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Sentencing addicts to death
Cutting state funding for detox programs will take a human toll, and it’s not even good fiscal policy

Not a chance

FOR SIX DAYS in early May, Lisa P., a 31-year-old Boston resident who has asked that her last name not be published, witnessed firsthand just how strained the state’s detox system has become. A long-time heroin addict who’s mixed her habit with the occasional snort of cocaine, Lisa took in the scene at CAB Health and Recovery Services, in Boston. Across the hall from where she sat slumped in a chair, lethargic from medication, five doors opened to reveal five rooms, all empty but for 15 detox beds. Some were stored away, folded, crammed into corners. Others stood vacant, stripped down to a thin sheet. Clients shuffled about the floor — many with a confused look that said, in Lisa’s words, "they don’t have a chance."

The scene inspired a sense of fatalism in Lisa, a squat, hefty woman whose bangs fall just above dark, leaden eyes. After all, she knows the score. She knows the struggle of addiction and, she says matter-of-factly, "I know I will die if I don’t quit." She’s already had too many of what she calls "near-death experiences." She’s shared needles; she’s prostituted; she’s overdosed. The way she figures it, death is just a matter of time — unless she can manage her newfound sobriety.

"I do want to stay clean," Lisa asserts. Still, she’s tried to kick her heroin habit several times since getting hooked at age 18 — to no avail. She worries about the possibility of yet another relapse. With no health insurance to speak of, and with the dearth of "free care" detox beds statewide, she fears what she may have to confront if her attempts at a clean-and-sober life were to fail.

"If you take away all the detox beds," she notes, "a lot of people will die." Maybe even her. While some substance abusers can sober up on their first trip to detox, it’s not unheard of for those who are chronically addicted, like Lisa, to go through detox four, five, or even 10 times before they’re finally able to stay clean. Chronic addiction afflicts people much like other chronic health conditions, such as diabetes or heart disease. In other words, it’s a lifelong battle.

As Lisa concludes: "People think addicts are worthless human beings who don’t deserve to live. But I know I could help people. I just need some help" to stay clean.

— Kristen Lombardi

THE STORY OF Sean P.’s attempts to get into a detox program earlier this month doesn’t illustrate the havoc that budget cuts are wreaking on drug addicts trying to get clean. It doesn’t illustrate the problem because Sean, a 30-year-old cook from Revere who has struggled with a heroin addiction for 11 years, eventually did make his way into detox. It took him two weeks and dozens of phone calls to detoxification centers around Massachusetts, but he made it. On his own, Sean, who spoke to the Phoenix on condition that his last name not be used, cut his 10-bag-a-day habit down to two after deciding to get clean. When he ran out of money for heroin, he turned to "a common pain medication," for which he’d had a prescription thanks to an old knee injury. When those pills ran out, he turned to his mother, with whom he was living, for money to buy a bag on the streets. Even though she knew her son was going to use the money to buy drugs, she handed it over. The drugs helped him manage the physical symptoms of heroin withdrawal — the violent shakes that make you feel as if your bones are rattling together, the searing headaches, the overwhelming nausea.

The reason Sean’s story is relevant nonetheless is because his is the exception that proves the rule that cutting Medicaid — the government-funded health-care program — puts people’s lives at risk. Substance-abuse-treatment providers interviewed for this article estimate that on April 23, the day that Sean first called a Boston-area detox facility in search of a bed, about 150 others did the same thing at facilities around the state. Most of them, like Sean, likely had no health insurance, and thus were told, as Sean was, that they’d have to wait two to four weeks until a "free care" bed opened up. Unlike Sean, they probably didn’t keep calling other facilities every day until a bed became available. Unlike Sean, they probably didn’t cut down on their habit to keep focused on the goal of getting clean. Unlike Sean, they probably couldn’t fall back on family members for support. And unlike Sean, they probably let the moment pass and resumed an active and destructive habit.

I don’t know this from interviewing these people. Such interviews would have been impossible to arrange. I had no way of finding the addicts and alcoholics who couldn’t gain access to detox programs — and neither did any of the program directors I interviewed, whose job it is to help those who want to get clean. Sure, addicts leave call-back numbers at drug-treatment facilities, which put their names on waiting lists. Frequently, though, these numbers are for a friend’s house, where the addict is crashing temporarily. By the time the center calls back, the addict is long gone. Or they leave the number of the pay phone from which they’d called. More often than not, addicts who’ve sunk so low that they’re finally willing to get clean have lost their homes. They don’t have cell phones. They shack up at shelters. And often, their families will no longer provide support because they’ve been burned one too many times. As Carol Eliadi, the director of the Worcester-based UMass-Memorial Community Healthlink detox program, where Sean eventually found a bed, puts it: "This population really needs service on demand. If they’re turned away, we almost always lose them."

