This is where heroin al­most killed her

De­spite soar­ing rates of ad­dic­tion, treat­ment re­mains hard to ac­cess and pro­hib­i­tively ex­pen­sive

The Washington Post Sunday - - FRONT PAGE - BY MARC FISHER AND KATIE ZEZ­IMA IN MAYS LAND­ING, N. J.

Ash­ley Gib­bons had been hold­ing it to­gether, or so she told her­self. Sure, she had sold off her elec­tron­ics, stolen money from her mother and slept with guys who gave her money. But it wasn’t as if she was an ac­tual pros­ti­tute: “I didn’t go and find ran­dom peo­ple. I knew them,” she said.

She had tried heroin for the first time at 21, four years ago, and for a long while, it re­mained an oc­ca­sional thing. But she needed more and more to get high, and, though she held onto her job, pretty soon ev­ery­thing else was fall­ing apart.

Ash­ley’s mother, Alicia Gib­bons, tried to­gether daugh­ter into re­hab. She called at least 20 places, and they ei­ther didn’t have a bed avail­able or didn’t take her in­sur­ance.

One place said it had room — but then said Ash­ley wasn’t us­ing enough heroin to qual­ify. At another fa­cil­ity, man­agers ac­cepted Ash­ley, but when she got off the bus, they de­nied her ad­mis­sion

she had used heroin in the pre­vi­ous few days and this pro­gram was only for peo­ple who were clean.

There were so many re­jec­tions that, at one point, Alicia said she handed her daugh­ter “a ra­zor and told her to cut her arm so they would put her in the men­tal hos­pi­tal be­cause they would detox her” there.

Ash­ley hit bot­tom last year. Af­ter spend­ing two months in jail, she bought four bags of heroin and shot up two. She re­turned, still high, to the three-story town­house she shares with her mother, her mother’s boyfriend, her four sib­lings and her 5-year-old daugh­ter.

Ash­ley drew a bath inthe up­stairs bath­room, the one with an in­flat­able puffer fish dan­gling fromthe ceil­ing and prints of hump­back whales and fish on the walls. She climbed in and in­jected two more bags of heroin. Then she nod­ded off, her head slip­ping un­der the wa­ter.

Down­stairs in the liv­ing room, where a mir­rored sign reads “Hope,” Alicia won­dered why she hadn’t heard her daugh­ter leave the bath­room. She bounded up stairs. Jig­gled the han­dle of the door. Locked. She banged on the door, called Ash­ley’s name. Si­lence. Banged again, screamed her daugh­ter’s name. Noth­ing.

Alicia raced down­stairs and got her boyfriend, Jose Vega, who ran up and broke through the bath­room lock. Ash­ley “was bluegray, no pulse,” her mother said. Alicia and Vega pulled her onto the tile floor. Vega fu­ri­ously started CPR, although he’d never learned it. “It just kicked in,” he said. Ash­ley’s sis­ter called 911 while Alicia ran to her bed­room and pulled out her nalox­one kit, a leop­ard-print cos­metic case con­tain­ing three nee­dles and a vial of the drug that re­v­erses the ef­fects of a heroin over­dose. Alicia had taken a course on the drug while Ash­ley was in jail. Now, she trem­bled as she pushed the nee­dle into the vial— and broke the nee­dle.

The sis­ter yelled at the 911 op­er­a­tor, Vega kept try­ing CPR, and Alicia at­tached another nee­dle. This time, the drug flowed into the sy­ringe. The mother plunged the sharp into her daugh­ter’s arm. Twice more, she filled the sy­ringe and in­jected her daugh­ter. Fi­nally, Ash­ley started to con­vulse.

“All of a sud­den, I came to and I puked up all this wa­ter,” Ash­ley said. “I was so high, though. It sounds hor­ri­ble, but that was, like, the best and the worst high I ever had inmy en­tire life. I’ll never feel that again un­less I over­dose and die and come back again.”

That time, Ash­ley got into a re­hab fa­cil­ity for two weeks of treat­ment and then into a half­way house, where the state paid most of her bill through a pro­gram for peo­ple younger than 25. But Ash­ley turned 25 while she was there and was told she had to leave, in part, she says, be­cause she hadn’t been fol­low­ing the rules. She now owes the fa­cil­ity $3,000.

