Heroin-addicted cry out for treatment now, but help can be slow

An average of nearly 500 calls a day rang into Cincinnati’s Center for Addiction Treatment (CAT) in September. The website caught 1,100 visits a day.

The phone and web traffic for CAT’s services are two measures of how many people want help for heroin addiction. Problem is, immediate treatment is hard to get.

“We are not close to treatment-on-demand ability,” said Sandi Kuehn, CEO of the West End-based center.

Offering services when people want them would put Cincinnati among the national leaders in the battle against heroin addiction. Experts cannot name a city that has all forms of treatment on demand.

Addiction doctors say that the Cincinnati region does not have enough treatment facilities for everyone who needs the help. Many who want treatment do not know how to get what is available, and many who are addicted do not have the means, including transportation or a phone, to find treatment.

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A view of Cincinnati looking south toward Kentucky. Photographed from the Carew Tower. The Ohio river separates Cincinnati from Kentucky. The Brent Spence Bridge is on the far right. At left is the John A. Roebling Suspension Bridge.

Treatment on demand for heroin addiction usually means quickly providing medication to stop a patient’s cravings and help stabilize them, then finding long-term treatment that includes counseling.

Addiction experts say it’s important to give people treatment when they ask for it because people may want treatment one minute, but succumb to heroin the next.

Not having treatment on demand is “like denying treatment to a person with advanced heart disease,” said Linda Richter, director of policy research and analysis for the National Center on Addiction and Substance Abuse.

One user’s story: No phone, no treatment

Justin Warfield, 30, is in the Hamilton County jail awaiting treatment. He thinks being in jail is the only way he can get help.

When he was homeless in July, he said he’d tried to get residential treatment but abandoned the idea because it seemed impossible to do.

“You have to call every day,” he said. “I don’t have a phone. I can’t even call my mom.”

Justin-inmate-prison
Justin Warfield, 30, has been incarcerated at the Hamilton County Justice Center since August on drug related charges. He’s due for release in October of 2018. Warfield first experienced with heroin when he was 14. By the time he was in his early 20’s, he had a full-blown heroin addiction. Prior to jail, he was living on the street and was 30 pounds lighter. He said for the first time in many years, he’s excited about sobriety and getting into treatment, which will be part of his sentence.

Even if he’d had a phone and a way to charge it, Warfield said he’d probably call a heroin dealer before he’d keep in touch with a treatment center.

“It’s hard-wired into my brain at this point,” Warfield explained.

His mother, Colleen Owens of Camp Washington, has seen her son vacillate between wanting treatment and refusing it over the years.

“When they want help, they need to be able to get help then, not later,” Owens said. She sobbed, adding, “Later might be too late.”

While Greater Cincinnati and Northern Kentucky aren’t able to promise treatment on demand yet, we are getting closer.

More help faster, but without a bed

Addiction treatment is becoming more available in the Cincinnati area, with outpatient clinics and programs “popping up all the time,” said Nan Franks, CEO of the Addiction Services Council, a Greater Cincinnati nonprofit.

But while the clinics have shorter wait times than inpatient treatment, clinic treatment usually requires an appointment. The clinics mostly offer FDA-approved medications buprenorphine and injectable naltrexone for opioid addiction. They match medication with counseling.

BrightView Health has four locations in Southwest Ohio “with more under development,” said founder Dr. Shawn Ryan, a certified addiction expert. The first opened in 2015. “We’ve gone from zero- to about a 1,000-patient capacity,” Ryan said.

His clinics offer same-day and next-day treatment. People can walk in and get what they need, Ryan said. Patients are given buprenorphine as soon as they are medically approved for it. “That can be within hours,” he said.

The Center for Addiction Treatment opened its outpatient clinic in September, which is when calls nearly doubled. Kuehn said clients can get treatment in 24 to 48 hours.

In Northern Kentucky, Dr. Michael Fletcher, a certified addiction expert, has openings in his Chemical Addiction Network clinic. And St. Elizabeth Physicians just expanded its Journey Recovery clinic to try to meet the demand.

Going from ER directly to treatment

One way to get more people treatment when they are likely to want it is by offering it in emergency rooms to overdose survivors, rather than handing them a resource list and watching them walk out the door.

St. Elizabeth Healthcare recently brought the concept to our region. On Oct. 1, it started a pilot program at its Edgewood hospital to try to get OD patients into treatment before they leave the hospital.

Syringe-onGround
A needle is abandoned on a path through a wooded area where homeless congregate in Cincinnati.

The St. E “bridge” program provides an addiction medication, buprenorphine, to overdose survivors and a peer recovery specialist to guide people into treatment.

It’s a form of treatment on demand that’s gaining favor across the nation.

Dr. Ross Sullivan pioneered his program in Syracuse in 2016 as an emergency doctor at Upstate University Hospital. He prescribed buprenorphine to patients who’d overdosed. Within months, he had approval to start a clinic for the ER patients. Like at St. E, a peer recovery specialist secures full treatment for the patients.

As of his last count, Sullivan had 165 patients referred by the ER. Of those, 132 showed up to their clinic appointment, and from there, 86 percent were linked to treatment.

It’s difficult for families, but hopsitals can’t coerce patients into treatment, said Dr. Leana Wen, Baltimore’s health commissioner, who has gained national attention for her city’s “kitchen sink” response to heroin.

