All Posts tagged NJ Heroin addiction

How A Big Drug Company Inadvertently Got Americans Hooked On Heroin

Video

When she was 18, Arielle would come home every day and embark on what she calls an “Easter egg hunt.” She wasn’t looking for candy. Arielle was hunting behind stairwells and inside closets in her suburban Long Island home for the OxyContin bottles her cousin brought home from work at a pharmacy and was hiding from her mother around the house.

“I found them one day, and I wanted to try them because all of my friends were already hooked,” said Arielle, who asked that her last name be withheld to avoid hurting her chances of getting a job. “I would see [my cousin] nodding out on the couch and not really being present, and that was how I wanted to feel. My best friend had just passed away, so I was numbing out the feelings.”

It took about a year before Arielle moved from prescription painkillers into the illegal drug that killed her best friend: heroin. She snorted it for the first time after tagging along with a friend who was going to buy some. “I was like, ‘I love it,'” she said. Heroin was cheaper than prescription pills — about $10 a bag, compared to $60 to $80 per pill — and gave her a more potent high.

Her friend helped her inject the drug. “It was a feeling that I don’t think anyone should experience. Because once you experience it, you want to experience it over and over again,” she said. “ Next thing I know, I’m addicted.”

Arielle landed in a Long Island jail last year after she was caught breaking into a house and stealing money to buy drugs. Now 26 and living at a substance abuse treatment center, she says she’s all too aware that her story isn’t unique.

Between 1996 and 2011, the number of people who ended up in substance abuse treatment centers in Suffolk County, where Arielle lives, as a result of heroin jumped 425 percent, according to a 2012 special grand jury report from the county’s Supreme Court. During the same period, the number of people who landed in substance abuse treatment for opioid pill use spiked 1,136 percent, the report found.

Long Island is one of many areas of the country where heroin addiction is reaching harrowing levels, according to Gregory Bunt, the medical director at Daytop Village, a New York-based substance abuse treatment center. The crisis is getting renewed attention after actor Phillip Seymour Hoffman died last month from an apparent heroin overdose. The rise in heroin use mirrors a decade-long spike in abuse of prescription opioids — painkillers that are a medical cousin to heroin, but are legal as long as they’re prescribed by a doctor.

In recent years, more prescription drug abusers have started turning to heroin for a cheaper high as the price of pills skyrockets on the black market, Bunt said. Two factors have contributed to the cost increase: opioid addiction boosting demand and doctors becoming more cautious about prescribing opioids, decreasing supply, Bunt said.

Another reason for the price increase: The Drug War, according to a January 2012 report from Radley Balko. Government crackdowns have made it difficult for even reputable doctors to prescribe pain pills. To fill the void, doctors and others looking to make a buck off the prescription pills created so-called “pill mills” — offices that prescribe pain medication in high volume and often serve people addicted to the drugs.

The result: Nearly four out of five people who recently started using heroin used prescription painkillers first, according to a 2013 study from the Center for Behavioral Health Statistics and Quality.

“A lot of people who got in trouble with the prescription opiates are switching over to heroin, and they get more for their buck, so to speak,” Bunt said. In his experience, he added, much of the heroin available today is laced with other additives, like additional painkillers — making it more dangerous.

“Once you inject the heroin that’s available today, you’re at very high risk for fatal overdose,” he said.

See full-size image here.

Infographic by Alissa Scheller for The Huffington Post
For decades, opioid painkillers, like oxycodone, hydrocodone and morphine, had been used successfully to treat conditions like intense pain at the end of life for cancer patients and acute pain after an injury like a broken bone.

But everything changed when OxyContin — and the marketing campaign that came with it — started in the 1990s, experts say. The drug, developed by Purdue Pharma, had a time-release mechanism that spaced out its effects over a longer period of time.

In dozens of seminars in ritzy hotel conference rooms across North America, the company sold doctors on the idea that the time-release function made OxyContin perfect for a population of patients who were suffering from chronic pain. Representatives also argued that the drug’s spaced-out effects made it less likely that patients would get addicted — which was the main factor deterring many physicians from prescribing opioids for chronic pain.

“This campaign focused on convincing doctors that they shouldn’t worry about addiction, so the medical community was taught to believe that addiction to opiates was relatively rare,” said Andrew Kolodny, the director of Physicians for Responsible Opioid Prescribing.

The pitch was convincing, Kolodny said, because no doctor wants to believe that they’re keeping a patient in pain unnecessarily. By 2001, OxyContin had exceeded more than $1 billion in sales, and by 2003, nearly half of the doctors prescribing OxyContin were primary care physicians, according to a 2004 report from the Government Accountability Office.

“As prescriptions began to take off, it led to an epidemic of opioid addiction,” Kolodny said. “We all became much more likely to have opioids in our homes, so it created a hazard.”

