How To Get Off Heroin: An inadequate addiction treatment system takes on an epidemic

So, you want to get off heroin; now what?

      If it’s an emergency, go to the hospital.  

         If you’re lucid, get to a detox center.

If you’re Section 35 court ordered to get clean, the state will place you in a bed put aside specifically for Section 35ers.

After a couple of days, check out of detox and head to a stabilization center, a place where recovery can continue for the next couple of weeks, either with or without medical assistance.

Next up it’s going to be either outpatient services, attending meetings for things like Narcotics Anonymous, or moving into a sober living environment and attending meetings. Either way, you’ve got to develop a plan to overcome addiction and put it into action now.

Have a network of people who can support you and your decision to stay clean.

Relapse.

Repeat.

Repeat.

Repeat.

Repeat.

In an ideal situation, this is how substance abuse recovery would work for the estimated 3,333 Massachusetts residents who seek opioid addiction treatment each month, give or take a few “repeats.” And yes, relapse is an anticipated part of treating this disease, just like any other. Heroin addiction relapse rates, as in how often symptoms occur, are similar to those for other chronic medical illnesses such as diabetes, hypertension, and asthma, according to a 2000 research paper published in the Journal of the American Medical Association, “Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation.”

But so very often, this is not how getting off drugs works. There are obstacles in the way of the rehab process and they start right when a person decides to get clean. Massachusetts doesn’t have the medical infrastructure and treatment beds available to overcome the opioid addiction epidemic — and it’s likely going to be a long time before it does. In September, the most recent information available, there were an estimated 176 opioid-related deaths in Massachusetts, according to state data.

Wait times to gain admission to one of the 24 detox programs at a center or hospital in Massachusetts — often the first stop on the road to getting clean — can exceed hours or days. Afterward, only 17 percent of those discharged from detox will make it to the next step and find a clinical or transitional rehab bed for the next several weeks, according to the Center for Health Information and Analysis. Those who are admitted can wait up to 10 weeks for entry.

“The challenges are, say they come into detox [at the Carlson Center] or at Providence or whatever and there are no beds at the [stabilization] level — there aren’t a lot of beds there,” said Susan O’Connor, director of the Carlson Recovery Center in Springfield for Behavioral Health Network. “That’s where sometimes, the system can get clogged.”

O’Connor said she’s aware of people who have waited six months to get into long term residential sober living programs.

“The issue is, the further down the line of the continuum of care, there may not be beds.”

Scott Bousquet, 57, resident manager of Bridge Home in Springfield, Wednesday, Jan. 4, 2017.

When treating a disease, gaps in health care can mean life and death.

“Thirty days is nothing. That’s not enough time to battle addiction,” said Scott Bousquet, a resident manager at The Bridge Home sober-living program in Springfield. Bousquet, 57, doesn’t just work with people seeking substance abuse treatment, he’s a recovering addict as well.

Getting off drugs “really is a very difficult war and you’ve got to lose lots of battles to win the war,” he said.

And too many people lose the war. Bousquet, who is also a counselor at Cole’s Place, a sober home with the capacity to house 40 men in Springfield, attended memorial services for three former clients in December, 2016.

“We’re all asking ourselves, what were we missing? When they left the house, had we done our jobs?”

One man, said Bousquet, had only 10 percent of his liver functioning when he left. “He drank himself to death,” Bousquet said. “I think he gave up.”

Another man left Cole’s found a job and seemed to have a good network of supportive people waiting for him when he left after 90 days of treatment. “Ninety days is nothing,” said Bousquet.

The third man overdosed.

Bousquet said to make sobriety stick, addicts have to embrace a recovery program that suits them, even if it is difficult to find.

“I’ve been to detox a bunch of times, I’ve done this and I’m still doing recovery,” he said. “Addicts have to give up on this idea that you could do it yourself. You do need care to have recovery.”

State money funds much of the treatment for addiction — the state and insurers pay for detox as well as stabilization, and insurers pay for outpatient services, beyond that it’s out of pocket for care — and the state certifies where additional treatment beds can be added. Massachusetts also recently got involved in certifying good sober living environments that seek the recognition.

For the recovery system to grow, politicians need to be convinced that helping addicts is a worthy use of taxpayer money. And stigma against addicts is present.

While Gov. Charlie Baker and many state politicians have vowed to tackle the state’s opioid crisis, more than 25 percent of Americans surveyed by the Pew Research Center in 2014 said the government should focus more on prosecuting drug users.

