The life of a heroin addict is not the same as it was 20 years ago, and the biggest reason is what some doctors call “heroin lite”: prescription opiates. These medications are more available than ever, and reliably whet an appetite that, once formed, never entirely fades.
The actor, who quit heroin more than 20 years ago, reportedly struggled to break a prescription painkiller habit last year. Experts in addiction say that the use of medications like Vicodin, OxyContin and oxycodone — all opiates like heroin — has altered the landscape of addiction and relapse, in ways that affect both current users and former ones.
“The old-school user, pre-1990s, mostly used just heroin, and if there was none around, went through withdrawal,” said Stephen E. Lankenau, a sociologist at Drexel University who has surveyed young addicts. Today, he said, “users switch back and forth, to pills then back to heroin when it’s available, and back again. The two have become integrated.”
Rates of prescription opiate abuse have risen steadily over the last decade, while the number of people reporting that they used heroin in the past 12 months has nearly doubled since 2007 to 620,000, according to government statistics. That’s no coincidence, researchers argue: more people than ever now get a taste of opiates at a young age, and recovering addicts live in a world with far more temptations than there were a generation ago.
“You can get the pills from so many sources,” said Traci Rieckmann, an addiction researcher at Oregon Health & Science University. “There’s no paraphernalia, no smell. It’s the perfect drug, for many people.”
Millions of people use these drugs safely, and doctors generally prescribe them conscientiously. But for some patients, prescription painkillers can act as an introduction — or a reintroduction — to an opiate high. The pills set off heroin craving in recovering addicts, doctors say, every bit as well as they soothe withdrawal in current users.
Dr. Jason Jerry, an addiction specialist at the Cleveland Clinic’s Alcohol and Drug Recovery Center, estimates that half of the 200 or so heroin addicts the clinic sees every month started on prescription opiates.
“Often it’s a legitimate prescription, but next thing they know, they’re obtaining the pills illicitly,” Dr. Jerry said.
In many parts of the country, heroin is much cheaper than prescription opiates. “So people eventually say, ‘Why am I paying $1 per milligram for oxy when for a tenth of the price I can get an equivalent dose of heroin?’ ” Dr. Jerry said.
Investigators do not yet know whether Mr. Hoffman was taking prescription opiates at the time of his death. Toxicology tests are pending, and the purity and content of the heroin found in his apartment will certainly be a focus.
While the deluge of prescription painkillers is new, other risk factors for overdose have not changed in decades.
“These are common danger zones,” said Dr. Nicholas L. Gideonse, the medical director of O.H.S.U. Richmond Community Health Center in Portland.
Even a change in where a person uses his or her drug of choice can increase the likelihood of an overdose, studies suggest. “If you habitually use in your car, for example, the body prepares itself to receive the drug when it’s in that environment,” Dr. Rieckmann said. “It’s called conditioned tolerance. When people using are in an unfamiliar places, the body is less physically prepared.”
The risk of dying from an overdose is higher when people are using alone. “Another person, sober or not, can notice when someone nods off, or just say, ‘Hey man, slow down,’ ” Dr. Lankenau said. “And users act as a gauge for each other of when they’re doing something dangerous.”
Many needle exchange programs and clinics now have overdose prevention courses, teaching users to notice danger signs and administer the drug naloxone, an opiate blocker that E.M.T.s use to revive addicts who have overdosed.
None of which might have spared Mr. Hoffman. One thing that has not changed for heroin addicts over the past 20 years is the certainty that this next shot will not be deadly.
“You have to understand that addicts inject three or four times a day for years and years on end,” Dr. Gideonse said. “They don’t perceive any one shot to be dangerous or potentially deadly, because in their experience, there’s no reason to.”
By Rick Nauert PhDSenior News Editor Reviewed by John M. Grohol, Psy.D. on February 19, 2014
Teen prescription drug abuse programs have experienced mixed levels of effectiveness, ranging from big drops in drug abuse to no measurable effect.
The finding comes from a study of 11,000 teenagers by researchers at Duke and Pennsylvania State universities.
The best results came from pairing a school-based program with a home-based intervention, resulting in a 10 percent decrease in abuse rates.
