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State and Local Level Efforts on Substance Abuse Treatment

An Ohio City Reaches out to Addicted Locals

Heroin and prescription drug abuse has reached the level of an epidemic in the US. According to the 2014 National Survey on Drug Use, 435,000 Americans in the 12+ age group were estimated to be current heroin users, which represents approximately 0.2 percent of this population.[3] 

The New York Times provides further illumination on heroin abuse rates and related facts, as follows:

  • From 2012-2013, there was a 39 percent increase in the number of heroin-involved fatal overdoses.
  • Of all individuals who currently use heroin, 75 percent started out using prescription opioids.
  • In 2014 alone, Mexico’s production of opium increased by 50 percent
  • Some states have experienced an outbreak of HIV and hepatitis C infections due to a rise in intravenous heroin abuse, including Kentucky, West Virginia, and Indiana.[4] 

The statistics on prescription pill abuse are just as alarming. Consider the following facts from the National Institute on Drug Abuse:

  • In 2010, there were an estimated 8.76 million Americans abusing prescription pills.
  • Within the prescription medications of abuse category, there are three main types: opioids (5.1 million), tranquilizers (2.2 million), and stimulants (1.1 million).
  • Approximately 52 million Americans who are 12 or older have recreationally used prescription medications at least once in their lifetime.
  • The US represents only 5 percent of the world population but consumes 75 percent of the world’s prescription drug supply.[5] 

Of all types of prescription medications of abuse, opioids (prescription painkillers) are linked closely with the heroin epidemic. Prescription opioids are synthetic drugs that are chemically designed, in part, to resemble opium. Heroin is categorized as an opiate because it is at least partially made of organically occurring opium (synthesized from the poppy plant). Notes Dr. Jay Unick, author of a 2013 research study regarding prescription opioid and heroin overdoses, people tend to use these drugs interchangeably. In other words, when you see a rise in the use of one, you will see a concomitant rise in use of the other.[6]  Researchers have also found that individuals who abuse opioid medications may seek heroin as a less costly alternative or if they cannot access the prescription pills.[7] 

The city of Middletown, Ohio, is only too aware of the heroin and opioid epidemic and its propensity to cause fatal overdoses. In response to a rise in local heroin- or opioid-involved overdoses, the city developed an emergency response team to follow up with individuals who have recently experienced a drug overdose. The team is composed of a paramedic, officer, and social worker, and their goal is to help the overdosed person to enter drug abuse treatment.[8]  The city and other donors have provided at least $150,000 in funding. The program is considered effective; from July 2015 to 2016, of 106 nonfatal reported drug overdoses in the city, 84 individuals agreed to enter an inpatient or outpatient program after they met with the three-person intervention team.[9] 

At this point, the program is reactive, which is expected when a drug epidemic is unfolding. However, this program can provide the infrastructure for a more layered set of drug abuse prevention services in the future. City officials are keen to see the program grow to the point where it can identify and help individuals who abuse drugs even before they experience an overdose. Those involved in the emergency response process argue that the compassionate approach — providing drug treatment instead of incarceration — appears to be the most effective way forward to curb the local prescription opioid and heroin epidemic.

Offering Help for Addiction

A Police Department in Maine Helps Residents on Heroin

Maine is also facing a heroin epidemic. In 2015, the first nine of months of the year saw 71 heroin overdose fatalities.[10]  In response, one town police department launched a new program. The Scarborough Police Department is home to Operation Hope. This program opens the police department’s doors to people experiencing addiction to heroin and other drugs. Individuals can come into the station and ask for help. At that point, trained officers will provide the individual with a seat in a safe waiting room as they look for an opening at a rehab center. From October 1, 2015 (its first month) through January 31, 2015, the program helped 109 individuals into rehab. Operation Hope is based on a model that is in operation in Gloucester, Massachusetts. But the Maine program differs in one important respect from the Gloucester program: From October through January 2015, 77 percent of the 109 people who needed helped were sent out of state for treatment (to states including Pennsylvania, New Hampshire, Arizona, and California).[11] 
Police Department in Maine

The reasons why residents seeking recovery help in Maine end up having to leave home for treatment reveals that Maine has myriad deficiencies in the architecture of its healthcare system. While Maine does have over 200 drug recovery centers, most are not set up to accept uninsured patients or those who have Medicaid. In fact, Operation Hope workers often have to look for charity beds in other states, which can be a daunting and time-consuming task. Those individuals who sought help from Operation Hope and were able to stay in Maine typically had private insurance or could afford to pay an estimated $10,000-$20,000 out-of-pocket per month for local recovery programs.

