Long waits for treat­ment add to ad­dicts’ des­per­a­tion

The Washington Post Sunday - - CHEAP FIX: HEROIN’S RESURGENCE - BY MARC FISHER marc.fisher@wash­post.com

port­land, maine — Shawn Cross thought heroin was mak­ing him an ex­cel­lent man­ager at the auto parts store where he had gone from de­liv­ery guy to man­ager in five years. On the job, ev­ery day, ev­ery four hours, he snorted opi­ate pills or heroin.

He hired ad­dicts be­cause they might help him score drugs. Some­times he missed work to drive his sup­plier two hours south on In­ter­state 95 to Haver­hill, Mass., where the dealer would call Do­mini­can gang mem­bers, who would ar­range a meet­ing along a coun­try road, a quick hand-off car to car.

Cross had held it to­gether while he was snort­ing Oxycon­tin, the pre­scrip­tion painkiller. But when the sup­ply of illegal pills started to dry up five years ago, Cross did what he had promised him­self he would never do: He made the switch to heroin.

“The with­drawals just trump ev­ery­thing,” he said, “and that’s what was avail­able.”

Heroin de­liv­ered the most al­lur­ing highs he had ever ex­pe­ri­enced and drove him to a des­per­a­tion he had never imag­ined. Af­ter a three-year de­scent into des­ti­tu­tion, Cross would be­gin another quest, one that be­dev­ils mil­lions of ad­dicts na­tion­wide: a fran­tic, frus­trat­ing search for treat­ment.

From the mo­ment he started us­ing heroin, Cross thought of him­self as a lost cause. “If you’re do­ing just pills, you can tell your­self, well, doc­tors pre­scribe them. You can tell peo­ple you’re do­ing pills,” he said. “You don’t get to­gether with your friends and say, ‘Let’s do some heroin.’ ”

He spent all his in­come, and more, on drugs — easily $1,000 a week. He stopped pay­ing for heat­ing oil. He stopped pay­ing rent. He per­suaded his re­luc­tant mother to take in his girl­friend and dog; his mother made him sleep in his car.

Af­ter a time, there was no plea­sure in it. Cross did drugs to avoid feel­ing sick. Des­per­ate for treat­ment, he went to the only re­hab cen­ter in the area that ac­cepted men as pa­tients, Mercy Re­cov­ery Cen­ter. It was full. With lim­ited state fund­ing and low re­im­burse­ment rates from Med­i­caid, there was lit­tle in­cen­tive for med­i­cal fa­cil­i­ties to add longterm re­hab beds.

Last month, Mercy, Maine’s largest treat­ment cen­ter, closed its doors and elim­i­nated 250 beds be­cause of de­clin­ing in­sur­ance re­im­burse­ment rates. For ad­dicts such as Cross, that leaves only the state-funded re­hab pro­gram; the wait is 18 months.

And a po­lit­i­cal bat­tle over treat­ment fund­ing threat­ens to add to ad­dicts’ des­per­a­tion in Maine: Last year, about 40 per­cent of heroin ad­dicts who got treat­ment were put on methadone ther­apy. But Gov. Paul LePage (R) has pro­posed end­ing state fund­ing for methadone treat­ment, sav­ing about $1.6 mil­lion over two years.

LePage wants ad­dicts to be treated with sub­ox­one, another re­place­ment opi­ate that sat­is­fies crav­ings but doesn’t make the user nearly as high. But sub­ox­one can be pre­scribed only by doc­tors who have un­der­gone spe­cial train­ing, and fed­eral rules al­low each physi­cian to treat only 30 pa­tients at a time — or up to 100 with ap­proval from drug en­force­ment of­fi­cials. The strict con­trols shut out many ad­dicts, leav­ing them to self-med­i­cate by buy­ing sub­ox­one on the street, ac­cord­ing to physi­cians, drug coun­selors and ad­dicts.

“We have nowhere to put peo­ple who don’t have a wealthy mother in the sub­urbs,” said Caro­line Teschke, who runs Port­land’s public health clinic. “Ev­ery day, we have peo­ple beg­ging for help. The only sure way to get help is to be a young preg­nant fe­male.”

“There’s no treat­ment,” added Maine At­tor­ney Gen­eral Janet T. Mills (D). “We had over­dose deaths in ev­ery county in the state last year, but we have fewer treat­ment fa­cil­i­ties and we’ve re­moved thou­sands of peo­ple from the Med­i­caid rolls. We don’t know how to deal with it. These are peo­ple who want treat­ment, and we have noth­ing for them.”

The dam­age mounts with each pass­ing month: Over the past three years, child abuse and ne­glect cases have shot up by 58 per­cent. Over the past decade, the num­ber of drug-af­fected new­borns has spiked by 600 per­cent.

As wait lists for re­hab grow longer, prop­erty crime has crept up, and more peo­ple have showed up at the home­less shel­ter in down­town Port­land. Ev­ery day this April, some­one in Maine died of a drug over­dose, Mills said.

“Ev­ery­one knows some fam­ily af­fected by heroin by now,” Mills said. “Fam­i­lies are start­ing to speak out; they’re say­ing ‘ heroin’ in the obituaries. But there’s still a level of em­bar­rass­ment about it: ‘Heroin, that doesn’t hap­pen here.’ ”

In in­ter­views, ad­dicts at a court-or­dered coun­sel­ing ses­sion in Port­land said users are re­sort­ing to des­per­ate mea­sures to get help.

“Go to jail,” said a man in his 30s. “Have a kid so you can get in­sur­ance.”

“Work the sys­tem — play the sui­cide card,” said a man in his 50s.

Cross’s mother found a doc­tor who put him on sub­ox­one. But Cross sold the pills to buy more heroin.

Fi­nally, Cross was ar­rested and charged with felony drug traf­fick­ing: He drove his dealer to an apart­ment where she sold to an un­der­cover agent. Af­ter his first stint in jail, he snorted Oxycon­tin in the park­ing lot as he left the fa­cil­ity. His dealer picked him up.

But af­ter another ar­rest, in 2013, this time for vi­o­lat­ing pro­ba­tion, Cross went to drug court and spent four months in jail — long enough to go through with­drawal. “The jails around here are ba­si­cally detox fa­cil­i­ties,” he said.

He went on sub­ox­one again but lost his in­sur­ance eight months later, af­ter state of­fi­cials re­fused to ac­cept fed­eral money to ex­pand Med­i­caid. More than 25,000 peo­ple were forced off the public health-care rolls.

With no sub­sidy, Cross’s outof-pocket cost for sub­ox­one would jump from a $3 co-pay to $700 a month. His doc­tor told him it was time to ta­per off the drug, quickly. He went through vi­o­lent with­drawal pangs for a month. Then he started work­ing again, for the first time in five years, build­ing houses, roof­ing.

He and his girl­friend now have a 10-month-old, a daugh­ter who has “never known me as an ac­tive ad­dict.”

“And she never will,” Cross said. “I owe her that.”


Shawn Cross, at his home in Lis­bon, Maine, is a re­cov­er­ing drug ad­dict who be­gan us­ing heroin af­ter switch­ing from opi­ate painkillers.

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