By contrast, most school-based programs were ineffective when used by themselves, with just one exception.
While the results are sobering (no pun intended), the six-year study is among the first to measure the success and cost-effectiveness of prescription drug abuse prevention efforts.
Abuse of prescription opioids, a form of painkiller, is the fastest-growing form of illicit drug use in the country, affecting more than 12 million Americans and killing more people annually than heroin and cocaine combined, according to the Centers for Disease Control and Prevention.
As a result, the U.S. Food and Drug Administration has recommended restricting access to painkillers such as Percocet, Oxycontin, and Vicodin.
“These drugs are very available, and highly addictive,” said Max Crowley, Ph.D., an NIH Research Fellow at Duke’s Center for Child and Family Policy.
“There’s a growing national debate about whether we should restrict access to these drugs, but at the same time, the drugs are hugely important for pain management. What’s being left out of the debate is the role of prevention.”
Crowley and his co-authors found that only one school-based program was effective when used by itself.
The Life Skills Training program resulted in 4 percent lower drug abuse rates, compared with a control group. The 18-session course teaches social skills that build competence and encourage assertiveness.
“Life Skills Training was also among the most cost-effective programs studied, costing an average of $15 per child,” Crowley said. “By contrast, the study notes that prescription drug abusers cost society an average of $7,500 each for treatment and other expenses, by conservative estimates.”
Life Skills was among four prevention programs the researchers studied.
The team looked at 28 rural public school districts in Iowa and Pennsylvania, tracking students from grades 6 through 12. They examined a home-based program called Strengthening Families 10-14 and three school-based programs: Life Skills Training, Project Alert, and All Stars.
All four were “universal” programs that were offered to all teenagers in a given district.
The researchers analyzed pairs of demographically similar school districts. Within each pair, one community received a prevention program or programs, and the other did not.
The research team surveyed teenagers each year, asking teens to anonymously report whether they had ever used a prescription painkiller for nonmedical purposes. The authors then compared drug use levels in districts that received interventions versus those that did not.
In communities that received no intervention, a quarter of high school seniors reported having misused prescription painkillers.
The most substantial reductions in abuse rates occurred when the Life Skills program was combined with the Strengthening Families program. The All Stars intervention also yielded reductions when it was used alongside the Strengthening Families program.
Crowley said he hopes policymakers and educators will put the findings to use.
“Policymakers and other leaders are actively searching for efficient ways to curb prescription drug abuse,” Crowley said.
“These results give policymakers options regarding how to handle this growing epidemic.”
N.J. addicts suffer from shortage of drug treatment facilities – See more at: http://www.northjersey.com/news/herion_paterson_drugs_rehab_parents.html#sthash.hgN5WdQj.dpuf
Three months after fleeing a Florida rehabilitation center, Amanda, a 24-year-old from Woodcliff Lake, was using heroin again. She stole her grandmother’s credit card, bought thousands of dollars worth of electronics and sold them in Paterson for drugs.
Which is how Amanda’s parents came to spend a Friday evening this July driving across New Jersey, their strung-out daughter in the back seat, looking for a facility that could treat her.
“We called eight or nine places,” Amanda’s father, James, recalled. “Nobody had a bed. Nobody.”
Insurance wouldn’t cover detoxification in an emergency room, rehabilitation clinics wouldn’t take her until she was clean, but every detoxification unit had dayslong waits for admission, James said. At a hospital in Summit, James encountered hallways full of “moaning and groaning” addicts waiting for beds and insurance clearance, he said. James was told at the front desk that if he paid cash, there might be a bed for Amanda the next morning.
A friend gave Amanda some Suboxone, a drug used to treat opioid addiction, so she could spend the night at her parents’ house. The next morning, they found a facility in Kearny that could take her.
Amanda’s story is typical. As heroin and prescription painkillers ravage parts of the state, at least a third of New Jersey addicts seeking treatment cannot get it. A shortage of treatment facilities, coupled with high costs and insurance hurdles, leaves tens of thousands each year without adequate or timely care, and their families scrambling for help. In 2009, the latest year for which state figures are available, at least 30,000 adults and 15,000 adolescents were turned away from treatment.
