Tuesday, August 30, 2016

As Opiate Crisis Worsens, Access to Treatment Facilities Remains Static

Posted By on Tue, Aug 30, 2016 at 1:59 PM

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There is one inpatient treatment bed available for every 52 heroin addicts in Cuyahoga County, according to data provided by the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County. When prescription medication like oxycodone, hydrocodone and fentanyl are factored in, the data point becomes bleaker: approximately one bed for every 207 people abusing opiates in this county.

There are only 387 inpatient beds in Cuyahoga County, with 169 of those being funded publicly by the ADAMHS Board. Those beds serve a massive population; according to a 2014 Substance Abuse and Mental Health Services Administration survey, there are between 70,000 and 90,000 Cuyahoga County residents abusing prescription medication. (Included in that number: 20,000 heroin addicts.) 

Inpatient treatment is an involved process, one that often includes supervision and counseling in a residential setting. Outpatient treatment services are available too, and an individual's decision to proceed to treatment can be voluntary or court-mandated. It's a vital component to getting clean.

On top of that, though — and here's the kicker — there are only 63 detox beds available here (or one detox bed for every 318 heroin addicts). Detox is distinguished as a process that sees addicts getting clean in a safe facility, like Rosary Hall at St. Vincent Charity Medical Center, for a few days. It can be a painful experience. Once the immediate withdrawal symptoms subside — and an addict is no longer "dopesick" — inpatient services typically pave the path ahead to long-term sobriety.

The problem is that access to that path isn't easy. Whichever path an opiate addict takes to an open bed here in Cuyahoga County, the first step is often spent idling on a waiting list — a significant problem amid a public health crisis where one wrong step could cost someone his or her life. ADAMHS CEO William Denihan says that, recently, wait times have ranged from three weeks to none at all. It's a problem that has been brought up by sources in our reporting over the past year (see here and here). Call 216-623-6888 to begin the path toward addiction treatment in Cuyahoga County.

Earlier this year, County Executive Armond Budish said that one goal is to lift or ease Medicaid reimbursement restrictions that limit the number of addiction treatment beds available in a given publicly insured facility. (These regulations haven't been updated in more than 20 years. They were introduced in the 1960s as a way of limiting the population of men and women committed to institutions for mental health issues. When the addiction field began growing the 70s and 80s, the regulations grew to encompass those services as well.) Lifting those caps today would allow, at the very least, dozens of additional treatment beds to open up here in Cuyahoga County. 

"We're asking that they remove the restrictions on the addiction side and either double it or just remove it altogether," Denihan told Scene, referring to the nationwide push for reform. His is an adamant call. "This is critical: getting the beds and offering long-term sobriety."

Of course, inpatient treatment services remain just one element of the ongoing fight against opiate addiction here. Denihan also lauded the work of Project DAWN, which has distributed 1,500 naloxone kits this year in Cuyahoga County. He reported that more than 160 lives have been saved through that organization. 

Still, though, the county is facing its most serious health crisis in decades. By the end of 2016, it's likely that the heroin/fentanyl overdose death count will top 500 — more than double the number of deaths in 2015 (228), 2014 (224) and 2013 (199). The current increase is dramatic.

"Even with those numbers, we were overwhelmed by the need for people with treatment," Denihan said, charting the course through recent years. "Our capacity has not changed. That capacity of beds and availabilities for detox is one of the major dilemmas that we have right now. We just don't have the funds for those, and that's a very critical point right now."

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