- Posted June 5, 2014 by
Kings Park, New York
Suburban Heroin: As the heroin epidemic rises, the access to rehabs declines.
Long Island, NY - via www.suburbanheroin.com
Heroin has taken up residency in suburban Long Island. The number of heroin users and heroin-related deaths has been steadily rising over the past few years. And the most rapid growth is among those under age 21. This has been reported over and over. But with the increase in heroin abuse, the already limited access to treatment is getting worse.
Abuse of prescription painkillers such as Vicodin, Roxicodone and OxyContin, has increased 33 percent in five years, according to the National Institute on Drug Abuse. A study by Drs. Robert Heimer and Lauretta Grau of Yale University found abuse of prescription opioids does lead to heroin use within one year. In August 2013, New York implemented iStop, a state law that monitors prescription medications to curb opioid abuse and “doctor shopping,” which is when a patient goes to multiple doctors to get more prescription drugs than recommended for normal use. Now prescription drugs have become difficult to obtain and expensive on the street. And the consequence has been that users turned to a stronger, more available and cheaper alternative: heroin.
Overdoses from opioids, which include heroin and some prescription painkillers, killed more than 2,000 New Yorkers in 2011, according to the Centers for Disease Control. That’s double the number who died in 2004. Long Island hit record numbers with 242 reported heroin-related deaths in 2012 and 2013. And the Island has seen a steady increase in heroin-related arrests for last two years.
These local increases reflect national trends.
Seizures of heroin increased more than 50 percent from 2008 to 2012, according to the Drug Enforcement Administration. Fatal heroin-related overdoses increased about 75 percent between 2007 and 2011, according to the Substance Abuse and Mental Health Services Administration. And the number of heroin users has nearly doubled, according to Centers for Disease Control. That’s hundreds of thousands more users nationwide.
Four out of five new heroin users said their addictions started from prescription pain medication, according to the Substance Abuse and Mental Health Services Administration, a federal agency. Users like Keith Wilson know what this addiction is like firsthand. Wilson said there are only three outcomes to falling down the rabbit hole of heroin use: addiction, recovery or death.
Wilson, 26, is from the upper-middle-class community of Setauket on the North Shore of Long Island. He began taking Vicodin when he was barely a teen. He was 14. He said he continued to use Vicodin and OxyContin on and off until he was 19 when, he said, he was tricked into doing heroin.Wilson, 26, is from the upper-middle-class community of Setauket on the North Shore of Long Island. He began taking Vicodin when he was barely a teen. He was 14. He said he continued to use Vicodin and OxyContin on and off until he was 19 when, he said, he was tricked into doing heroin.
“This kid who was selling a lot of drugs in this area started selling heroin but told his buyers that it was crushed-up OxyContin,” he said. “So people were getting addicted to [heroin] and didn’t even know they were doing it.”
“I was getting the same type of high [as pain pills], if not stronger, with heroin, and was paying a third of the price,” he said in a soft voice while smoking cigarettes in his bedroom at his aunt’s house. His aunt doesn’t know of his addiction.
At the worst points during his five years of heroin use, Wilson said, he was shooting a full gram of heroin in a day—15 bags at $5 per bag.
He soon found himself chasing the euphoric high from heroin so often that his budget could not keep up. “I would do crazy schemes just to get money that I can’t believe I did,” he said. He and his friends would walk the parking lots of big-box stores like Walmart looking for receipts. If he found a receipt with a high value, he would go into the store, match the items from off of the shelf with the items on the receipt, head to customer service and return the items for cash.
Wilson said he hit his rock bottom about a year ago when he stopped using and went into withdrawal. “I locked myself in my room and played Xbox for a week straight,” he said. He had no health insurance and assumed he wouldn’t be admitted to rehab.
Wilson said he has been off heroin for a year now but admits he has slipped up. “I don’t think I need rehab,” he said over the hip-hop music that played from his laptop. “I don’t agree with the N.A. or A.A. [Narcotics Anonymous and Alcoholics Anonymous] slogan ‘Once an addict, always an addict.’”
Wilson’s friend Rob, 27, is also a recovering heroin addict. The two men used to use heroin together. Wilson said they had saved each other from overdoses several times.
Unlike Wilson, Rob, who asked to be identified only by his first name, chose to go to rehab. “I thought if I didn’t, I was going to die,” he said, and he realized he wanted to accomplish something with his life. “No matter of how I looked at my future, all I could see was homelessness, or death, or jail time, and I couldn’t deal with it any more, and I knew I had to do something.”