Although the Affordable Care Act requires insurance programs within its ambit to provide a minimum level of recovery services, Maine has not expanded its Medicaid program in a way that always helps low-income or no-income residents get adequate drug recovery services. Further, some treatment centers have found it difficult to rely on Medicaid to cover the cost of their recovery services. In 2014, two drug treatment centers in Maine closed; each facility cited financial problems, including low Medicaid reimbursements and the state’s failure to expand Medicaid.[12] 

While there isn’t information available as to how program participants fare in the long-term (and Operation Hope is a relatively new program), the intake levels and the socioeconomic diversity of participants demonstrate that Operation Hope is fulfilling an important local need. The idea that people who need drug treatment would feel comfortable walking into a police station reflects that as a society we really have moved away from seeing drug abuse as a crime. Operation Hope provides the type of compassionate response to substance abuse that this disease needs and deserves.

Prison Officials in Massachusetts Intervene on Inmate Addiction

No sector of society is immune from substance abuse, and this point is especially true in the penitentiary system. Of the approximate 2.3 million inmates in the US, an estimated 65 percent experience alcohol or drug abuse.[13]  This statistic is especially worrisome when one considers that comparatively only 9 percent of the general population experiences substance abuse. Even further, only an estimated 11 percent of inmates in need of recovery services receive treatment.[14] 

But the problem of addiction and under-treatment is not contained to prison. There is an aggressive cycle at work for many inmates. Upon release, they may relapse, which in turn motivates them to commit crimes to fund their drug abuse, which then lands them back in prison.

But a team of prison officials in Barnstable, a part of Cape Cod, Massachusetts, is intervening to help inmates stay out or get out of this cycle. The main treatment service they offer applies to inmates who are addicted to heroin or prescription opioids and about to be released. The prison treatment team can provide the inmate with Vivitrol, a drug that effectively blocks the high heroin or prescription pills induce. The medication can also reduce drug cravings. Vivitrol is indicated mainly for people who experience heroin or prescription opioid abuse.

The program has been in operation for at least four years and has led to a decrease in relapse rates among released individuals. Of those individuals who took Vivitrol at some point over the four-year program period, there was a 9 percent re-arrest rate. Compare this rate to the national statistic for recidivism: Within five years of release, 77 percent of drug offenders are re-incarcerated. Regarding drug relapse, of the 200 reported inmates who took Vivitrol at some point in the program’s first four years, approximately 50 percent maintained abstinence.[15] 

According to one corrections expert, one of the greatest challenges to the program is getting released individuals to continually participate. The individual must get a monthly Vivitrol injection in order for the opioid-blocking effects to be maintained. Further, the medication works better when the recovering person is also engaging in supportive aftercare services, such as an outpatient drug treatment plan, residence in a sober living house, weekly personal counseling sessions, and attendance at mutual-aid meetings, such as Narcotics Anonymous or the non-faith-based SMART Recovery group.

The Barnstable program has not been implemented at the federal level, but other states offer medication-based assistance to inmates who are experiencing heroin or prescription opioid abuse. Various state prison or jail systems have such programs in operation, including Missouri, Tennessee, Colorado, Kentucky, California, New York, and Maryland. In the future, the Federal Bureau of Prisons may offer this treatment. These states can be seen as important test programs, and if their success is evident and well-documented in the long-term, it will make a strong case for the federal government to implement this same program or one like it across the federal penitentiary system.

The hope is that one day the gap between treatment needs and delivery of treatment services in prisons and jails will close. This achievement would not only provide benefits within the penitentiary system but outside of it. If drug treatment programs in the prison and jail system can lead to a reduction in recidivism rates and help released prisoners to maintain sobriety, it’s a win for the individual as well as society.

Helping At Risk Demographics

Universities Supporting Recovering Students

College students can be particularly vulnerable to alcohol and drug abuse. In 1988, the State University of New Jersey, Rutgers reportedly created the first recovery support program on a college campus. According to The New York Times, at least 20 additional public and private schools now provide supportive services for students who have recently completed a drug recovery program or are actively in recovery.[16]  Some schools, such as Texas Tech University, use federal funds to develop the program. The availability of government funds for such programs reflects a widespread consensus that students need support where they live and study, and that drug abuse should never compromise a person’s ability to get a college education.

In 1988, Rutgers was truly in the vanguard with respect to on-campus recovery support. The state university dedicated two dormitories to students in recovery.[17]  The program’s administrators understood the reality of alcohol and other drug use triggers on campus. Providing recovering students with the option to live in specialized and separate accommodations not only helped to protect them from the unhelpful influences on campus, but also promoted the benefits of mutual aid between recovering students.

The following are some of the features of the Rutgers program that may also be found in other recovery programs at different schools:

  • Monthly house meetings with the acting recovery counselor
  • Free classes on relapse prevention
  • Ongoing group therapy sessions
  • Onsite Narcotics Anonymous or Alcoholics Anonymous meetings
  • Alcohol and drug free social programming
  • Participation in athletic teams and running groups[18] 

There is a universal consensus that the recovery process does not end when a person completes a rehab program. Aftercare is a critical phase of recovery. The availability of recovery support programs on college campuses helps not only to prevent relapse but also to ensure that recovery and getting a college degree are not mutually exclusive goals. As on-campus aftercare programs spread, starting or continuing college after completion of a rehab program may become an option for many. A life in recovery is not only about maintaining abstinence but also about welcoming opportunities, which for some may include a college degree.