Thousands more do receive treatment, only to cycle in and out of emergency rooms and rehabilitation programs, their inpatient stints cut short by insurance plans, lack of cash, or relapse. Even the most comprehensive insurance plans tend to limit coverage of inpatient care to 14 days or less, leaving families to choose between paying thousands of dollars out-of-pocket for the standard 28-day treatment or pulling an addict out of care.
“There is without doubt a treatment shortfall in this state,” said Dan Meara of the National Council on Alcoholism and Drug Dependence, who estimated that some places turn away half those seeking treatment. “There is not enough funding, and there are not enough beds.”
And the situation is growing worse, placing a burden on the state’s hospitals and criminal justice system. Over the past five years, the number of emergency room visits for behavioral health issues has nearly doubled — much of that increase attributed to substance abuse. The number of drug-induced deaths is also on the rise, with hundreds throughout the state and thousands nationwide dying from prescription painkiller and heroin overdoses.
This surge, coupled with concern over crime and violence associated with drug addiction and mental illness, has spurred the federal government into action. Health care reform is expected to extend substance abuse treatment benefits to 62.5 million more Americans by 2020. And on Friday, the Obama administration announced regulations that will require insurance companies to cover addiction and mental health care in the same way physical illnesses are covered.
But it will take time for these regulations, which do not extend to Medicaid managed-care plans, to become part of the health care system, which is fraught with delays in all areas of treatment. With addiction — when even small gaps in treatment can mean relapse or death — these interruptions are demoralizing, terrifying and sometimes fatal.
In New Jersey, middle-class families may be hit hardest by the cost of addiction treatment. They often do not qualify for public services that serve the uninsured and indigent, and which can be more rigorous than private rehabilitation. Nor can they afford to pay out-of-pocket for treatment, which can cost more than $1,000 a week for private inpatient care.
“The middle class is the one that gets squeezed,” said Frank Greenagel Jr., recovery counselor at Rutgers University and chairman of a state task force on heroin and opiate addiction. “They have insurance, but maybe insurance doesn’t cover it all.”
Even families like Amanda’s that have resources — financial stability, good insurance, patience — find that it is extremely difficult to break the grip of addiction. By this summer, Amanda’s 27-year-old brother had already been through eight facilities, from California to Maine, for his addiction to prescription painkillers and heroin. James, who asked that the family’s last name not be published because of privacy concerns, has estimated that he has spent $400,000, not including travel and legal expenses, on his children’s addictions. They went through treatment centers so often that they now gets “alumni” discounts.
Take Judy Castiglione of Jefferson: She is $90,000 in debt after three years of trying to keep her son William off heroin. “Finding an open bed was almost impossible,” she said, and insurance rarely paid for it. In the meantime, she said, she was “Crazy Mom”: She had GPS built into her son’s car, monitored his phone and wound through downtown Paterson in a white minivan, armed with a baseball bat, searching for dealers.
Or Joe Sardonia, who works for the Monmouth County Parks Department, who said caring for his 20-year-old daughter, a heroin addict, has left him frustrated and broke.
“In most cases, when my daughter wanted help, she couldn’t get it,” Sardonia said.
And then there is Kim Kaupp of Mendham: Kaupp pretended to be his son, Jack, while on the phone with the insurance company, claiming to be high in order to secure treatment. Jack Kaupp died at age 26 in February 2012: His father found him in a Morris Plains welfare hotel, a needle in his arm.
Their stories, along with interviews with dozens of parents, clinicians and authorities, portray a broken treatment system that often compounds the misery of addiction. They show the challenges that New Jersey and the United States face in translating policy into effective and affordable care.
But there are also success stories: programs that work, addicts now sober. Officials at Bergen County public services try to find a bed for any resident who needs it. State officials are mobilizing to stem the tide of addiction. For the parents whose children have turned a corner, this is cause for hope and cautious optimism.
Fewer hospital sites
The path to recovery begins with detoxification. But even as more New Jersey residents — particularly suburban young adults — are seeking help for heroin and opiate addiction, fewer hospitals offer treatment.