“I don’t have it,” she said. “I make $8.75 at Shop Rite, and that’s $150 a week. I’m an ad­dict, not a rich bitch.”

Through it all, Alicia has kept push­ing to get Ash­ley the treat­ment she needs. A tone point, the mother got so des­per­ate that she called the cops in the hope of get­ting her daugh­ter ar­rested.

“I just wanted her away,” Alicia said. “It takes get­ting into trou­ble to get man­dated to go away. I kept press­ing charges against her. Charges, charges, charges.”

Rates of heroin ad­dic­tion and fa­tal over­dose are sky­rock­et­ing in the United States, and a po­lit­i­cal con­sen­sus has emerged to em­pha­size treat­ment over crim­i­nal pros­e­cu­tion. But there’s lit­tle agree­ment on how to pay for more treat­ment, leav­ing ad­dicts fac­ing ob­sta­cles so daunt­ing even a healthy per­son would strug­gle to over­come them.

Treat­ment cen­ters are of­ten pro­hib­i­tively ex­pen­sive, over­crowded, un­der­funded and sub­ject to byzan­tine gov­ern­ment rules. Health in­sur­ance cov­er­age is stingy to nonex­is­tent. Andthe so­cial stigma of heroin ad­dic­tion is still so po­tent that many users and their fam­i­lies are re­luc­tant to seek help in the first place.

That leaves one sure route into re­hab: “Treat­ment in the over­whelm­ing ma­jor­ity of cases be­gins be­hind bars,” said Jim McGreevey, the for­mer New Jersey gover­nor, who runs an ex­per­i­men­tal treat­ment pro­gram in Jersey City.

The need for more treat­ment is acute, said Obama ad­min­is­tra­tion drug czar Michael Bot­ti­celli, who es­ti­mates that up to 80 per­cent of heroin ad­dicts are never treated.

“We’re ap­proach­ing the same mor­tal­ity rate as at the height of the AIDS epi­demic,” he said. When ad­dicts first get treated in jail, “it means we have missed so many op­por­tu­ni­ties.”

In many states, gover­nors have tack­led the epi­demic more force­fully with rhetoric than re­sources. In Maine, where the num­ber of peo­ple seek­ing treat­ment for heroin ad­dic­tion has tripled since 2010, Gov. Paul LePage (R) has called on lawen­force­ment “to dis­rupt the drug sup­ply and hunt down the traf­fick­ers” while he has sought to cut Med­i­caid en­roll­ment and cov­er­age, say­ing state health-care pro­grams are too gen­er­ous.

Ver­mont Gov. Peter Shum­lin (D) de­voted his en­tire State of the State ad­dress last year to what he called “a full-blown heroin cri­sis.” The state at­tacked its wait­ing lists, lead­ing to a 40 per­cent in­crease in the num­ber of ad­dicts get­ting treat­ment. But over­dose deaths have con­tin­ued to climb. Ver­mont also adopted a “good Sa­mar­i­tan” law grant­ing im­mu­nity from pros­e­cu­tion to any­one who calls for help if they wit­ness an over­dose.

In New Jersey, Gov. Chris Christie (R) has made treat­ment a corner­stone of his pres­i­den­tial cam­paign, declar­ing in one TV ad that “we need to be pro-life for the 16-year-old drug ad­dict who’s lay­ing on the floor of the county jail.” But while Christie has signed bills aimed at im­prov­ing ac­cess to preven­tion and treat­ment, “there’s no money to in­crease the num­ber of beds,” said state Sen. Joe Vi­tale (D), one of the leg­is­la­ture’s most per­sis­tent treat­ment ad­vo­cates.

Mean­while, pri­vate in­sur­ance com­pa­nies of­ten deny cov­er­age for sub­stance-abuse treat­ment, ac­cord­ing to a re­cent sur­vey by the Na­tional Al­liance on Men­tal Ill­ness. In New Jersey last year, just 10 per­cent of sub­stance-abuse ad­mis­sions were cov­ered by pri­vate health in­sur­ance — down from 22 per­cent the pre­vi­ous year.