“We have now this incredibly unusual public health crisis that’s essentially caused by physicians, caused by the health care industry,” said Meldon Kahan, the medical director of substance use services at the Women’s College Hospital in Toronto.

chart

Chart via the Harvard Kennedy School.
 

In 2007, Purdue and three of its top executives pleaded guilty to misleading doctors, regulators and patients about OxyContin’s risk of addiction. The company agreed to pay more than $600 million in fines. In 2010, Purdue developed a version of the drug that was harder to crush and snort or inject than the original, aimed at deterring abuse. In April, the FDA banned the original OxyContin and all of its generic versions from hitting the market.

Purdue Spokesman Raul Damas wrote in an email statement to The Huffington Post that “like any public health issue, opioid abuse is the result of many factors, not just one drug or one company.” Brand-name OxyContin represents a small share of oxycodone-based drugs on the market, and Purdue has taken steps to curb the addiction epidemic, like paying for addiction hotlines and working with law enforcement to help them better identify pills that are frequently abused.

“The recent increase in heroin abuse is an unfortunate result of many different factors, and what often gets lost is that prescription opioids play an important role in helping patients and physicians address the very real issue of chronic pain.” Damas wrote. “Purdue has led the development of abuse-deterrent opioids, but these efforts need to be complemented by public education and treatment, so that we address demand, as well as supply.”

People typically become addicted to the prescription pills in one of two ways, Kolodny said. The majority of younger users, like Arielle, find the pills lying around at home or at friends’ houses. But the other demographic suffering from prescription painkiller addiction — middle-aged Americans — typically get the pills from their doctors for things like chronic back or head pain. Once their bodies adjust, their doctors have to up the doses to mitigate the pain.

Betty Tully experienced this phenomenon firsthand. She went to her doctor in January of 2001, looking for a fix for the pain that had plagued her lower back for decades. Tully’s doctor said he had just the thing, a new “miracle drug” that could help her pain without putting her at risk of addiction. He started her on 20 milligrams of OxyContin. Soon, she was asking for more, so he upped her doses.

“By June, I was an absolute zombie. I couldn’t work anymore, I couldn’t drive my car anymore. I left my car running one day on the street,” the former real estate agent said. “I was calling his office and screaming that I needed this medicine.”

By the end of 11 months, Tully was on 280 milligrams of OxyContin per day. The mother of two, who had held down jobs since she was 12 years old, refused to leave the house for fear she’d miss a dose and go through terrible symptoms of withdrawal like nausea and profuse sweating. When she decided to get clean, it took her six years to completely get off the drug, and she says she’s lucky she was able to finally kick the habit. Indeed, according to Kolodny, “middle-aged women getting pain pills from doctors” are dying from overdoses at some of the highest rates in history. In 2010, 40 percent of U.S. drug overdose deaths were women, many of whom died from abusing prescription pills.

“I should be among those statistics,” Tully said. “There’s not many people that can take that much and be breathing every day.”

CORRECTION: Language was changed to clarify that while 40 percent of drug overdoses in 2010 were women, not all of them died from taking prescription pills.

 

 

 

 

 

More

Prescription Painkillers Seen as a Gateway to Heroin

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.

Details are still emerging about the last days of Philip Seymour Hoffman, the actor who died last week at 46 of an apparent heroin overdose. Yet Mr. Hoffman’s case, despite its uncertainties, highlights some new truths about addiction and several long-known risks for overdose.

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.”

Video|4:48

 

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.”

More

Heroin deaths surge at the Jersey Shore

 

 

http://investigations.nbcnews.com/_news/2014/01/13/22292970-heroin-deaths-surge-at-the-jersey-shore?lite

The Jersey Shore, famous for sun, fun and reality TV, now has a new and less welcome distinction. Deaths from heroin and prescription drug overdoses in Ocean County, N.J., already among the highest in the state per capita, more than doubled in 2013, and three residents have already overdosed in 2014.

“It is a suburban epidemic facing us throughout New Jersey,” said Angelo Valente, executive director of the Partnership for a Drug-Free New Jersey. “A lot of suburban counties are affected at dangerous levels.”

“This is no longer just an inner city issue,” said Al Della Fave, spokesman for the Ocean County prosecutor’s office.

 

In 2012, 53 people died of heroin and prescription drug overdoses in Ocean County, a boardwalked string of beach towns like Seaside Heights, home to the long-running reality series “The Jersey Shore.” Ocean County had already claimed the New Jersey state title for highest number of heroin-related emergency room admissions, ahead of urban counties like Hudson and Essex with larger populations. It led the state in 2011 with 11 percent of all admissions and again in 2012 with 11.4 percent of admissions, despite having less than seven percent of the state’s population.

Last year, the county death toll from overdoses soared to 112, with the majority heroin-related, roughly ten percent of a state total of 1,188 overdose deaths. Three locals have already died in 2014. Over the weekend, two men died of heroin overdoses in Point Pleasant and Seaside Heights. Local police have issued a warning about a possibly tainted brand of heroin being sold under the name “Bud Light.”

