Approaches to addiction treatment evolve
BY TYLER STOCKS, WILLIAM F. WEST AND JON HAWLEY
Adams Publishing Group
Sunday, May 12, 2019
Michael Carden was a recovering heroin addict who went through detox, got on a methadone program and became a social worker with the goal of helping other addicts.
In the early 2000s, he worked for a syringe exchange program in New York City, where he and his staff offered addicts medication, food, shelter, clean needles and whatever else they needed until they were ready for treatment.
Sometimes, even after treatment, they relapse. That happened to Carden several times, and in 2012 he died of an overdose at the age of 40.
After his death, his mother, Diannee Carden-Glenn, began working with the N.C. Harm Reduction Coalition, a grassroots effort to help people impacted by drug use and other problems. In 2017, when syringe exchange programs were legalized in North Carolina, she self-funded and started ekiM for Change.
The Greenville-based outreach provides clean hypodermic needles to help addicts avoid disease like hepatitis and AIDS, as well as other services in hopes of opening doors to recovery. The services are free. She wanted to help others like Carden did because most of the addicts Carden encountered had limited means.
“During the years between when he started using and his death, there were often relapses,” Carden-Glenn said. “During those times, because he was an older person, I had more years to understand the disease and how hard it is to maintain abstinence, no matter what kind of support you have, how hard you work at it, what the triggers are, those kinds of things. Michael and I talked a lot about the disease, and I also used to go to New York with him and work in syringe exchange programs up there and got to know the people that he worked with and learned to love them just like he did.”
An ongoing epidemic that has snagged thousands in North Carolina and more across the country in the trap of opioid addiction has stretched already limited resources to help people hooked on the drugs — addictions that started most often through the use of legal prescription painkillers.
Outside of help from nonprofit and grassroots efforts that have sprung up as a result of the crisis, advocates said getting treated for opioid addiction usually comes down to two things they don’t often have: money and insurance.
“There aren’t a lot of options ... If you don’t have insurance and you don’t have a decent job, you can’t afford to go to treatment,” Carden-Glenn said.
Indigent users who need a 30-day detox program may face long waits for admittance into a facility like the Walter B. Jones Alcohol and Drug Abuse Treatment Center in Greenville, one of only three state-run programs. Several outpatient programs provide treatment and counseling regimens to addicts who qualify for Medicaid — PORT Health treats patients throughout eastern North Carolina — but that’s no help to people in the coverage gap, those who don’t qualify Medicaid but are too poor to afford private insurance.
Many North Carolinians face barriers to treatment, said Dr. Susan Kansagra, section chief of Chronic Disease and Injury for the state Division of Public Health, although the state is working to address them.
The Department of Health and Human Services in 2017 received more than $35 million in federal funding to support a variety of programs through Local Management Entities like Trillium Health.
“The funding has supported over 10,000 individuals in the last two years in getting access to treatment throughout our state,” Kansagra said.
The department is working to build prevention programs that steer people away from opioid use in the first place and establish avenues to refer people to treatment. One effort works through hospital emergency departments, which see a lot of uninsured opioid addicts.
“Fifty percent of the people who come into the ED for opioid overdoses are uninsured,” Kansagra said. “One of our largest priorities is making sure individuals have access to treatment and recovery resources. The priority we have is making sure we close the insurance gap so more people have access to health insurance so they can go to treatment.”
Bills to expand Medicaid to more than 500,000 North Carolinians have largely stalled in the General Assembly. Gov. Roy Cooper, Kansagra’s boss, has threatened to veto the state budget unless some form of expansion is included.
DHHS is working with hospital emergency departments and emergency medical service agencies on post overdose response and how to follow up with families, she said. “Once somebody has an overdose, we’re actually connecting them to treatment and recovery resources.”
First responders across eastern North Carolina are trained and equipped to administer naloxone, a fast-acting and lifesaving medication that reverses — or at least interrupts — opioid overdoses. The drug, which has a brand name of Narcan, is so effective that addicts quickly regain consciousness and sometimes refuse hospitalization.
Olivia Doherty, coordinator for community paramedicine with Elizabeth City Pasquotank-Camden Emergency Medical Services, said hospitalization is becoming increasingly important because some illicit opioids have become so strong that naloxone may not work.
