October 25, 2014

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Heroin addicts face barriers to treatment

Patty DiRenzo holds a picture of her son, Salvatore Marchese, in her home in Blackwood, N.J. Salvatore died from a heroin overdose in 2010. (AP Photo/Mel Evans)

Patty DiRenzo holds a picture of her son, Salvatore Marchese, in her home in Blackwood, N.J. Salvatore died from a heroin overdose in 2010. (AP Photo/Mel Evans)

NEW YORK (AP) — As the ranks of heroin users rise, increasing numbers of addicts are looking for help but are failing to find it — because there are no beds in packed facilities, treatment is hugely expensive and insurance companies won’t pay for inpatient rehab.

Some users overcome their addictions in spite of the obstacles. But many, like Salvatore Marchese, struggle and fail.

In the course of Marchese’s five-year battle with heroin, the young man from Blackwood, N.J., was repeatedly denied admission to treatment facilities, often because his insurance company wouldn’t cover the cost. After abusing marijuana and prescription painkillers as a teenager, Marchese had turned to heroin for a cheaper high.

Then one night in June 2010, a strung-out, 26-year-old Marchese went to the emergency room, frantically seeking help. The doctors shook their heads: Heroin withdrawal is not life-threatening, they said, and we can’t admit you. Doctors gave him an IV flush to clean out his system, and sent him home.

Marchese and his sister stayed up all night calling inpatient treatment centers only to be told: We have no beds. We’ll put him on a waiting list. Call back in two weeks.

As Marchese grew sicker with diarrhea, body aches and shakes, his sister tried a new tack. She called one more place and told them her brother was using heroin and also drinking alcohol. That did the trick, because alcohol withdrawal can cause life-threatening seizures.

A banner and ornaments commemorate Salvatore Marchese in a memorial outside the home of his mother, Patty DiRenzo, in Blackwood, N.J. Salvatore died from an overdose of heroin in 2010. Salvatore was denied admission to treatment facilities again and again, often because his insurance company wouldn't cover the cost. (AP Photo/Mel Evans)

A banner and ornaments commemorate Salvatore Marchese in a memorial outside the home of his mother, Patty DiRenzo, in Blackwood, N.J. Salvatore died from an overdose of heroin in 2010. Salvatore was denied admission to treatment facilities again and again, often because his insurance company wouldn’t cover the cost. (AP Photo/Mel Evans)

He was admitted the next morning, and released 17 days later when his funding from the county ran out. Less than three months later, Marchese was found dead of an overdose in his mother’s car, a needle and a bag of heroin on the center console.

“Insurance companies need to understand that this is a disease,” said his mother, Patty DiRenzo. “Heroin is life-threatening, I don’t care what they say. Because we’re losing kids every day from it.”

Of the 23.1 million Americans who needed treatment for drugs or alcohol in 2012, only 2.5 million people received aid at a specialty facility, according to the federal Substance Abuse and Mental Health Services Administration. Heroin addicts are a small slice of overall users, but their numbers nearly doubled from 2007 to 2012, to 669,000. At the same time, the number treated for heroin did increase sharply, from 277,000 to 450,000.

What is at issue is whether they are getting the treatment they need to successfully beat their habits. Advocates say they are not, partly because the insurance industry has not come to grips with the dangers of heroin withdrawal and its aftermath.

It is true that, unlike withdrawal from dependencies on alcohol or benzodiazepines like Xanax,heroin withdrawal does not kill. But it is so horrible — users feel like their bones are breaking, they sweat and get the chills and shakes, and fluids leak from every orifice — that many are drawn back to the drug, with fatal consequences.

Even if addicts survive withdrawal, they often relapse if they fail to make it into treatment. That’s when many overdoses happen, because they try to use as much heroin as they did before, and their newly drug-free bodies can’t handle it.

Because withdrawal is not directly deadly, most insurance companies won’t pay for inpatientheroin detoxification or rehab, said Anthony Rizzuto, a provider relations representative at Seafield Center, a rehabilitation clinic on Long Island.

They either claim that the addict does not meet the “criteria for medical necessity” — that inpatient care would be an inappropriate treatment — or require that the user first try outpatient rehab and “fail” before he or she can be considered for inpatient.

“Ninety-nine-point-nine percent of the time, we hear ‘denied,’” Rizzuto said. “And then we go to an appeal process. And we get denied again.”

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, the national trade association that represents the health insurance industry, defended the industry’s practices.

“Health insurers rely on evidence-based standards of care that look at: what is the right level of coverage, the right site of coverage, the right combination of treatments,” she said.

There is a great deal of debate in the addiction world about what is the best way to get clean, but most authorities agree that inpatient care is often essential for full-blown addicts — a first, crucial step in the process.