Pres­i­dent Obama’s Af­ford­able Care Act was sup­posed to ad­dress this prob­lem: It re­quires in­sur­ers to treat ad­dic­tion like any other medi cal con­di­tion. But the law only went into ef­fect for many in­sur­ance plans in Jan­uary. Bot­ti­celli ac­knowl­edged that “there’s room for greater en­force­ment,” adding that the ad­min­is­tra­tion is in­ves­ti­gat­ing com­plaints of de­clined cov­er­age, higher co-pays and re­im­burse­ment lim­its.

The in­sur­ance com­pa­nies’ ap­proach to sub­stance abuse is “hugely short­sighted,” Bot­ti­celli said. “There are huge eco­nomic costs to un­treated ad­dic­tion.”

Heroin users who are ar­rested at least get free— if med­i­cally unsound— detox sim­ply by be­ing locked up. If they’re lucky, they can move on to in­ten­sive re­ha­bil­i­ta­tion and maybe a pe­riod in “sober hous­ing,” half­way houses de­signed to keep them ab­sti­nent long enough that, with con­tin­ued ther­apy, it might stick.

But a bliz­zard of bu­reau­cratic rules makes it hard to land in these fa­cil­i­ties. Many heroin ad­dicts sell to their friends, and fed­eral law pro­hibits any­one con­victed of drug dis­tri­bu­tion from re­ceiv­ing wel­fare ben­e­fits. That life­time ban means no rent vouch­ers, no food stamps and, of­ten, no abil­ity to pay for treat­ment.

In­creas­ingly, states are opt­ing out of this ban. New Jersey has not, although Christie signed a law lift­ing it for in­mates who agree to un­dergo drug treat­ment in prison.

“What was meant to be a de­ter­rent has be­come a crush­ing, de­bil­i­tat­ing post-in­car­cer­a­tion sen­tence,” McGreevey said. “The only way we can al­ter the be­hav­ior of us­ing and selling drugs is to, for a lim­ited pe­riod, en­sure that [ad­dicts] are able to eat, have sober hous­ing— and get treat­ment.”

In a store­front in a run-down sec­tion of Jersey City, McGreevey at­tacks ad­dic­tion with ev­ery tool at his dis­posal. His pro­gram of­fers re­leased pris­on­ers ca­reer train­ing, job­place­ment coun­sel­ing and con­tin­u­ing ther­apy. It pro­vides hous­ing in a fa­cil­ity where ev­ery­one must be em­ployed or in school. And its 56 vol­un­teer lawyers per­suade judges to con­vert ad­dicts’ fines into jail time, so they can leave de­ten­tion with a clean slate.

“Ba­si­cally, you have to come here from jail, but with­out this place, you’d be right back in jail,” said Sean Mc Clin­tock, 47.

Two years ago, McClin­tock, the burly son of a fire chief, was caught shoplift­ing to raise money for heroin. He tried to get into a detox fa­cil­ity in New Jersey but was told that he’d have to get on a wait­ing list. A help­ful nurse gave him ad­vice on the sly: Take the train un­der the Hud­son River and try one of New York City’s more gen­er­ously funded hos­pi­tals. That same night, McClin­tock walked into the emer­gency room at Man­hat­tan’s Belle­vue Hos­pi­tal and was put in a seven-day detox pro­gram, even though he had no in­sur­ance.

McClin­tock went to jail on the shoplift­ing charge and con­nected with McGreevey’s pro­gram. It now pro­vides him with hous­ing and a job, as well as reg­u­lar drug test­ing and coun­sel­ing.

Af­ter spend­ing most of his adult life be­hind bars, McClin­tock has been out and clean for nearly two years, he said — “the long­est I’ve been out of jail since I was 19.”

About a quar­ter of McGreevey’s clients re­lapse, a rel­a­tively low rate, given that most ad­dicts re­turn to drugs and crime at least once af­ter treat­ment. But Mc Greevey’s state con­tract

pro­vides care for only 284 peo­ple; New Jersey recorded 781 heroin over­dose deaths last year.