She said the agency's paramedics encourage overdose victims to seek hospitalization and longer-term help. Her agency also is partnering with neighboring Perquimans County to form a post overdose response team. Getting an addict to admit they need help — even after near-death from an overdose — is extremely difficult, however.
The region has significant gaps in care and rehabilitation for addicts, officials said. One of the biggest simply is a lack of awareness. Helpful services are available, but people don't know what they are or which services to start with.
One such service, Nash County’s HOPE Initiative, gained national attention when the police chief in Nashville started it in February 2016. Its purpose is to help people with any substance use disorder find treatment and a pathway to recovery without fear of arrest by law enforcement.
Board president Shelly Gray came aboard in February 2018 after she lost her son, Tate Faulkner, 23, to an overdose of heroin and Xanax. Volunteers man a mobile phone and talk to callers about the recovery process and determine if they are a candidate for detox. The initiative has relationships with programs that can aid with long-term treatment.
It has received assistance from the town of Nashville, the city of Rocky Mount and Nash County. The Nash County Recovery Alliance Center in Rocky Mount provides resources as well, Gray said.
Right now, the HOPE initiative needs volunteers, she said.
“It's an awesome experience to help people,” she added.
Opioid abuse has powerful, even permanent, effects on the brain, said Lisa Creef, a licensed clinical social worker and counselor in Elizabeth City. It takes months and years to heal the damage to the body and mind, personal relationships and professional life.
“Our area is so far behind” in recovery services, Creef said. “We need sober living (facilities) here.”
She said the region has a few detox and short-term rehabilitation centers, but some have long wait times while others may be extremely expensive. Residents may have to travel hours for long-term care. Trillium had plans to build a facility in Greenville, but funding and momentum waned.
Going to a detox center is an arduous, roughly month-long process, but it's only one step on the road to recovery, Creef said. Sober living facilities provide a supervised, structured place for opioid survivors to live while they heal and work.
The Elizabeth City Treatment Center administers methadone and other medically-assisted treatments. The center's program director, Melissa Smith, said it opened in 2017 because CEO Chris Fontana wanted to bring treatment close to home.
The clinic has seen hundreds of patients come through its doors already, and about 205 are enrolled today, Smith said. There's still so much regional need that Fontana is working to open centers about in Ahoskie and Williamston.
Smith said the center administers medication to patients over a period of approximately 18 months, helping wean them off addiction. That's only part of the answer, though.
Medication only helps “quiet” the cravings, but underlying drivers of addiction are still there, Smith explained. The center refers people to counseling services and 12-step programs, and tries to assist them in other ways, such as clothing drives to help them look sharp for job interviews, she said.
Smith also said that recovery is in some ways a lifelong process. The saying, “once an addict, always an addict” has unfortunate truth to it, she said.
State Rep. Greg Murphy, a Greenville physician who has introduced multiple pieces of legislation to help tackle the opioid epidemic, said addiction is a disease that changes the chemistry of the brain just like diabetes changes the chemistry of the pancreas.
“These are good people,” Murphy said. “They’re just caught up with a disease and an overwhelming and all-encompassing disease. And what we’re trying to do is get them back to be functional members of society, tax-paying members, get them back with their families, reunite families, businesses, churches, everything.”
Murphy’s STOP Act in 2017 established strict controls on opioid prescriptions. It also was designed to invest in local treatment and recovery services. State lawmakers have been slow to budget the $20 million appropriated by the STOP Act, however. Murphy said last week $10 million had been included in the upcoming biennial budget.
Carden-Glenn said many addicts simply can’t afford treatment without assistance. Her syringe exchange program is helping more than 230 people, she said. It is reaching them by offering a compassionate, non-judgmental service.
“People who are using opiates or any other substances can come to the syringe exchange program where there’s no stigma, there’s no blame, no anything. ... They begin to talk about where they’re at in their life, how they got where they’re at.”
That’s how the healing starts, she said.
“I think a lot of the continued opiate use is because there is no place — there’s no safe place for people who are using opiates to go and say ‘please help me’ that doesn’t cost money.”