Homelessness and Substance Abuse Treatment Efforts

Housing First is a nonprofit organization with a simple but powerful mission: provide housing first to chronically homeless individuals and then provide them with case management services, including substance abuse treatment (as needed).[19]  Housing First was considered a breakout approach when put into action in Los Angeles in 1988. Homelessness relief professionals had long been beholden to policies that required homeless individuals to be psychologically stable and drug-free before being transitioned into permanent housing.

Though Housing First has its opponents, this model is considered to be effective at keeping chronically homeless individuals in housing. A reported 85-90 percent of program participants remain in housing.[20]  One criticism leveled against the Housing First model is that it targets the chronically homeless and takes federal funding (albeit a reportedly small amount) away from other homeless groups, such as families.[21] However, this criticism doesn’t really undermine the goals and services of Housing First but suggests that government spending is too thin in the area of homelessness relief.

In terms of Housing First and the delivery of substance abuse treatment, a 2009 survey found that Housing First programs did not significantly reduce substance abuse compared to other housing programs.[22]  A look at other studies found mixed results. Studies of individual housing programs within Housing First found that it was more difficult for Housing First to retain individuals who were actively using drugs. The researchers did not go so far as to say that Housing First would not work for those who are actively experiencing substance abuse but noted that policymakers should consider a person’s current drug use status as a possible relevant factor in their ability to maintain permanent housing.[23] 

Homelessness is a complex problem, as is substance abuse. Some studies showed that individuals who were entering the Housing First program had moderate substance abuse levels. This intake information may reflect that people who are in the recovery process or who have a moderate substance use disorder are better positioned to benefit from a permanent housing opportunity than those who are severely addicted. The importance of research findings, such as these, is that they draw attention to the specialized needs of individuals who are experiencing substance abuse. The Housing First program has proven that it can keep participants housed, so it may be possible that the program can be modified to provide a level of supportive services that will help keep a recovering person housed.

Local communities and states are proving to be effective test labs, so to speak, for ideas on how to effectively and humanely address substance abuse. As discussed, one community may develop a model that can be implemented in another locale and prove just as effective. While not all local programs may be scalable, they can provide the building blocks for national programs.

Even when programs cannot produce positive outcomes, despite funding and the best intentions, they can serve as lessons on what not to do or what elements of a program need to be tweaked. Necessity remains the mother of invention and there’s a nationwide consensus that the US needs to stem the drug epidemic. Not only do local, state, and federal authorities need to help individuals into drug recovery treatment but they must also work to ensure such that services are actually available to all who need them.

 

[1] Loose, A. (May 1, 2015). “MCSO jails kids in TOUGH Tents program to prevent crime, drug abuse later in life.” ABC 15, Arizona. Accessed May 9, 2016.
[2] Ibid.
[3] “Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.” (2014). Substance Abuse and Mental Health Services Administration. Accessed May 9, 2016.
[4] The Number’s Behind America’s Heroin Epidemic.” (October 30, 2015). The New York Times. Accessed May 9, 2016.
[5] “Popping Pills: Prescription Drug Abuse in America.” (January 2014). National Institute on Drug Abuse. Accessed May 9, 2016.
[6] Popovich, N. (July 8, 2015). “Rapid rise of heroin use in US tied to prescription opioid abuse, CDC suggests.” The Guardian. Accessed May 9, 2016.
[7] “Abuse of Prescription Pain Medications Risks Heroin Use.” (January 2014). National Institute on Drug Abuse. Accessed May 9, 2016.
[8] McCrabb, R. (May 5, 2016). “Ohio Town to Create Response Team for Drug Overdoses.” EMS World. Accessed May 9, 2016.
[9] Ibid.
[10] Lawlor, J. (February 28, 2016). “Operation Hope helping addicts, but treatment depends on the charity of out-of-state programs.” Portland Press Herald. Accessed May 9,
[11] Ibid.
[12] Ibid.
[13] Vestal, C. (January 13, 2016). “Helping Drug-Addicted Inmates Break the Cycle.” The Pewter Charitable Trusts. Accessed May 9, 2016.
[14] Ibid.
[15] Ibid.
[16] Sullivan-Moore, A. (January 20, 2012). “A Bridge to Recovery on Campus.” The New York Times. Accessed May 9, 2016.
[17] Ibid.
[18] Ibid.
[19] “Housing First Model.” (n.d). Pathways National. Accessed May 9, 2016.
[20] Ibid.
[21] Law, V. (Spring 2007). “Too Much of a Good Thing.” National Housing Institute. Accessed May 9, 2016.
[22] Kertesz, S. et al. (June 2009). “Housing First for Homeless Persons with Active Addiction: Are We Overreaching?” The Milbank Quarterly. Accessed May 9, 2016.