by Chuck Hoven
(Plain Press, September 2016) This year the rate at which Cuyahoga County residents are dying from overdoses of heroin and fentanyl has increased to more than a person per day. The dramatic rise in the deaths of individuals addicted to opiates and heroin is a cause of alarm. Addicted individuals, their family members and friends are often at a loss as to how to seek help to change an addicted individual’s life and help them avoid becoming the victim of an overdose.
The Alcohol Drug Addiction and Mental Health Service (ADAMHS) Board of Cuyahoga County, which helps to fund many of the detoxification and drug treatment programs in Cuyahoga County, is an excellent resource for those seeking help. Calling their 24-hour hotline at 216-623-6888 or visiting their website atwww.adamhscc.org is a good way to start the process of getting help. The ADAMHS Board provides funds to allow programs to serve individuals not covered by Medicaid or insurance who could not otherwise afford treatment.
William Denihan, Chief Executive Officer of the Alcohol Drug Addiction and Mental Health Services Board of Cuyahoga County (ADAMHS) helps explain how many people become addicted after being prescribed opiates by a doctor for pain management. He offers a scenario where a 35-year-old mechanic breaks his wrist at work. His doctor prescribes the opioid pain medication, OxyContin. The prescription includes 50 pills to go home with. While taking those prescribed pain pills, Denihan says the mechanic goes from liking the glow he feels from taking the pills, to wanting the glow, to needing the glow.
Once addicted, keeping up the habit can be very expensive, said Denihan. Often, addicted individuals turn to heroin as an alternative. He says heroin dealers have found a way to make the drug into pills or capsules that can be sold for $5 or $10. Those using the drug can then grind it into a powder for snorting or injecting.
Denihan says a person that becomes addicted to prescription medicine may be staying home and not working because they can’t work. To get more prescription drugs, some individuals pretend they are in the market to buy a home and visit house sales to steal prescription pain drugs from peoples’ medicine cabinets. Others may start to steal from family and friends to support their addiction.
Denihan believes that family members can contribute to enabling individuals, allowing them to put off dealing with their addiction by providing them a place to stay. He suggested that one way to force individuals to go to treatment is to press charges against them for crimes they commit and get them into drug court. He says the drug court can give them the option of incarceration or treatment. He says often the leverage that drug court can apply is necessary for those who are not willing to voluntarily commit themselves to detox and treatment programs.
With the mixing of the dangerous fentanyl, and now, the even more dangerous carfentanil in the local heroin supply, deaths from overdoses are on the increase. Pulling out a large chart, Denihan shows the dramatic increase in Cuyahoga County in the number of deaths due to heroin and opiates such fentanyl in 2016. He points out that in Cuyahoga County there were 197 deaths due to heroin and opiates in 2013, the number of deaths increased to 223 in 2014 and to 228 and 2015. This year, at the current pace, Denihan says the number of fatalities is projected to reach 500 people.
In an effort to stem the number of deaths due to overdoses, Project DAWN was formed to distribute Nalozone kits which can be used to revive a person that has stopped breathing due to an opioid overdose. Denihan says 1,500 kits have been distributed over the past few years. At least 150 lives have been reported saved by use of the kits, says Denihan. On the Near West Side, the kits are available at McCafferty Health Center on Thursdays from 4-8 p.m.
The capacity of service providers in Cuyahoga County to help persons addicted to opiates and heroin is being tested and stretched says Denihan. He said that while Cuyahoga County taxpayers generously support the ADAMHS Board programs with the Health and Human Services levy, the State of Ohio could do a better job in funding programs.
On the federal level, Denihan said the Comprehensive Addiction and Recovery Act passed this year did a number of good things, but no funding was included. Denihan says a rule created during the Kennedy Administration to prevent the warehousing of mental health patients, is preventing Medicaid from funding treatment programs with more than 16 beds. Programs serving more than 16 individuals at a time, can’t qualify for Medicaid reimbursement, said Dehihan. Changing this federal rule will allow some local programs to expand and offer more beds. Denihan said that Matt Talbot has an empty building they could use for more treatment beds, but are reluctant to do so because it is very difficult to run the costly treatment programs without Medicaid. Denihan says while Congresswoman Marcia Fudge is aware of the problem, bipartisan support will be needed to make the change in the rule enforced by the federal Substance Abuse and Mental Health Services Administration.
While the ADAMHS Board provides funding to a whole array of providers that serve individuals in need of help to overcome an addiction, Denihan says the number of cases far exceeds the capacity of the programs to provide help needed.