Bergen Regional Medical Center now has the only designated detoxification facility in the county; its 54 beds are almost always full, with 12 to 18 new patients arriving each day, said Thomas Rosamilia, vice president for behavioral health services.
“There is nothing harder than sending somebody home without a bed,” he said. “You never know if they’re going to come back.”
The number of behavioral health cases in New Jersey emergency rooms jumped from 289,851 in 2007, to 521,518 in 2012 — an 80 percent increase, said Kerry McKean Kelly of the New Jersey Hospital Association. “The physicians and nurses in our ERs will tell you pretty consistently that substance abuse is a major contributor to the overall growth.”
Emergency rooms will stabilize patients and release them even though the patients have limited access to further treatment, Kelly said. Statewide, families and clinicians alike report that long-term inpatient and outpatient treatment programs often cannot take them.
“At that point, once you’re clean, where do you go?” said Sue Debiak, coordinator of the Bergen County Office of Alcohol and Drug Dependency. “It is astounding to me that people can’t get help. People are driving around looking for a place to put their son. You don’t see hospitals closing diabetes or cancer care services.”
From July 2009 to July 2010, state-licensed treatment facilities admitted 78,313 patients. In the 12 months before July 1, 2013, that number was nearly 85,000. Some 45 percent were for heroin and opiate addiction, more than any other drugs.
At the same time, the state’s expanding drug court program — which aims to treat, rather than incarcerate, certain drug offenders — is sending more people into mandatory care, further increasing the squeeze in publicly funded treatment centers. Officials say the 102 state treatment facilities may be near a saturation point.
Jennifer Kaupp said finding a bed for her son, Jack, was a “full-time job.” The Kaupps spent upward of $300,000 on a “merry-go-round” of treatments for Jack, maybe 10 percent of which was covered by insurance.
“They know you are desperate, they know you will do anything,” said Jennifer Kaupp. “You are watching your kid kill himself.”
In the end, the Kaupps let Jack go — he spent his last months homeless, moving between shelters and charity facilities.
“The professionals said you cannot keep enabling him,” Kim Kaupp said. “Just let him hit bottom, and he’ll eventually come back.”
“But he never did,” said Jennifer Kaupp.
Judy Castiglione still weeps when she remembers reporting her son, William, to the police. And how he cried out for her as he was led down the driveway in handcuffs. “Part of me regrets it because now he has a felony record,” Castiglione said. “But part of me doesn’t because I think he would be dead today.”
The criminal justice system is now seen as the best way to get somebody into treatment, parents say — especially drug courts, which are tough and thorough.
“In New Jersey, the only way to get help is if you commit a crime,” said James, whose son is now in the drug court program.
Insurance issues
Part of the disconnect between insurers and treatment stems from the nature of addiction, clinicians say. Mental illness is poorly understood and politically sensitive. And addiction, in particular, is replete with undertones of morality, responsibility, entitlement. Success in treatment can be difficult to measure, and relapse is common.
From the parents’ perspective, insurance companies perpetuate a cycle of ineffective treatments, James said. “They keep paying for you to stay two weeks, 20 times, instead of sending you away for six months. He gets out, big hugs, doing OK, goes back to work. Two weeks later, relapse.”
Insurance companies have seen a “heavy trend toward opiate use in the Northeast,” said Mary Mcelrath-Jones of UnitedHealthcare, adding that the insurer was working to “increase access to effective evidence-based treatments.”
“We always err towards as much rehabilitation as possible in the environment that most closely mirrors the environment in which the person will live,” said Susan Millerick, a spokeswoman at Aetna. An addict may need in-patient treatment, “but to the extent that we can get them home or community-based and provide them with support, then that’s typically what will be covered.”
But that goes against the counsel of addiction experts, treatment programs and families themselves, who say long-term treatment that removes addicts from their environment is often most effective.
Addiction care is also expensive.
“There has to be a check on the appetite for coverage,” Ward Sanders, president of the New Jersey Association of Health Plans, said. “You can’t just close your eyes and say this is appropriate coverage — coverage would be unaffordable for everybody.”
A rehabilitation center told Joe Sardonia that his daughter needed long-term residential care; but insurance would only cover intensive outpatient, he said. “It appears that they do their best to get people out of rehabilitation as soon as possible,” he said. “She wasn’t home 24 hours before she overdosed.”