 In Baltimore, four hospitals offer buprenorphine induction, but all hospitals connect overdose survivors with an outreach worker. That social worker “follows them out the door,” Wen said, staying in touch with them until they are ready to get treated.

One user’s story: Arrested to get treated

Katerra Jervis of Elsmere, a longtime heroin user, knew she wanted help. The only way she knew how to get it was to get herself arrested. So that’s what she did on March 22.

“I just wanted help so bad I didn’t care what I had to do,” said Jervis, 29.

She made her decision after a friend sent her a link to an Enquirer story about the jail’s evidence-based treatment program.

She showed up at the Campbell County jail, and Newport police cited her for public intoxication. Jervis says she “faked” her way into the citation. A police report states she had “pinpoint” pupils and was “a danger to herself, others and public property.”

The officer stated that Jervis “wanted to get help to end her addiction to heroin” and that “she wanted court-assisted addiction help.”

She pleaded guilty to disorderly conduct and got in. She graduated from the program Aug. 28 and took a two-year follow-up program option.

“It’s the best thing that ever happened to me,” Jervis said.

Jason Merrick, director of an addiction services program at the Kenton County jail, wasn’t surprised at Jervis’ story, adding that such situations “probably occur more often than we would admit or know.”

Helplines work, if people know about them

For those who can call, the Cincinnati area has two 24-7 heroin helplines staffed with addiction counselors who are finding treatment fast for people who need it.

 

“We probably have access every day,” said Addiction Services Council’s Franks.

The council’s staff is tapped into the treatment community and can cut through the runaround that so many describe they face when searching for help.

But not everyone knows about the helplines.

Amanda Cicchinelli of Loveland, whose son, Austin, struggled with heroin addiction for three years, said she was unaware of a helpline. Over the years, she said, she hunted for treatment repeatedly for her son.

”We made countless phone calls through the years,” Cicchinelli said. “It was a never-ending cycle of walls and barriers. Waiting lists and restrictions. Desperation became the deciding factor in where he went – not the program or treatment offered.”

Austin Cicchinelli, like most people with heroin addiction, wanted and didn’t want treatment. He cycled in and out of programs, his mother said, propelling her into a frantic search for help for him again and again.

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Amanda Cicchinelli with her son, Austin. After he died from a heroin overdose, she started Austin’s Hope, a nonprofit organization to help others find help.

He kept a diary in 2016 that chronicled his thoughts about addiction, his wish to help others, his own need for help and, ultimately, his hopelessness.

July 23: “I wish I could build a time machine and stop myself from all of the choices.  I would show myself the things I was too naive and blind to see.  I would stop myself from ever even buying my first bag of weed.”

Aug. 21: “A woman I met on the streets overdosed. I bet people just look at her and think she’s just another addict. Nobody cares about an addict. No one contemplates that she is her parents’ daughter.”

Oct. 4: “I’m one shot away from being another T-shirt.”

Cicchinelli used heroin for the last time on June 26 this year.

“He was 21 when he died at his grandparents’ house, down the road from me, in Loveland,” his mother said.

Why can’t we get on-demand treatment?

How much more addiction treatment is needed isn’t clear, because the size of the opioid problem isn’t known.

Health officials in the region say they can’t provide an educated guess about the number of people who use heroin and other opioids, much less an actual count of the population. The research and data just aren’t there.

Rundown-Buildings-OverTheRhine
Vine street in Over-the-Rhine, north of Liberty Street. According to the city of Cincinnati statistics, in the first six months of 2017, police and fire responded to 1,142 overdose calls. The top three neighborhoods were East Price Hill, downtown and Avondale.

“If folks don’t come into the picture because of criminal justice, treatment, emergency types of reasons, we don’t know they exist,” explained Jennifer Mooney, the family health division director for Cincinnati Health Department.

Nationally, the federal Substance Abuse and Mental Health Services Administration estimates one in 10.8 people who need addiction treatment get it at a specialty program. Put another way, that’s roughly 2.3 million of the 21.7 million who reported in a 2015 survey that they needed treatment.

Even if the size of the problem were clear, there are other barriers to treatment and removing them “is complicated,” said Kenton County’s Merrick, who also is board president of the Kentucky chapter of People Advocating Recovery.

One problem, for example, is that insurance companies often require pre-authorization for treatment. People Advocating Recovery plans to ask the Kentucky legislature to hasten the process.

“If they could figure out a way to do this, we could give people treatment immediately,” Merrick said.

Another problem: Money.

Often, those who ask for treatment don’t have insurance. They have to get signed up, and that represents a delay. Beyond that, Merrick said, most treatment centers are understaffed and underfunded, making it difficult to provide immediate treatment.

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Dr. Mina “Mike” Kalfas, a Northern Kentucky family physician and certified addiction expert, treats a patient for opioid use disorder in his Fort Wright office.

A final barrier is the misunderstanding that those who are addicted don’t want help, said Dr. Mina “Mike” Kalfas, a Northern Kentucky addiction specialist who has more than 200 heroin patients.

“Just about everybody I know battling addiction falls into one of two categories: Those that want help and those that have given up,” he said.

How to get help for yourself or somebody else

For 24-7 help, call the Addiction Services Council:

• Cincinnati area: 513-281-7880
• Northern Kentucky: 859-415-9280