm an addict, not a rich bitch."

Through it all, Alicia has kept pushing to get Ashley the treatment 
she needs. A tone point, the mother got so desperate that she called 
the cops in the hope of getting her daughter arrested.

"I just wanted her away," Alicia said. "It takes getting into trouble 
to get mandated to go away. I kept pressing charges against her. 
Charges, charges, charges."

Rates of heroin addiction and fatal overdose are skyrocketing in the 
United States, and a political consensus has emerged to emphasize 
treatment over criminal prosecution. But there's little agreement on 
how to pay for more treatment, leaving addicts facing obstacles so 
daunting even a healthy person would struggle to overcome them.

Treatment centers are often prohibitively expensive, overcrowded, 
underfunded and subject to byzantine government rules. Health 
insurance coverage is stingy to nonexistent. And the social stigma of 
heroin addiction is still so potent that many users and their 
families are reluctant to seek help in the first place.

That leaves one sure route into rehab: "Treatment in the overwhelming 
majority of cases begins behind bars," said Jim McGreevey, the former 
New Jersey governor, who runs an experimental treatment program in Jersey City.

The need for more treatment is acute, said Obama administration drug 
czar Michael Botticelli, who estimates that up to 80 percent of 
heroin addicts are never treated.

"We're approaching the same mortality rate as at the height of the 
AIDS epidemic," he said. When addicts first get treated in jail, "it 
means we have missed so many opportunities."

In many states, governors have tackled the epidemic more forcefully 
with rhetoric than resources. In Maine, where the number of people 
seeking treatment for heroin addiction has tripled since 2010, Gov. 
Paul LePage (R) has called on law enforcement "to disrupt the drug 
supply and hunt down the traffickers" while he has sought to cut 
Medicaid enrollment and coverage, saying state health-care programs 
are too generous.

Vermont Gov. Peter Shumlin (D) devoted his entire State of the State 
address last year to what he called "a full-blown heroin crisis." The 
state attacked its waiting lists, leading to a 40 percent increase in 
the number of addicts getting treatment. But overdose deaths have 
continued to climb. Vermont also adopted a "good Samaritan" law 
granting immunity from prosecution to anyone who calls for help if 
they witness an overdose.

In New Jersey, Gov. Chris Christie (R) has made treatment a 
cornerstone of his presidential campaign, declaring in one TV ad that 
"we need to be pro-life for the 16-year-old drug addict who's laying 
on the floor of the county jail." But while Christie has signed bills 
aimed at improving access to prevention and treatment, "there's no 
money to increase the number of beds," said state Sen. Joe Vitale 
(D), one of the legislature's most persistent treatment advocates.

Meanwhile, private insurance companies often deny coverage for 
substance-abuse treatment, according to a recent survey by the 
National Alliance on Mental Illness. In New Jersey last year, just 10 
percent of substance-abuse admissions were covered by private health 
insurance - down from 22 percent the previous year.

President Obama's Affordable Care Act was supposed to address this 
problem: It requires insurers to treat addiction like any other 
medical condition. But the law only went into effect for many 
insurance plans in January. Botticelli acknowledged that "there's 
room for greater enforcement," adding that the administration is 
investigating complaints of declined coverage, higher co-pays and 
reimbursement limits.

The insurance companies' approach to substance abuse is "hugely 
shortsighted," Botticelli said. "There are huge economic costs to 
untreated addiction."

Heroin users who are arrested at least get free-if medically unsound- 
detox simply by being locked up. If they're lucky, they can move on 
to intensive rehabilitation and maybe a period in "sober housing," 
halfway houses designed to keep them abstinent long enough that, with 
continued therapy, it might stick.

But a blizzard of bureaucratic rules makes it hard to land in these 
facilities. Many heroin addicts sell to their friends, and federal 
law prohibits anyone convicted of drug distribution from receiving 
welfare benefits. That lifetime ban means no rent vouchers, no food 
stamps and, often, no ability to pay for treatment.

Increasingly, states are opting out of this ban. New Jersey has not, 
although Christie signed a law lifting it for inmates who agree to 
undergo drug treatment in prison.

"What was meant to be a deterrent has become a crushing, debilitating 
post-incarceration sentence," McGreevey said. "The only way we can 
alter the behavior of using and selling drugs is to, for a limited 
period, ensure that [addicts] are able to eat, have sober housing- 
and get treatment."

In a storefront in a run-down section of Jersey City, McGreevey 
attacks addiction with every tool at his disposal. His program offers 
released prisoners career training, jobplacement counseling and 
continuing therapy. It provides housing in a facility where everyone 
must be employed or in school. And its 56 volunteer lawyers persuade 
judges to convert addicts' fines into jail time, so they can leave 
detention with a clean slate.

"Basically, you have to come here from jail, but without this place, 
you'd be right back in jail," said Sean Mc Clintock, 47.

Two years ago, McClintock, the burly son of a fire chief, was caught 
shoplifting to raise money for heroin. He tried to get into a detox 
facility in New Jersey but was told that he'd have to get on a 
waiting list. A helpful nurse gave him advice on the sly: Take the 
train under the Hudson River and try one of New York City's more 
generously funded hospitals. That same night, McClintock walked into 
the emergency room at Manhattan's Bellevue Hospital and was put in a 
seven-day detox program, even though he had no insurance.