In South Jersey, Michael and Darla DeLeon’s cell­phones ring around the clock with pan­icked par­ents try­ing to get their chil­dren into treat­ment. The cou­ple— he’s a re­cov­er­ing heroin ad­dict who spent a decade be­hind bars — travel the coun­try teach­ing par­ents about heroin and ob­sta­cles to treat­ment.

“I can’t tell you how many peo­ple we lost on wait­ing lists,” Darla said.

Here, as in­many places with soar­ing over­dose num­bers, the most im­me­di­ate ac­tion taken to com­bat heroin-re­lated deaths has been to make it eas­ier to ob­tain nalox­one, also known by its brand name, Nar­can. A few states have even made nalox­one avail­able with­out a pre­scrip­tion.

But the DeLeons and some other treat­ment ad­vo­cates are wary of re­ly­ing too heav­ily on nalox­one. It saves lives in mo­ments of cri­sis but does lit­tle to steer ad­dicts away from the drug.

“I had a girl Nar­caned nine times, and she died with a nee­dle in her arm,” Darla said.

Some states have re­sisted ex­pand­ing ac­cess to nalox­one. In Maine, LePage ar­gued that be­ing brought back to life could cre­ate “a false sense of se­cu­rity that abusers are some­how safe from over­dose.”

“Re­viv­ing a per­son from an over­dose is good, but that’s the be­gin­ning of some­thing, not the end of some­thing,” said Robert L. Du Pont, who served as White House drug czar in the 1970s and was the first di­rec­tor of the Na­tional In­sti­tute on Drug Abuse.

Du Pont ad­vo­cates mak­ing treat­ment and long-term mon­i­tor­ing manda­tory for peo­ple saved by nalox­one. In South Jersey, Ocean County Pros­e­cu­tor Joseph D. Coronato is work­ing to make that hap­pen.

Ocean County has one of the state’s high­est rates of heroin ad­dic­tion. Ad­dicts saved by nalox­one used to be in and out of the ER in a few hours, sta­bi­lized and ready to get high again. But un­der an in­no­va­tive agree­ment fi­nanced with drug for­fei­ture funds, lo­cal hos­pi­tals pro­vide emer­gency in­ter­ven­tion, clear­ing an ad­dict’s path to im­me­di­ate detox and re­hab.

Be­cause of health-care pri­vacy laws, the county does not have data on how many over­dose vic­tims have been moved to re­hab. But the county’s rate of fa­tal over­doses ap­pears to have slowed some­what, from 101 in 2014 to 68 in the first nine months of this year.

Some­times, against all odds, the sys­tem works. Pa­trick Cu­ra­tola had never met any­one who used heroin. He’d never been ar­rested. He’d never even taken the bus. He grew up in the sub­urbs. Good fam­ily. Money no prob­lem.

As a teen, he smoked weed with friends. In his early 20s, he dab­bled in tran­quil­iz­ers such as Val­ium and Xanax. A few years later, his brother gave him “blues,” or Rox­i­codone, a nar­cotic pain re­liever that he took af­ter work.

“That feel­ing of melt­ing in­tomy bed at night felt real good,” said Cu­ra­tola, now 33.

He started tak­ing more and more pills. When his girl­friend ob­jected, he found his way to a Nar­cotics Anony­mous group and then an out­pa­tient pro­gram, which ac­cepted him even though he didn’t have in­sur­ance. Af­ter five months in the pro­gram, Cu­ra­tola said, he was clean for the first time in years.

It didn’t last. A few weeks af­ter the pro­gram ended, he wanted to get high and went to his brother, who by then had grad­u­ated to heroin.

“I’d never seen heroin in my life,” Cu­ra­tola said. “I was scared to death I was go­ing to die.” But the high oth­ers de­scribed was so al­lur­ing and the drug so much cheaper than any­thing he’d used — “$15, I was good for the night” — that he started sniff­ing.

Three months later, he over­came his fear of in­jec­tions and shot up.

“The eu­pho­ria I felt within five sec­onds was un­like any­thing I ever felt,” he said. He never sniffed again.

