Michael Schoenhofer calls it “the Enough Question”:
Are there enough detox beds and treatment program slots to address the heroin and opioid addiction epidemic in our area?
“That’s the question we’re all grappling with,” said Schoenhofer, who heads the Mental Health and Recovery Services Board of Allen, Auglaize and Hardin Counties.
Schoenhofer and other addiction treatment officials said there was no way to prepare for this crisis, one that, in 2014, saw 2,744 people — nearly 53 people a week — overdose on opioids in Ohio.
“In 20 years, I’ve never seen anything like this, this massive number of people who are just addicted,” Schoenhofer said. “There’s no one agency that can manage it. It’s like if you had a tornado hit or a natural disaster.”
He finally gets around to answering the Enough Question.
“I can say, there’s never enough.”
Overwhelmed
Schoenhofer, treatment program providers, and former heroin addicts paint a picture of a public health system that is overwhelmed.
There are not enough detox beds for people who want them. There are waiting lists for treatment programs. There are not enough qualified doctors to oversee medication-assisted treatment, which is highly recommended for people coming off opioid addictions. And although Gov. John Kasich’s administration has aggressively sought to fight Ohio’s heroin problem, it has cut state funding to local county mental health and addiction boards, hampering their ability to provide help to those seeking to kick their heroin habit.
Ohioans are not alone. Only about one in 10 people with alcohol or drug addictions get medical treatment, compared to seven out of 10 people with hypertension or diabetes, according to the National Center on Addiction and Substance Abuse at Columbia University in New York.
Messy and painful
Detoxification from heroin is notoriously messy and painful, with symptoms that include vomiting, diarrhea, headaches and muscle cramps, but it’s not deadly, the way that delirium tremens from acute alcohol withdrawal can be. Many people can, and do, detox by themselves at home.
However, addiction specialists say that without medical supervision, relapse is highly likely. They say the majority of people will succumb to the physical pain of being “dope sick,” and use again.
Further complicating matters is that heroin causes lasting changes to areas of the brain that manage pleasure, reward and motivation, memory, learning, judgment, and impulse control
“The part of the brain responsible for food, water and sex now adds the drug to that list,” said Dr. Brad Lander, a chemical dependency specialist at The Ohio State University Wexner Medical Center in Columbus. “It has become a base drive.”
It’s why only 40 percent to 60 percent who enter treatment will still be sober a year later, Lander said.
“When we call it a chronic brain disease, this is what we mean,” he said.
Not enough detox beds
It’s also why Lander and other addiction specialists believe that a doctor-supervised detoxification, followed by medication-assisted treatment, or MAT, is the best hope for long-term recovery. MAT combines behavioral therapy with pharmaceuticals like methadone and Suboxone to reduce cravings, blunt withdrawal symptoms, and avoid relapse.
Since the closure of Mercy Hall at St. Rita’s Medical Center in 2011, there is no detox center in Limaland.
Coleman’s Lisa Ashafa, director of peer and specialty services at Coleman Professional Services, said the organization refers opioid users to Zeph Center in Toledo or Arrowhead Behavioral Health in Maumee for detox.
“There’s always an assessment that day, but it can be anywhere from a day to a week before a bed opens,” she said. “Dayton, there are detox facilities there, too. You can be waiting six to eight weeks.”
High hurdles for medication-assisted treatment
The wait for a slot in an inpatient or outpatient rehabilitation program can take even longer, especially if it’s a Medication-Assisted Treatment program that uses drugs to help wean patients off heroin.
Methadone, a controlled substance in its own right, has been used to treat heroin addiction since the 1960s. It’s only dispensed through clinics and one opened in Lima eight months ago. The clinic, operated by Premier Care, is one of only 17 in Ohio. It serves about 120 clients a day.
Regional executive director Jeremy Carpenter said there’s no waiting list, but the daily clinic visit and its time requirements are big hurdles for many.
“Everybody wants treatment until they identify what it takes to be in treatment,” he said. “That number dwindles when you look at the number of people actually struggling with addiction.”
Suboxone, one of the newer addiction treatment drugs, is also closely monitored because it, too, is a controlled substance. Doctors must get approval from the federal government to dispense it, and even then, they are limited by law to treating 30 to 100 patients.
Kevin Ochs, 35, of Lima, has been recovered from his heroin addiction for 16 months. He waited eight months to get into Coleman’s Suboxone program, which has two physicians on staff.
“In the meantime, I was using every day, calling them every day,” he said. “Anytime during that eight-month period, I could’ve OD’d.”
Not enough money
Although private doctors and private insurers can help a heroin addict receive treatment, it’s the public sector that disproportionally shoulders that burden, and its cost. Spending on addiction treatment totaled about $28 billion in 2010, according to CASA. Of that amount, only $5.8 billion — about 21 percent — came from private insurers and self-payers.
Making matters worse, the opioid epidemic started hitting its terrible stride at around the same time that state funding was being cut to local counties’ public health services.
Putnam County’s Mental Health, Alcohol & Drug Addiction Recovery Board saw its state aid drop from $815,261 in fiscal year 2009 to $351,818 in fiscal year 2013, a five-year low. The Mental Health and Recovery Services Board of Allen, Auglaize and Hardin Counties’ state funding dropped from $5.2 million in 2008, before the fiscal crisis and recession, to $2.6 million, the lowest in 10 years.
“And then you come into this growing opiate epidemic and it’s like, oh my gosh, where do you get the money?” Schoenhofer said.
He was lucky. Voters passed a new, 1 mill, five-year levy in 2014, and renewed a 0.5 mill levy last year.
“Our providers say they’re getting inquiries from eight to 20 people a week. That’s 80 people a month. That’s a lot of people looking for help,” he said. “Keeping up with demand has taken up all of our resources.”
State efforts to expand treatment
Both the state and local governments are taking steps to make it easier for those who want help, to get help.
Much of work undertaken by Kasich and his Cabinet Opiate Action Team has focused on making it tougher to overprescribe pain medication, which has fueled the current heroin epidemic, and on preventing overdose deaths. When it comes to treatment, Kasich signed an executive order in 2011 allowing treatment centers to add Suboxone and another new drug, Vivitrol, to their programs. A year later, Ohio Medicaid began covering Medication-Assisted Treatment. And the governor’s 2016 Mid-Biennium Review includes a proposal that will make it easier for more methadone clinics to open.
“Gov. Kasich has made fighting opiate addiction and preventing overdose deaths a major priority since Day One,” said Ohio Mental Health and Addiction Services spokesman Eric Wandersleben.
More local Medication-Assisted Treatment
Closer to home, with help from that new levy money, the MHRSB provided funding to its treatment providers so that they could offer Suboxone and Vivitrol.
The results have been astounding. In two years, the number of MAT programs grew from just one to three, and the number of clients those programs served mushroomed from 45 to 291 through March.
“We’re on track to serve 400 people this year,” Schoenhofer said.
He said he’s working through Lima’s two major medical institutions, St. Rita’s Medical Center and Lima Memorial Health System, to find doctors willing to help treatment centers with their Suboxone and Vivitrol programs. And he’s hoping to encourage St. Rita’s to reopen its detox ward.
A spokeswoman for St. Rita’s said there were no specific plans “at this time.”
Schoenhofer said he hopes that, even as he and others in the field of addiction treatment struggle to meet current demand, that more people seek treatment.
“There are so many people who OD. That’s what worries us,” he said. “I hope we can encourage people to just begin the journey of recovery.”
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