Sardonia said he understands that both sides have financial concerns.
“I get it,” said Sardonia, who has already spent $20,000 on treatment. “But it just doesn’t seem like the program is set up so that there is a degree of success.
“Economically, it’s a nightmare,” he added. “Emotionally, it’s a nightmare.”
Treatment shortage
As the Affordable Care Act aims to reshape treatment nationally, Governor Christie, an advocate for drug courts and substance abuse treatment, recently announced that the state-employee benefit program would provide for mental health parity, including addiction coverage.
But despite moves to expand coverage, there remains a statewide shortage of facilities and qualified clinicians. And after addicts are released, they often cannot find housing, employment or education — barriers that sometimes challenge sobriety.
“Every time he went to rehab, and got out, now what?” Jennifer Kaupp said. “There is no care for these people after they go through these programs.”
The Kaupps, like many parents, fear that an entire generation of young adults will be lost to opiate addiction. They estimate that their area has buried a half-dozen people Jack’s age in the past few years. This year, Bergen County has lost more than 20 people to overdoses. Ocean County has seen nearly 100 heroin- and prescription pill-related deaths so far in 2013.
But there are many more casualties of the statewide epidemic of heroin and prescription-painkiller abuse. Sardonia’s daughter recently moved into a halfway house but has few prospects for the future.
“She has no money of her own, no resources, no education, no job,” Sardonia said. “It’s sad, it’s very sad.”
James said his two children are now in recovery; his son recently landed a new job in New York. “There is hope, because I’ve seen it,” James said. September was the first month in three years he had not paid a bill for rehab.
William Castiglione is now living in a group home for recovering addicts and has been clean for more than 60 days, he said. “Some days it’s easy, some days it’s not,” Castiglione said. Today, Castiglione has a broad, muscular build; at the height of his addiction, he said, he weighed 135 pounds.
Castiglione has seen the insides of jail cells and rehab facilities from Florida to New Jersey. In the end, he said, it’s not the location that matters — it’s the addict’s desire to get clean.
“Jail is just as good as a rehab, if you’re ready,” Castiglione said. “If not, the best place in the world isn’t going to make you stop.”
Email: obrien@northjersey.com
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Northjersey.com : News
N.J. addicts suffer from shortage of drug treatment facilities
Sunday, November 10, 2013 Last updated: Sunday November 10, 2013, 4:32 PM
BY REBECCA D. O’BRIEN
STAFF WRITER
The Record
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William and his mom, Judy Castiglione.
VIOREL FLORESCU/ STAFF PHOTOGRAPHER
William and his mom, Judy Castiglione.
National Prescription Drug Take Back Day – Saturday, October 26, 2013 –
The National Prescription Drug Take-Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications.
A very real and personal story shared by Aunt Rachel. This is the tragedy that effected our family. This is the reason why prevention needs to be spread.
Every summer since I can remember, my husband’s family has gathered at the New Jersey shore, where he and his three siblings grew up. All together, we were a group of eighteen, ten adults and eight cousins. These yearly reunions were a wonderful time for the kids to reconnect after the long school year. There was nothing quite as beautiful as watching them ride the waves together. The picture to the right, taken in July 2010, shows the smiling faces of cousin Bobby (16, from Houston, TX) and cousin Justin (20, from Freehold, NJ).
The two boys couldn’t have been more different. Justin was outgoing and boisterous, and had the ability to captivate an entire room with his big personality, humor and generosity. When he was in high school, Justin was a state-ranked weight lifter, an all-county football player and captain of the football team. Bobby, on the other hand, was a quiet observer with tremendous wit and charm. He was a gifted academic with a scientific mind, likely of genius intelligence, earning a nearly perfect grade point average as well as a nearly perfect SAT and advanced SAT scores.
Yet, despite their differences, they had one thing in common: An addiction to prescription medications that ultimately resulted in their deaths. Justin was 21 years old when he died. Bobby was just 17.