McClintock went to jail on the shoplifting charge and connected with 
McGreevey's program. It now provides him with housing and a job, as 
well as regular drug testing and counseling.

After spending most of his adult life behind bars, McClintock has 
been out and clean for nearly two years, he said - "the longest I've 
been out of jail since I was 19."

About a quarter of McGreevey's clients relapse, a relatively low 
rate, given that most addicts return to drugs and crime at least once 
after treatment. But Mc Greevey's state contract provides care for 
only 284 people; New Jersey recorded 781 heroin overdose deaths last year.

In South Jersey, Michael and Darla DeLeon's cellphones ring around 
the clock with panicked parents trying to get their children into 
treatment. The couple-he's a recovering heroin addict who spent a 
decade behind bars - travel the country teaching parents about heroin 
and obstacles to treatment.

"I can't tell you how many people we lost on waiting lists," Darla said.

Here, as inmany places with soaring overdose numbers, the most 
immediate action taken to combat heroin-related deaths has been to 
make it easier to obtain naloxone, also known by its brand name, 
Narcan. A few states have even made naloxone available without a prescription.

But the DeLeons and some other treatment advocates are wary of 
relying too heavily on naloxone. It saves lives in moments of crisis 
but does little to steer addicts away from the drug.

"I had a girl Narcaned nine times, and she died with a needle in her 
arm," Darla said.

Some states have resisted expanding access to naloxone. In Maine, 
LePage argued that being brought back to life could create "a false 
sense of security that abusers are somehow safe from overdose."

"Reviving a person from an overdose is good, but that's the beginning 
of something, not the end of something," said Robert L. Du Pont, who 
served as White House drug czar in the 1970s and was the first 
director of the National Institute on Drug Abuse.

Du Pont advocates making treatment and long-term monitoring mandatory 
for people saved by naloxone. In South Jersey, Ocean County 
Prosecutor Joseph D. Coronato is working to make that happen.

Ocean County has one of the state's highest rates of heroin 
addiction. Addicts saved by naloxone used to be in and out of the ER 
in a few hours, stabilized and ready to get high again. But under an 
innovative agreement financed with drug forfeiture funds, local 
hospitals provide emergency intervention, clearing an addict's path 
to immediate detox and rehab.

Because of health-care privacy laws, the county does not have data on 
how many overdose victims have been moved to rehab. But the county's 
rate of fatal overdoses appears to have slowed somewhat, from 101 in 
2014 to 68 in the first nine months of this year.

Sometimes, against all odds, the system works. Patrick Curatola had 
never met anyone who used heroin. He'd never been arrested. He'd 
never even taken the bus. He grew up in the suburbs. Good family. 
Money no problem.

As a teen, he smoked weed with friends. In his early 20s, he dabbled 
in tranquilizers such as Valium and Xanax. A few years later, his 
brother gave him "blues," or Roxicodone, a narcotic pain reliever 
that he took after work.

"That feeling of melting into my bed at night felt real good," said 
Curatola, now 33.

He started taking more and more pills. When his girlfriend objected, 
he found his way to a Narcotics Anonymous group and then an 
outpatient program, which accepted him even though he didn't have 
insurance. After five months in the program, Curatola said, he was 
clean for the first time in years.

It didn't last. A few weeks after the program ended, he wanted to get 
high and went to his brother, who by then had graduated to heroin.

"I'd never seen heroin in my life," Curatola said. "I was scared to 
death I was going to die." But the high others described was so 
alluring and the drug so much cheaper than anything he'd used - "$15, 
I was good for the night" - that he started sniffing.

Three months later, he overcame his fear of injections and shot up.

"The euphoria I felt within five seconds was unlike anything I ever 
felt," he said. He never sniffed again.

Within weeks, Curatola was buying heroin on the street and stealing 
from his parents-cash, their TV, their jewelry. A few months later, 
hewas pulled over in a traffic stop; police found heroin and arrested 
him. The first thing he did after leaving the police station was buy 
more heroin.

After his fourth arrest, in 2011, Curatola went through with drawal 
in a jail cell in Bergen County, N. J. The prosecutor offered to move 
his case to drug court, which would get him treatment in exchange for 
a strict regimen of drug testing and counseling. Five days after he 
agreed to the deal, he was sent to a six-month, state-funded 
outpatient program.

Then it ended. And Curatola "felt like every once in a while I 
deserved a bag of heroin."

Last year, he was arrested again. After four months in jail, he was 
sent to Integrity House, a state-funded rehab facility, where he was 
treated for addiction, anxiety and depression. Then he moved to a 
sober halfway house, where he got help finding a job as a waiter.

Now Curatola is in an outpatient program, financed with his Medicaid 
and state welfare benefits, which are paid directly to Integrity 
House. He has stayed on track, even after his brother died of a 
heroin overdose.

Curatola's story is the anomaly, McGreevey said: "Far more common is 
the anguished call I get from the parent of an 18-year-old son over 
whom the parent has no legal authority and they're trying to secure a 
bed somewhere ... and there's nothing for them."

But Curatola has been clean for nearly a year now, and he's starting 
to talk about the future.

"I still have a lot to prove," he said. His parents cut him off after 
too many lies; his father died last fall, before they could reconcile.

"I'm still dealing with the guilt of not being there the one time he 
needed me," Curatola said. "That's my inspiration now, to do right by 
my dad and make him proud."
- ---
MAP posted-by: Jay Bergstrom