He now works in a research laboratory, but this came after he spent a year at the Russell E. Blaisdell Addiction Center, an inpatient facility in Orangeburg, a town in Rockland County about 25 miles north of Manhattan. He decided to go to this center because it is state financed and he was paying with Medicaid.
Although he said he firmly believes in the slogan about addicts that Wilson rejects, he nevertheless thinks the rehab programs and 12-step programs are outdated and geared for an older generation. Alcoholics Anonymous and Narcotics Anonymous meetings are “full of older men who have lost their families, homes and everything,” he said. “That’s not us. We were kids who liked to party and got addicted to some strong stuff.” But he goes to meetings anyway.
Addiction is a cycle of denial, decline, recovery and relapse. Of those addicts in treatment, the vast majority will quit their programs or relapse within a year, studies show.
But before that can happen, addicts have to get into a program in the first place. And that has become harder than ever.
On Long Island, there’s a lack of bed capacity. Several substance abuse rehabilitation centers have closed in recent years. Hospitals have reduced the number of detoxification beds—Nassau County University Medical Center eliminated all 20 of its detox beds, and just 30 inpatient rehab remain.
Even Superstorm Sandy has played a role. Long Beach Medical Center had the largest number of rehab beds, 205, in Nassau County. The storm destroyed the hospital, and it will not be reopening.
That leaves only the 30 beds at the county medical center for addicts seeking inpatient care in Nassau. In 2013, 38 people died a heroin-related death in this county alone.
The county hospital updated its policy for addicts in 2013 and no longer takes walk-ins. Its policy requires addicts to call ahead for appointments unless the addict is actively detoxing.
Other obstacles block those who want to quit, even when they have health insurance coverage for treatment.
Many insurance companies’ policies require that an opioid addict have a mental illness or another addiction to be covered. And without the insurance company behind them, patients face paying steep out-of-pocket costs. On Long Island, the typical heroin abuser is from a middle-class, suburban family that is too wealthy to qualify for state or federal subsides and too poor to pay up front.
Clare Krusing is the director of communications for America’s Health Insurance Plans. She said health plans base their coverage decisions “on the safety and effectiveness of treatments for the individual patient and the specific condition.”
Experts say the quest for coverage can be problematic right from step one in the cycle: detox.
Dr. Jeffrey Reynolds, executive director of the Long Island Council on Alcoholism and Drug Dependence, said withdrawal from heroin—even if used intravenously—is not deadly. Unlike withdrawal from alcohol or benzodiazepines—Xanax, Klonopin or Valium—opioid withdrawal does not cause death.
Some recovering addicts said their withdrawals were so uncomfortable they felt like they were going to die—or certainly wished they would. They compared it to having the flu and the worse hangover you’ve ever had, times 20. Not fun.
Withdrawal from long-term alcohol or benzodiazepine abuse is deadly because both addictions alter brain functions, and halting usage can cause potentially fatal seizures and cardiovascular collapse.
Because it is not medically necessary to be under medical supervision during heroin detox, many insurance policies cover detoxification “when reasonable and necessary.” The insurers decide case by case whether to pay.
But without detoxing, addicts can’t get into rehab. The user needs to be completely free of the drug before starting treatment. So, many addicts attempt withdrawal at home, like Wilson, and if they are successful—if they didn’t break and go pick up a bag, or commit suicide—they can begin a treatment program.
The next hurdle is getting coverage for rehabilitation. The coverage policies for some large health insurance companies, including Anthem, Cigna and United Healthcare, state that the patient must show a history of substance abuse. This often translates to a requirement that addicts seeking inpatient care need to have tried—and failed—at outpatient treatment.
“Without effective recovery programs, the likelihood of relapses are high,” said Anthony Rizzuto, an executive at Seafield Center, an alcohol and substance abuse treatment center in Westhampton Beach. He said if the access to effective treatment were smoother, the heroin epidemic would decrease.
“As far as I’m concerned, the system is broken,” Rizzuto said. “I don’t know if you can fathom that if somebody that you loved and cared about was getting high, and you, as a parent, have insurance and have the benefit …” that coverage might not be forthcoming.
The Affordable Care Act rules that insurance must cover the costs for mental illness and substance abuse treatments in the same way that it covers physical health care, which is great on paper. (However, the implementation of this part of the bill has been delayed for two years.) But Reynolds said that it does not fix the problem of bed capacity.
In addition to the 30 beds left in Nassau County, there are about 300 detox and inpatient beds in Suffolk. But each has waitlists—some for weeks. “At a time when we should be expanding, we are decreasing services,” he said.
Ian, 26, is from the middle-class town of Holtsville in central Long Island. He confronted a series of obstacles in trying to end his heroin addiction six years ago. He asked to be identified by his first name only.