Funding from the ADAMHS Board helps to support detoxification and treatment programs for individuals who are not covered by Medicaid or insurance, says Denihan. The detoxification programs are very expensive, says Denihan, requiring three to five days of 24 hour supervised care. Data provided by the ADAMHS Board lists Rosary Hall, Salvation Army Harbor Light, and Stella Marris as agencies it works with to provide detoxification to addicted individuals. All three agencies have programs serving adult men and adult women. In total, there are 63 detox beds available. Denihan says the waiting list for detox can sometimes range from 10 days to two weeks. The ADAMHS Board regularly monitors the waiting lists receiving reports on a regular basis. A late August look at the waiting lists indicated a one to three-day waiting period at Rosary Hall, zero waiting time at Salvation Army Harbour Light and a 1-10-day wait at Stella Maris. Denihan says that the problem with putting people on a waiting list is that they will continue using while waiting to get in the program and some do not come back.
Detoxification is typically followed with an outpatient Medically Assisted Treatment or a non-medical community residential treatment program. Denihan believes the medically assisted programs and total abstinence residential treatment programs are both effective in helping addicts work toward recovery. The ADAMHS Board measures success as the number of individuals who complete a given program.
The ADAMHS Board lists Community Action Against Addiction, as an outpatient medically assisted treatment program. The Community Action Against Addiction website indicates that the program uses Naltrexone orally or Vivitrol by injection as treatment for clients in the opioid treatment program. The program has no waiting list and on an average month serves 109 women and 132 men.
A number of non-medical residential programs are also listed including: Catholic Charities Matt Talbot and St. Vincent’s programs, Community Assessment and Treatment Services, Hispanic UMADAOP, Hitchcock Center for Women, New Directions, and Orca House. In total they offer 387 residential treatment beds. In late August the wait times to get into the residential treatment programs range from zero to four weeks for women and zero to five weeks for men.
In late August, the number of men on the waiting list for a detox or treatment program was 94, with 45 of those individuals having a scheduled admit date. The number of women on the wait list was 50. In the August 22nd report the ADAMHS Board indicated that it provided funding for 16.5 of the 63 detox beds being used and 169 of the 387 residential treatment beds in use.
For individuals suffering from an addiction or family members seeking help someone with an opioid addiction, the ADAMHS Board can help direct them to detoxification and treatment programs that can help. The ADAMHS Board Hotline is available to help with referrals 24 hours a day at: 216-623-6888. Information is also available on individual programs at the ADAMHS website at: www.adamhscc.org.
A new program developed over the past couple of years offers an option to those coming out of treatment programs. Through the Sober Bed Pilot Program announced in early 2015, the ADAMHS Board offers funding for Stella Maris and Cleveland Treatment Center to contract with area halfway houses to provide at least 90 days of aftercare support. The idea of the program came from surveys of individuals in recovery, said Denihan. The ADAMHS Board description of the program says halfway houses provide “aftercare support to a newly sober individual rather than returning the person to the setting where the addiction may have begun.”
Denihan says there are now 50 sober beds in halfway houses run by private nonprofit organizations that provide a low cost option ($15 – $22 a day) versus the cost of a treatment program ($100 or more a day.) Jeff Knight who runs three sober houses with 30 beds in four different locations says individuals generally are referred to him after going through detox and getting out of a treatment program which generally last about 30 days. He says he meets with the person and interviews them prior to them being admitted to a house.
He says currently his houses serve all men who use the time for different purposes. Some guys come out of treatment and already have a job to go back to. Others use the time to get their driver’s license back, pay back child support, or go to school to further their education or get job training. He says a number of guys opt to stay longer than the 90 days covered by the ADAMHS board. A number have stayed six months or a year. The half-way house offers an informal network as guys let each other know when they hear of a job opening. Knight says he keeps the places nice and runs a tight ship. Over the three years he has been running the halfway houses, Knight says he has had some success stories of guys going on to do well and has had a few people recycle. He says he is tougher on people that want to come back after having relapsed, being strict with them to hold them accountable.
Denihan says a number of other new resources have emerged to help in the effort to fight heroin and opiate addiction. One is the formation of Heroin Anonymous meetings. Another is the formation of group of young recovering addicts in their early to mid 20s that are volunteering to talk to young people in middle schools and high schools to help them avoid the path of drug addiction. The emergence of family fundraisers, who raise funds for treatment programs in the memory of a loved one who has died, is also helping to get more needed resources to programs, said Denihan.
Denihan says he hopes crisis intervention training of first responders will help them to recognize human trafficking victims who are also suffering from an addiction and provide victims a diversionary option where they can get a medical referral. Another option for individuals caught up in crime as a result of an addiction, is drug court or mental health court. In those cases, the judge can make sure the probation officer holds the person accountable to seeking treatment and going to meetings with the threat of a charge and going to prison hanging over their heads, said Denihan. If the person follows the program outlined by the judge, they can be exonerated and not have a charge on their record, he said.
Editor’s Note: Heroin Anonymous meetings are held at Stella Maris, 1320 Washington Ave., on Thursdays at 8 p.m. and Friday’s at 7:30 p.m. For more information about the group and other meeting locations and times visit their website at www.heroinanonymous.org