Della Fave said the popularity of heroin and related drugs has risen because of purity and price and that DEA reports show use is spreading in suburban and rural areas of New Jersey and Pennsylvania. Use of a needle is no longer a deterrent, said Della Fave, “because people are simply snorting the newer, purer product.”

Valente blamed the problem in part on young people’s access to medicine cabinets. “Prescription drugs are a gateway drug to heroin,” said Valente.

Ocean County prosecutors have even distributed warning cards to funeral homes so families understand the need to dispose of unused prescription medications, particularly those containing opiates, that may be left behind by the deceased. According to prosecutors, “It is our hope that these unused medications will be disposed of at the designated drop-off points so that they do not get into the hands of those who would use or sell them illegally.”

Della Fave also warned users that there’s still no consistency in how the product is cut. “Every time users take it,” he said, “they’re rolling the dice with their lives.

 

 

More

od

The War on Drugs is being fought against the wrong people. Prescription drugs kill more people than heroin and cocaine combined. On the other hand there’s marijuana which has cured some people of seizures, cancer, and various other ailments. Not to mention that it caused no deaths last year or at any other time in history. You would think that the FDA would advocate for it but instead it classifies marijuana as one of the most dangerous substances for human consumption. Sorry but I think it’s the FDA’s relationship with Big Pharma that is truly dangerous.

~Mentally Emancipated

More

FDA cracks down, finally, on painkillers: Our view

http://www.usatoday.com/story/opinion/2013/11/10/painkillers-prescription-drug-hydrocodone-fda-editorials-debates/3490545/

Doctors should be at forefront of curbing abuse.

SHARE 79 18 16 COMMENTMORE

The deadliest drug problem in America is not heroin or cocaine or even crack cocaine. It’s the abuse of perfectly legal prescription pain medications — familiar names such as Vicodin and Lortab and generic hydrocodone.

Last month, federal regulators finally got around to recommending stronger restrictions on access to these medications by limiting refills and mandating more frequent visits to doctors to obtain prescriptions. Now doctors, who helped create the problem, need to do their share to control it.

OPPOSING VIEW: New rules could harm patients

Fourteen years have passed since Ronald Dougherty, a doctor and addiction specialist, noticed something odd at his clinic in suburban Syracuse, N.Y.: More patients were addicted to legal drugs than to illegal narcotics. He petitioned the federal government to treat these drugs as the growing danger they were.

Dougherty, it turned out, was as prescient as the federal government was sluggish. Since 1999, overdose deaths from narcotic painkillers in the U.S. have quadrupled. Every day, they kill 45 people and send 1,370 to emergency rooms. By contrast, cocaine kills 12 people a day and heroin kills eight.

One addictive painkiller, hydrocodone, is the most prescribed medication in America — 4 billion prescriptions a year at last count. Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said “doctors caused” this epidemic. “We’re prescribing massive amounts of opiates,” he told us last week, “and patients are getting hooked.”

Dealing with the problem has been tricky. That’s because these medications are indispensable for some people with extreme, chronic pain — particularly from terminal illness that renders addiction meaningless. And because easy access has powerful support from patient groups, drug chains, drug makers and many physicians. These lobbies have impeded the most promising responses.

One of the best solutions is state prescription monitoring programs designed to prevent addicts from doctor-shopping. Some physicians, unaware that a patient is getting multiple prescriptions from several sources, become unwitting accomplices to addiction. Others get rich running pill mills.

Databases to monitor prescriptions and prevent overlap are finally running in almost every state. Pharmacists can record when they fill certain prescriptions, and doctors can check patient histories. But most doctors don’t use these registries — a failure both mystifying and outrageous. Doctors should be in the forefront of combating abuse.

To deal with this, a few states — Kentucky, New York and Tennessee, with more in the works — require doctors to query the database. New York’s database used to get, on average, 10,000 queries a month. In the two months since the mandate, there have been 2.7 million requests.

Florida’s approach — which targeted pill mills and made use of a strong database — cut hydrocodone deaths by 16% in the first half of 2012, compared with the preceding six months.

The Food and Drug Administration’s recommendation can do the same. Patients can only receive three, 30-day prescriptions at a time. They must see a doctor every 90 days to get new prescriptions.

The strict limits could make it harder for some rural or homebound patients to get necessary relief, suggesting a need for some narrow exemptions. But that shouldn’t be used as an excuse for further delay in dealing with such a deadly public health problem.

 

 

 

 

 

 

 

 

More

N.J. addicts suffer from shortage of drug treatment facilities

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
– See more at: http://www.northjersey.com/news/herion_paterson_drugs_rehab_parents.html?page=all#sthash.XsTeOA0h.dpuf

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
Print | E-mail
William and his mom, Judy Castiglione.
VIOREL FLORESCU/ STAFF PHOTOGRAPHER
William and his mom, Judy Castiglione.

More