Ian’s addiction started after he got hooked on Vicodin and OxyContin while attending Sachem High School North. Eventually, he was snorting heroin for a year and half. And then it took him three stints in rehab to finally get sober.
His first stint in rehab was at South Oaks Hospital, in Amityville, in 2007 when he was 19. He was there for five days of detox. He relapsed. A year later, he went to the Long Island Center for Recovery, in Hampton Bays, for a 20-week outpatient program.
Outpatient treatment allows patients to stay at home, but they must visit a rehab program one to three times a week for therapy sessions and for refills of prescription medication, if need be. Ian visited once a week and received Suboxone, a brand name for the controversial combination of the drugs buprenorphine and naloxone that was created for opioid dependence.
The buprenorphine is used to deal with the chronic pain many opioid users complain of, and the naloxone is an opiate blocker. If a patient is using Suboxone as prescribed and relapses with heroin, the opioid high would be blocked and the user would be sent immediately into withdrawal. Many critics—like Ian—say Suboxone is a replacement drug. Others, like Rob, attribute their sobriety to it.
Rob said he has been clean for a year. He attends a medication-assisted outpatient program in Setauket where he receives Suboxone. His said his health insurance does not cover his Suboxone treatment, and he pays “anywhere between $250 to $400” out of pocket for his biweekly visits.
“There’s a constant worry that I will not have the money to continue getting Suboxone and will fall back into that lifestyle,” he said.
Ian said the Suboxone and outpatient-type of program did not work for him. He relapsed almost immediately. He said that he used the Suboxone only on the days he couldn’t find heroin on the streets or would sell it to get cash to score dope.
Shortly after his second relapse, his parents decided to dip into their savings and front the $10,000 for an inpatient treatment program rather than follow their insurance company’s policies. Ian said that even when he had the cash, it was still difficult to get admitted.
“I remember it took me three days of calling all the rehabs I could think of on Long Island real early in the morning and hoping they would have an open bed for me,” he said. “So I had the willingness to give up dope, get sober and the money to pay for rehab, and I was still stuck.” He eventually was admitted into the Long Island Center for Recovery residence program for 28 days.
Now, six years later, Ian is sober. He is married and has two young children. He works the night shift as an electrician and attends weekly meetings to maintain his sobriety.
Other addicts have been less successful.
Linda Ventura of Kings Park lost her son Tom in 2012 after he spent a month at St. Christopher’s Inn, an inpatient rehab center in Garrison, 50 miles north of Manhattan. It was his fourth time in rehab during his six-year, 80-bag-a-day heroin addiction. Previously he had tried programs at four Long Island facilities—Nassau County University Medical Center, Long Beach Medical Center, South Oaks Hospital and Seafield Center—for various short periods. Ventura said she became frustrated with her insurance company, which, she said, claimed Tom was “not high enough” to be covered for the long-term intensive treatment medical professionals said he required.
As a last hope, St. Christopher’s Inn offered to give Tom a scholarship for the $12,000 cost of a 23-day stay. He came home sober, planning to enroll in college and move into a halfway house the next morning. He was safe in the home that he grew up in, or so Ventura thought. That same night, Tom relapsed, overdosed and died. He was 22.
Susan Roethel, 56, from the upper-middle-class town of Huntington, lost her daughter, Megan, to a heroin overdose in May 2012. Megan was 22 and in her third treatment program of her year-long heroin addiction. Previously, she was addicted to prescription pain pills.
“She had meetings early on Saturday morning,” Roethel said. “I spoke to her the night before and she told me she was planning on going. But she never woke up.”
Megan was a star athlete and an A student who had planned on attending an Ivy League college before addiction took over her life. After a stint at an inpatient rehab, Megan moved into a sober home.
“It was a hell hole,” her mother said. "I should have brought her home."
Megan told her mother that drug dealers lived in the sober home, which Roethel said may have threatened Megan’s sobriety and led to her relapse.
Sober houses in New York are unregulated. Many are privately owned, and the landlords are not involved in the recovery process. Anyone can open a sober house, also known as a halfway house, tomorrow and collect recovering addicts’ social services checks. Reynolds said out of the dozens of sober houses on Long Island, he could count on one hand the wholesome ones.
Roethel said the substance abuse programs on Long Island are ineffective. After Megan’s death, she took the matter into her own hands and created a drug awareness group called The Fallen on Long Island. Its goal is to bring attention to the continuous scourge of drug addiction and the often-deadly overdoses here.
Heroin may have taken up residence on Long Island. And the effects on its residents have been harsh. This isn’t the first time Long Island has had a drug epidemic, but without effective, accessible treatment programs, heroin may make suburbia its permanent home.