In and Out: Facilities Treat Opioid Patients During and After Their Stay
Recovery Centers of America is opening a 140-bed, 20-acre facility in Waldorf, Md., within 20 miles of Washington, D.C., in an area the company’s chief clinical officer describes as one with “very high needs” during the opioid epidemic in the United States that has exploded in recent years.
The U.S. Department of Health and Human Services says 116 people died daily from opioid-related drug overdoses nationwide in 2016, for a total of 42,249. Of that total, 19,413 died from overdosing on synthetic opioids other than methadone, and 17,087 died from heroin use.
The U.S. Justice Department recently announced a task force to investigate drug manufacturers and distributors for their roles in the epidemic and has aligned itself with cities, counties and medical institutions that are suing drug companies for reimbursements. U.S. Attorney General Jeff Sessions said the federal government also would seek repayment for its costs.
But in Washington, D.C., itself, the crisis looks different. Whereas synthetic opioids such as fentanyl and its analogues have ripped through many communities elsewhere and killed thousands of young people who have used drugs for just a short time, heroin is still very prevalent in the District, and the typical user is an older black male who has been shooting up for years, Health Department spokesman Tom Lalley said.
The D.C. Office of the Chief Medical Examiner reports there were 674 opioid deaths in the district from Jan. 1, 2014, through Dec. 31, 2017, with the highest single monthly total in November 2016. For 2017 alone, the total was 246 opioid deaths, the highest number in any single year. The number of opioids also increased from 120 found in the 2014 deaths to 473 for the 2017 victims.
The report said 80 percent of all opioid overdoses involved adults between 40 and 69 years of age, with the most deaths among those 50 to 59. Eight-one percent of the victims were black, most of them men, according to the report.
“We go into hard-hit areas where we can do the most good and serve the most people,” said Deni Carise, RCA’s chief clinical officer. The for-profit company, based in King of Prussia, Pa., has a second treatment center in Maryland, 108 miles away, in Earleville, along with other centers in Massachusetts, New Jersey, Pennsylvania and Delaware. Discussions also are underway throughout the northeast corridor for more facilities.
RCA put $25 million into renovating the Waldorf campus, the former Changing Point South treatment center. It is expected to open with 20 beds but to be at capacity by the end of the year.
“[Washington, D.C., is] an area with very, very high needs,” Carise said. “It’s also one of the most affluent cities in the world and it has a lack of adequate treatment facilities.”
Carise said all of RCA’s facilities are neighborhood-based so patients can take advantage of out-patient services once they have been released from inpatient status. Family and friends also can participate in therapy and education sessions so they can help build a sober recovery support network.
Typically, outpatient services are provided for eight weeks, though Carise said patients would benefit from nine months of support.
The crisis began in the 1990s when pharmaceutical companies began convincing doctors they could prescribe opioids without worrying their patients would become addicted. The result was the over-prescription of such medications. The White House Council of Economic Advisers has pegged the costs to the nation at $504 billion.
Maryland experienced a sharp increase in opioid-related deaths in 2017. The Maryland Department of Health reported 1,029 people died from opioids — mostly due to fentanyl — in the first half of that year, compared with 244 in 2010. The governor of neighboring Virginia has declared the opioid crisis a public-health emergency, saying that by the end of 2016, the number of deaths was up 77 percent from 2014. In response to the crisis in West Virginia, where 884 opioid deaths were reported in 2016, the Legislature created the Office of Drug Control Policy to try to stem the carnage.
“The problem won’t go away anytime soon,” RCA’s Carise said. “We’ve created whole communities where people reach for opioids for any kind of pain. Whole families [are] dependent on opioids.”
What makes the problem worse is the stigma still associated with addiction, according to both Carise and to Doug Tieman, CEO of the nonprofit Caron Treatment Centers, which is based in Wernersville, Pa., and has facilities in Pennsylvania and Florida.
“This is not about willpower or choices or moral laxness,” Tieman said, adding that addiction should be treated like any other chronic condition, such as diabetes, heart disease or asthma. “You wouldn’t give a diabetic 30 days of insulin and then tell them to go home and manage their disease through diet.”
Tieman said inpatient treatment needs to be followed up with outpatient programs — and not just for a few weeks. Tieman said various studies show that mandatory follow-up is essential for keeping a patient sober and that 60 percent maintain sobriety after five years if they stick to their recovery and 12-step programs. About 20 percent relapse after their first year, and 14 percent are not sober but say their lives are better.
“From a chronic illness perspective, that’s not bad,” Tieman said.
Carise noted most adolescents get hooked on pain pills after rummaging through the medicine chests of their parents or their friends’ parents. Junior high and elementary students get the drugs from older siblings. Even the real-estate industry has a problem: House hunters are going through the medicine chests of homes on the market.
Doctors have been prescribing 30 days of painkillers for three days of pain. When the pills run out, those who have become addicted may turn to heroin. Until eight years ago, most of the heroin in the U.S. came from Colombia. Now the majority comes from Mexico, and it is stronger and less expensive than in the past. Synthetic opiates and their precursors are coming in from China and Mexico. They are cheaper, more deadly and, in some cases, can be ordered online or made at home. Change one molecule and law enforcement can’t test for them.
“Addiction to opioids right now is different than anything I’ve seen in the past,” Carise said. “It’s so quick. Ten to 25 years ago we saw long-term users. Today it’s people who started with [oxycodone] at a party last summer. Now in February, they’re in treatment for heroin. There’s a really big difference. The trajectory from drug naïf to addict is very fast.”
RCA prides itself on being in-network for 90 percent of insurance programs so that patients aren’t hit with huge medical bills for their treatment. An average 30-day stay would cost $25,000 for someone without insurance, whereas the average RCA patient paying less than $1,500 out of pocket for co-insurance and a deductible.
Tieman said rehab costs around the country range from $5,000 to $100,000, depending on the services offered. He also noted that until 2005, the majority of treatment centers were nonprofits. That began changing in 2008 during the recession, when charitable donations began drying up. The Affordable Care Act, mental-health parity legislation and some other factors prompted investors to get involved. In 2010, less than $100 million was invested in the substance use disorder field. By 2016, that figure had grown to slightly less than $3 billion.