Justin started using marijuana when he was 14. By the time he was a senior in high school, he also started to use prescription pain medications recreationally. Once in college, his recreational use turned to addiction, and after one semester, he failed out and returned home. His parents had absolutely no idea that he was using prescription pills and thought his return was because he was home sick. In 2009, while attending community college, Justin ‘totaled’ his car. Admitting marijuana abuse, Justin wanted help so in 2010, his parents found him intensive outpatient treatment. But then in 2011, expensive items in the house went missing, yet the theft was a mystery. Justin’s parents did not learn of his addiction to prescription medications and heroin until he was stopped for a traffic violation and police found a needle and a pill in his car. Justin willingly entered a 30-day rehab program and soon thereafter, moved to a sober living facility. On July 13th, 2011, just days after a family gathering, Justin was found dead in a hotel room; the cause of death was drug overdose.
Bobby’s path to addiction was the same as Justin’s. He too started using marijuana heavily when he was 14. At 15, his recreational drug use escalated significantly. His mother’s pain medication, prescribed as part of her breast cancer treatment, went missing. Initial thoughts of Bobby’s involvement in the theft were disregarded, as it seemed preposterous that this high-achieving student would take drugs. Despite the lock that was then used to safeguard the medication, it continued to disappear. Bobby’s mother lost her 9-year battle with cancer on March 1, 2011, just three months prior to Justin’s death. Bobby, now 17, vowed to use his gifted mind to help find a cure for the deadly disease that took his mother so early.
In late October 2011, my husband and I went to Houston to visit with the family. During our stay, Bobby and I planned to work together to finalize his college application; he had his heart set on Princeton. Just moments after we arrived, my brother-in-law informed us that Bobby had recently confessed to being a prescription drug addict and asked for help. He had recently stolen $8K from his dad’s account to buy medications on-line; but now that the money was gone, he was out of options. We were stunned and devastated to say the least.
We had no idea what to do. Justin’s father, Bobby’s uncle in New Jersey, begged us to take him to the hospital or call the police, as he wished he would have done for his son. Bobby refused to go to the hospital and foolishly, we worried that a police record could interfere with college acceptance. Instead, we took him for an evaluation at an out-patient rehab center. The evaluation took half the day. Because of HIPPA laws, the addiction specialist could not tell us what she learned from Bobby about his use, but did tell us that he was one of the heaviest users she had ever encountered and was already far down the road of addiction. He would need, at minimum, 30-day residential (in-patient) treatment.
Although Bobby told us he was an addict, we had absolutely no idea how serious the problem was until that moment. Yes, in retrospect, there were signs of drug abuse that we attributed to teen behavior, but it was impossible to reconcile this expert opinion with the person we thought we knew. Unlike Justin, whose world fell apart because of addiction, Bobby was functioning almost as usual.
By 8pm that evening, we completed all the paper work for his admission to the residential facility which was to take place at 8am the next day. Tragically, Bobby didn’t make it through those 12 hours.
On October 25th, at 6am, his sister and I found him dead in his bed. He took heaping doses of some of his father’s accessible medication and sent a text to a friend. He couldn’t imagine loving anything more than his drugs. Bobby died just a little over three months after Justin.
These young deaths have devastated and forever-altered every member in our family as well as members of Justin’s New Jersey community, Bobby’s Texas community and our own community here in Maryland. Prior to these events, I had absolutely no idea that prescription drug abuse was an epidemic in our country. Even though I have a master’s degree in Public Health from Johns Hopkins and worked in psychiatric drug development for over 10 years, I had no understanding of the dangers of prescription drugs, how addictive they are, and how, even with one dose, they can kill. I had no comprehension of how different and dangerous the ‘drug landscape’ is today as compared to when I was a teenager in the 80s.
In an effort to help save other families and communities from this horror, I am committed to raising awareness among both adults and children, because knowledge is the best form of prevention. I now know that prescription drug abuse is everyone’s problem because it doesn’t discriminate by race or socioeconomic status; everyone is at risk. I work voluntarily as a Parent Partner with The Partnership at Drugfree.org, a national non-profit organization whose mission is to help solve the problem of teen substance abuse. As a Parent Partner, I have access to scientific information, educational programs, and professional assistance. Please help me honor Justin and Bobby by allowing me to share these resources with you.