It’s the detox worker’s best guess that most of the people who called looking for a bed on April 23, yet didn’t get one, have resumed prostitution or theft or both, just to support their habit. If these people aren’t arrested for the criminal activity in which they engage to pay for their drugs, they might call detox again. If they don’t overdose, they might call again. But, really, no one can say for sure what’s happened to them.

IF SEAN HAD decided to get clean just two months earlier, in February, he might have found a bed immediately. If not, he would have had to wait 24 to 48 hours, tops. Today, however, after millions of dollars in budget cuts to detox services, it’s become virtually impossible to find beds on demand. Community Healthlink keeps a waiting list for its 40 existing beds. In January, before the cuts went into full effect, the program turned away 10 people daily; now, the program turns away twice as many. Likewise, in Boston, CAB Health and Recovery Services fields an average 75 calls a day. In January, it admitted 14 people a day for services. In April, it admitted nine a day.

The budget reductions absorbed by detox programs stem from cuts to Medicaid, the joint state-federal program that provides health care to the poor. Since February, Medicaid (also known as MassHealth) has sustained three whacks of the budget ax in benefits that directly affect detox programs. First, Governor Mitt Romney wiped out Medicaid coverage for emergency-detox services as part of emergency cuts made in January to balance the fiscal year (FY) 2003 budget — for an estimated $7 million savings per year. Second, also under the emergency cuts, the governor got rid of Medicaid funding for second-stage-detox treatment, known as "Level B," which costs about $4 million annually. By far, though, the biggest hit came with the high-profile elimination of MassHealth Basic, a program that provided health insurance to some 36,000 chronically unemployed residents in the state — many of whom are long-term substance-abusers. At the same time, the Massachusetts Department of Public Health (DPH) has steadily reduced funding for substance-abuse services after two years of persistent budget cuts.

The result? As much as $26 million has been drained from the state’s detox system since the last of the budget cuts took effect on April 1. Such spending reductions have translated into a drastic decline in the number of detox beds statewide. In January, the state had subsidized as many as 997 detox beds. As of May 6, less than 500 detox beds remain. And by the end of the fiscal year, on July 1, the number is expected to drop to 420. As many as 15,000 Massachusetts residents, advocates estimate, will lose detox coverage as a result of the Medicaid cuts.

The cuts have all but crippled the state’s detox system. By April 1, when the MassHealth Basic coverage ceased to exist, CAB Health and Recovery Services, in Boston, was forced to shut down 20 of its 50 detox beds, including an entire 15-bed wing devoted solely to aiding female addicts in the city. CAB slashed another 41 beds from its Danvers detox clinic — dropping from 71 beds in March to 30 today. According to CAB president Kevin Norton, the Medicaid reductions have constituted a 50 percent loss in funding in a matter of months. "We had no choice but to reduce our beds," he says, as well as lay off 65 nurses, orderlies, and counselors last month.

In the scheme of things, though, CAB has fared well compared to others. Spectrum Health Systems, for instance, operates one of the most extensive substance-abuse treatment networks in 55 communities across Massachusetts — or, rather, it used to. In April, it dramatically downsized. Administrators shuttered a 24-bed detox center in Leominster, and reduced the number of beds at a Westborough facility from 77 to 35. All told, Spectrum got rid of 96 beds, making for a 70 percent reduction in its capacity. That means that it’ll be able to admit only 2200 people for detox services next fiscal year — as opposed to the 9500 it could accommodate when all its beds were up and running. Charles Faris, who heads Spectrum, says the Medicaid cuts are "like chopping off two legs of a four-legged chair. The system just couldn’t stand anymore."

Closer to the Hub, programs like the Cambridge and Somerville Program for Alcohol and Drug Abuse Rehabilitation (CASPAR) have also become what director Gail Enman calls "a casualty." Last month, the agency, located in Davis Square, boarded up its 40-bed detox program — which it opened last July after finishing a $1.5 million renovation. Because of slashes in Medicaid, CASPAR lost an estimated $1.8 million for detox services that it had administered to some 2000 people in less than a year. Says Enman, "Our whole program was decimated overnight."

So was the Beacon Recovery Center, a Greenfield-based detox program that closed its doors on May 9. When Beacon administrators took their 14 beds offline, they left Franklin County without a single detox facility. And because of Spectrum’s closure in Leominster, those who live in the area from Lowell to Greenfield — the north-central part of the state — now have no local detox services. Greenfield residents, for example, must drive 40 miles, to Springfield, to access such services. Or they must drive further east, to Worcester. Today, the closest detox, says Karen Moore, the vice-president of hospital operations at Franklin Medical Center, which ran Beacon, is located 30 miles away, in Pittsfield. "One of our concerns," she says, "is how people are going to seek help. If you have to drive 30 miles, will you seek it?"

Moore then offers up this observation: "This cut broadsided us in the field. I’m of the opinion that no good can come of it."

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Issue Date: May 23 - 29, 2003
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