Within weeks, Cu­ra­tola was buy­ing heroin on the street and steal­ing from his par­ents— cash, their TV, their jew­elry. A few months later, hewas pulled over in a traf­fic stop; po­lice found heroin and ar­rested him. The first thing he did af­ter leav­ing the po­lice sta­tion was buy more heroin.

Af­ter his fourth ar­rest, in 2011, Cu­ra­tola went through with drawal in a jail cell in Bergen County, N. J. The pros­e­cu­tor of­fered to move his case to drug court, which would get him treat­ment in ex­change for a strict reg­i­men of drug test­ing and coun­sel­ing. Five days af­ter he agreed to the deal, he was sent to a six-month, state-funded out­pa­tient pro­gram.

Then it ended. And Cu­ra­tola “felt like ev­ery once in a while I de­served a bag of heroin.”

Last year, he was ar­rested again. Af­ter four months in jail, he was sent to In­tegrity House, a state-funded re­hab fa­cil­ity, where he was treated for ad­dic­tion, anx­i­ety and de­pres­sion. Then he moved to a sober half­way house, where he got help find­ing a job as a waiter.

Now Cu­ra­tola is in an out­pa­tient pro­gram, fi­nanced with his Med­i­caid and state wel­fare ben­e­fits, which are paid di­rectly to In­tegrity House. He has stayed on track, even af­ter his brother died of a heroin over­dose.

Cu­ra­tola’s story is the ano­maly, McGreevey said: “Far more com­mon is the an­guished call I get from the par­ent of an 18-year-old son over whom the par­ent has no le­gal au­thor­ity and they’re try­ing to se­cure a bed some­where ... and there’s noth­ing for them.”

But Cu­ra­tola has been clean for nearly a year now, and he’s start­ing to talk about the fu­ture.

“I still have a lot to prove,” he said. His par­ents cut him off af­ter too many lies; his fa­ther died last fall, be­fore they could rec­on­cile.

“I’m still deal­ing with the guilt of not be­ing there the one time he needed me,” Cu­ra­tola said. “That’s my in­spi­ra­tion now, to do right by my dad and make him proud.”

LINDA DAVID­SON/THE WASHINGTON POST

Ash­ley Gib­bons sits on the tub in which she was found “blue-gray, no pulse” af­ter a heroin over­dose last year. She says, “That was, like, the best and the worst high I ever had inmy en­tire life.”

PHOTOS BY LINDA DAVID­SON/THE WASHINGTON POST

About this se­ries: From the New Eng­land coun­try­side to the cities of the Mid­west, the most deadly epi­demic of heroin use in half a cen­tury is tear­ing at the fab­ric of Amer­i­can life. In this se­ries of ar­ti­cles, The Washington Post ex­am­ines why heroin has made such a pow­er­ful come­back, how wellinten­tioned gov­ern­ment poli­cies have fu­eled de­mand for the drug and why enor­mous hur­dles stand in the way of bring­ing the epi­demic un­der con­trol. Ash­ley Gib­bons and her boyfriend, Chris Hopper, hang out at her fam­ily’s home in Mays Land­ing, N.J. Gib­bons, who first tried heroin four years ago, is bat­tling ad­dic­tion, and her mother has been push­ing to get her the treat­ment she needs.

SeanMcClin­tock, be­low left, is a re­cov­er­ing heroin ad­dict who has spent most of his adult life be­hind bars. McClin­tock, 47, says he has been clean since he con­nected two years ago with an ex­per­i­men­tal treat­ment pro­gram run by for­mer New Jersey gover­nor Jim McGreevey, be­low right, that pro­vides him with hous­ing and a job, as well as reg­u­lar drug test­ing and coun­sel­ing.

LINDA DAVID­SON/THE WASHINGTON POST

At the New Jersey mau­soleum where his grand­par­ents are in­terred, Pa­trick Cu­ra­tola, 33, grieves for his fa­ther, who died last fall while they were es­tranged, and his brother, who died in July of a heroin over­dose. Cu­ra­tola, a re­cov­er­ing heroin ad­dict, is in an out­pa­tient pro­gram fi­nanced with his Med­i­caid and state wel­fare ben­e­fits.

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