In 2016, Massachusetts added more than 60 new recovery beds to the system. About half of those were placed in Greenfield. This fiscal year, even with a mid-year cut to funding, substance abuse treatment in Massachusetts got a $15 million bump over the state’s last operating budget.

It’s a start, but it’s not enough. Between 2000 and 2012, fatal opioid overdoses in Massachusetts increased by 90 percent — from 355 deaths to an estimated 1,747 deaths — and are projected to have increased another 46 percent between 2012 and 2013, according to Baker’s office.

Massachusetts needs more rehab beds, say mental health care professionals — particularly after the first 30 days of long-term recovery, when it’s sink-or-swim at a time when many addicts are still figuring out how to stay afloat.

“You get this situation where you’ve got people saying ‘Hey, I’ve got to be somewhere, I’m desperate,’ and there’s no where; the system is backed up,” said Jay Sacchetti, vice president of shelter and housing at Servicenet.

It’s not hard to see why so many addicts fall through the system’s cracks when the number of treatment beds are considered. At each step of recovery, the availability of services shrinks.

In Massachusetts there are 900 detox beds; 297 medical stabilization beds and 331 transitional service beds; and 1,700 state-approved sober-living beds.

SOURCE: CHIA

Meanwhile, in 2013, the most recent information available, more than 101,000 residents sought treatment for addiction that year — 40,000 of them enrolled in acute detox treatment programs. And 10 percent of the state population — more than 1 million Massachusetts residents — meets the criteria for having a substance abuse disorder, according to Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health.

“We know that many people need a longer length to get physically and emotionally better. We also know that inpatient without recovery support afterwards will not be enough,” said Maryanne Frangules, executive director of Massachusetts Organization for Addiction Recovery.

“We need a seamless continuum of care honoring all pathways to recovery and nurture all who struggle along the way to help keep them alive.”

Because detox stints are short — usually between one and three days — the number of detox beds in Massachusetts is large enough to serve 3,500 people per month, according to the state-funded November report “Access to Substance Use Disorder Treatment in Massachusetts” by the Center for Health Information Analysis, an independent government agency.

Still, many addicts seeking treatment will have to wait for a bed to open up before they can check into a center or hospital. The daily occupancy rates at these centers are between 91 and 100 percent, according to the Center for Health Information Analysis’ report. Every month, detox beds in the state discharge more than 3,400 people. For addicts, this means calling local detox centers over and over again until someone answers and says there’s a bed available if you hurry down or going to one of the area’s few walk-in detox centers — The Franklin Recovery Center in Greenfield or The Carlson Recovery Center in Springfield.

“With the ebb and flow of people leaving, there’s always movement with our beds,” said O’Connor. “At Carlson we’ve been doing walk-ins for four or five years, it really works well. … Sometimes we have beds, it’s first come, first served, but we try to make it as accessible as possible for someone when they’ve had the thought.”

O’Connor said The Carlson serves people waiting for services lunch and dinner so they won’t have to venture out on the streets for food and possibly not return for treatment.

“We try to make people as comfortable as we can to help them until a bed opens up.”

Rehab gets a lot harder to continue after those first few days of detox because treatment resources become more scarce — and expensive. Typically, commercial health insurance plans have cost-sharing ranging from $69 to $500 for 24-hour care. But fewer insurers cover treatment after detox, which not everyone needs. If a recovering addict does need stabilization services, he or she will need to find a bed in one of the state’s 11 medical stabilization service providers or nine transitional programs that don’t provide intense medical care.

This critical time in the recovery process — fresh out of detox — is a terrible time for an interruption in treatment, but that’s what happens for many people. Only 17 percent of the people who are discharged from detox will be able to find a clinical or transitional rehab bed, according to the Center for Health Information and Analysis. People can wait up to 10 weeks to be admitted.

Stabilization centers have the capacity to treat 931 people per month — far fewer than the 3,500 people a month the detox beds can handle. There are also two programs just for Section 35 addicts. People typically stay in these programs for about two weeks to a month.

This winter, Greenfield added 32 more clinical stabilization beds, and addiction specialists around the area are already noticing a difference.

“There are more options for people to stay in a structured setting now,” said Stacchi, who added, people in recovery would often ask to enter Servicenet’s two long term sober living homes when really what they needed were stabilization beds.

“We’d get calls from detox from people who want to come to us in seven days because they’re not ready to be on their own and there’s nowhere else for them to go, but they’re not ready yet for our program,” he said. “That gap in the system, that shortage in beds in clinical support got people backed up and we’d get referrals of people who are not ready for this setting. Now, we’re seeing people are more prepared, they’re more ready to be in recovery homes.”

