The opioid epidemic is sweeping the nation, claiming more lives every year. Here’s a look at what is involved in effectively treating addiction.
"The epidemic has definitely gotten worse," says Victoria Read. "We're seeing more people die. People die really quickly from fentanyl." Fentanyl, the synthetic opioid anesthetic that's 100 times more potent than morphine, is sometimes taken deliberately and sometimes added to heroin or cocaine. The drug was responsible for half of all US drug overdoses in 2016. According to a report from the Rockefeller Institute, in New York State, the number of opioid-related deaths climbed 121 percent over a six-year period, from 1,760 in 2010 to 3,894 in 2016. In the Mid-Hudson Valley alone, at least 292 people died from opioids in 2015, according to the state health department, and that number continues to climb every year.
Fentanyl is so potent that, according to prescribing guidelines, a patient using a fentanyl patch for pain relief has to be careful not to use a heating pad with it for fear of releasing too much medication at once and causing a life-threatening condition.
The opioid crisis continues to fracture lives and families, from people prescribed pain medication who slide into addiction to the thousands who might have thought they were "partying" and find themselves self-medicating compulsively for physical or emotional pain. Opioids bring the pain with them: repeated use wears out the endorphin system, so that other pleasures fade to dull insignificance while the lure of the high stays strong.In April of 2017, Governor Cuomo allocated $200 million to addressing the epidemic, funding a mixture of heroin and opioid addiction-prevention, -treatment, and -recovery programs.
Victoria Read is on the front lines; as adult case manager with Family of Kingston, she fields phone calls and walk-in visits from addicted people on a regular basis. "Someone might come in off and on for months for other things before they're ready to address their opioid issues," she says. "We don't judge. We meet them where they are. But when the willingness to talk is there, we do something called motivational interviewing that helps them see what their choices are."
Opioid addiction usually calls for medical detoxification in an inpatient facility as a first step toward recovery. Addicted people can expect to feel horrible for about a week before they start to feel better, just quitting cold turkey with no medical supervision can be dangerous.
Addiction strikes people of all social strata; many of those Read deals with are financially strapped. To get Medicaid coverage for inpatient substance abuse treatment, the patient must be assessed at the Department of Social Services; one of the primary qualifiers is to have attempted and failed to stop using with outpatient treatment. Medicaid patients may have it easier in one respect: once a person is assessed and accepted for inpatient treatment, they'll typically be granted a six- to nine-month stay. Private insurance companies may be far more restrictive, and for many addicted to opioids, 28 days of rehab (the standard model) is just the beginning. "If you need inpatient, 28 days is probably not long enough," says Read. "But there are loads of rehabs that take private insurance, and only a few that take Medicaid patients. In Ulster County, there's only one that's inpatient, Samaritan Village in Ellenville, and two, Bridge Back and Step One, that do outpatient."
In recognition of the great need, Ulster County has created a dedicated section of its Ulsterhelps.org website where treatment options are sorted by demographics and facility types: there are resources specifically for men or women; teens or veterans; LGBTQ-friendly facilities; and those for the elderly, short-term, long-term and medically assisted. Each subset has a link to the state Office of Alcohol and Substance Abuse Services Treatment Availability Dashboard, where a customizable search will tell the user exactly where open beds exist statewide. The county also offers a page of contacts to help sort through the insurance maze.
Rehabs offer a comprehensive reset: group and individual therapies, nutrition, exercise, sober recreational options, a structured routine to make those first few weeks of sobriety bearable. Some facilities are tied to specific religious traditions, others secular. The vast majority employ some form of the 12-step recovery model. "I know there are other choices that exist, but not around here," says Read.
After rehab, some prefer a supported sober housing arrangement. There is one sober living house in Ulster County, in Saugerties; the people running it would like to add another, says Read, "but there's a lot of NIMBY sentiment around this."
Mid-crisis, the options for treatment have expanded over the past decade. But absent a decision made by the addicted person, the best rehab in the world might as well not exist.
"A great many of the people we see are self-medicating their trauma," says Read. "To stop, they have to decide to deal with all the stuff that put them there, and it's really big. We just try to be a safe place where they aren't judged, and I think we achieve that."
For more information on treatment for opioid abuse or addiction: Oasas.ny.gov.
Naloxone is a prescription drug that can prevent death from an opioid overdose. The Naloxone Co-payment Assistance Program (N-CAP) can cover up to $40 in prescription co-payments to reduce or eliminate out-of-pocket expenses.