If an addict wants full-time sober living after getting stable, he or she will need to find a sober home. Last year, Massachusetts began certifying quality sober homes on a voluntary basis and providing a list of approved places at mashsoberhousing.org.

“Until you go there, you couldn’t learn whether a place was good,” Bousquet said of finding a sober home before the state certification system. “You’d go into a home and they’d be letting people get away with using and the manager would reach into his pocket and two packets of dope would fall on the floor.”

If a sober home or halfway house isn’t what a recovering addict has in mind, she or he might opt to try sobriety with the help of medicine such as methadone or Buprenorphine, attending 12-step meetings, and/or seeking other outpatient services like talk therapy. Outpatient services can cost a person an average of $16-$31 per visit. And some insurance plans require $20-$30 per visit to pick up the addiction-treating drug methadone.

In the state there are 95 long-term residential programs — 79 of them are for adults, eight are for families, eight are for adolescents and children. People live in sober housing for varying lengths, anywhere from a month to a year. The system can serve about 600 people per month.

With about 900 people graduating from clinical or stabilization services every month, a third of addicts won’t get placed. People waited an average of 19 days between initial contact with a residential program and admission.

Bill Cosgriff (center), co-founder of The Bridge Home sober living environment in Springfield, has dinner with friends and Scott Bousquet, (right) a resident manager for the home.

The Bridge Home, where Bousquet is a resident manager, was established in the fall of 2016 to help fill this gap, said Bill Cosgriff, a Bridge Home cofounder, and provide more long term living opportunities for people looking to live sober.

“We know it takes people in substance recovery a year or two for the neurotransmitters to return to semi-normal and half the people who go into opioid treatment don’t finish the program,” Cosgriff said.

The home can serve eight people and it costs between $800 and $850 a month to live in the updated historical home which still has its original carved wood details, tile mosaics, and stained glass windows. In addition to providing a good living environment, The Bridge Home seeks to hook residents up with mental health experts, job skill education, and sobriety coaches. Cosgriff said addicts need this kind of extra help getting their lives together because of how the disease has been criminalized through the War on Drugs.

“The prison population has increased five-fold in the last 30 years with this war on drugs,” Cosgriff said. “Once you have a record it’s hard to find quality employment.”

Whether there is a gap in outpatient rehab service providers is hard to tell. Anecdotally, a survey by the New England Comparative Effectiveness Public Advisory Council, which includes state Medicaid agencies as well as insurers and providers, found that its members feel “there are not enough counselors to serve every patient with addiction” and further that many people practicing are “not specifically trained in addiction.” Most people can find a therapist or counselor within 48 hours of discharge, but 11 percent of people seeking outpatient treatment wait up to a week for their first appointment, Center for Health Information and Analysis states.

Detox in Western Mass

* Carlson Recovery Center-BHN

471 Chestnut St., Springfield

(413) 733-1431 or (413) 733-1423

*McGee Unit of Berkshire Medical Center

725 North St., Pittsfield

(413) 442-1400 or (800) 493-0183

*Providence Detox

1233 Main St., Holyoke

(800) 274-7724 or (413) 539-2981 or (413) 536-6032

*The Franklin Recovery Center

298 Federal St. (Route 5), Greenfield

(413) 737-2439 or (413) 733-1423

*Motivating Youth Recovery Community Healthlink, Inc.

12 Queen St., 5th floor, Worcester

(508) 860-1244

As abysmal as these wait times are, if you’re a woman they’re even worse. Nearly all rehab programs, outside of detox, are gender-specific. In Western Mass, there are three service providers solely for women: one long term living environment in Greenfield, short term care in Springfield, and detox in Pittsfield. Unlike the rest of recovery, detox beds are usually co-ed.

Massachusetts is responding to the crisis. In March, 2016, Massachusetts Gov. Baker signed landmark legislation to fight the opioid epidemic. The new law set limits on opioid prescriptions, create a prescription monitoring program, verbal substance abuse screenings in schools, and strengthens access to bed-finder tools for insurance providers. And in the coming year funding to support study and tracking of opioid use and efforts to quash addiction will be maintained, additional funding will be given to combat drug trafficking, and 45 beds for civilly-committed women with substance use disorders will be added to the state.

Based on national estimates, only about 11 percent of addicts will receive treatment for the disease. Of those who don’t seek treatment, 95 percent say they don’t need it, the SAMHSA study states, while 2 percent say they are unable to access services. For the brave few who do attempt to get treatment for their disease, services should be at the ready.

Contact Kristin Palpini at editor@valleyadvocate.com.