While most insurance policies allow coverage of up to 30 days in a residential center, nobody actually gets those 30 days, said Tom McLellan, CEO of the nonprofit Treatment Research Institute in Philadelphia who served as deputy drug czar under President Barack Obama. The average duration is 11 to 14 days. After that, most insurance companies stop paying, and facilities discharge patients before their treatment is done.

“It’s not enough time. And what do you do? And who’s at fault here?” McClellan said. “If the treatment program calls you up and says, ‘Your loved one is half-treated, we’d like to keep him for another two weeks,’ you take out a mortgage on your house and you cover it.”

Elizabeth Thompson’s parents did just that to pay for her treatment in eight inpatient facilities beginning at age 16. Some of her stays were too short to be effective, she said, and it wasn’t until she spent several months at a long-term facility in Delray Beach, Fla., that she successfully stayed clean.

“It almost didn’t matter so much what they did there, or the education or the therapy that I got, but just taking me out of my environment and keeping me in a place that was really difficult to use,” said Thompson, 30, a policy coordinator for the Drug Policy Alliance in New Jersey. “I didn’t have those triggers and those reminders. It straightened out my head so that I was able to recover.”

A 30-day inpatient stay can cost as little as $5,000, but the average cost is about $30,000. The cost of heroin detoxification alone, which usually takes three to five days, is around $3,000, Rizzuto said. Most clinics require payment upfront if insurance can’t be used.

There are about 12,000 addiction treatment programs nationwide, according to McLellan’s organization. Of those, about 10 percent are residential facilities, about 80 percent are outpatient programs and about 10 percent are methadone clinics. There’s also a small number of state-run programs funded by Medicaid.

Nora Milligan looks through a pile of legal healthcare documents before an interview at her home in Patchogue, N.Y. A single mother and critical care nurse, she said she was forced to file for bankruptcy in 2011 after years of paying around $1,000 a month for her son's heroin treatment. (AP Photo/Bebeto Matthews)

Nora Milligan looks through a pile of legal healthcare documents before an interview at her home in Patchogue, N.Y. A single mother and critical care nurse, she said she was forced to file for bankruptcy in 2011 after years of paying around $1,000 a month for her son’s heroin treatment. (AP Photo/Bebeto Matthews)

Two-thirds of all treatment programs are nonprofit programs funded by government grants, McLellan said. When those block grants run out — they have been shrinking in recent years — programs are forced to put patients on a waiting list until they get more money.

“The supply of available intensive treatment options is limited, and sadly, the demand is great,” said Dr. Bradley Stein, a senior natural scientist at the RAND Corp. who studies mental health and substance abuse disorders.

The main treatment facility in the southwest Ohio city of Hamilton is Sojourner Recovery Services, which has a six-month wait for beds for men. The nonprofit service has been expanding treatment options, including a new intense outpatient program for addicts, until beds are available.

Outpatients programs typically cost $1,000 per month and range from hospital-run programs that addicts attend five days a week to once-weekly group therapy sessions. Federal officials have been promoting outpatient care in the form of medication to help prevent relapse for opiate addicts. Most people pay the monthly $1,000 bill for these medications out of pocket, though some insurance companies cover them.

In New York, a bill going through the state Senate would amend the state’s insurance law to force providers to approve authorization and payment of substance abuse care. It would require that every policy that provides medical coverage has to include specific coverage for drug and alcohol abuse treatment services that are deemed necessary by a doctor.

That means the only prerequisite for receiving any kind of drug abuse treatment would be a doctor’s referral, preventing insurance companies from denying treatment based on a complicated set of guidelines. A similar law was passed in Pennsylvania years ago and has helped addicts get better access to treatment, the bill’s advocates say.

Nora Milligan of Patchogue, N.Y., is among the supporters of the New York bill. A single mother and critical care nurse, she said she was forced to file for bankruptcy in 2011 after years of paying around $1,000 a month for her son’s heroin treatment. Her son eventually qualified for Medicaid — because of her financial woes — but then the Medicaid managed care company, Fidelis, refused to pay for inpatient treatment.

“He had all the high-risk stuff there. Homeless, dangerous living, addiction,” she said. “He had the physical aspects. And they denied him. I was floored.”

Milligan took the company to court, which forced the provider to release its guidelines regarding “medical necessity.” Her son qualified for most of them, including risk of severe withdrawal and substantial risk of physical harm.

The exceptions: He wasn’t homicidal or suicidal, and he had no “psychosis, mania or delusions.”

Authorities ultimately found Fidelis had acted within state guidelines. In a written statement, Fidelis Care Chief Medical Officer Sanjiv Shah said decisions about addiction treatment are based upon state and national standards of care. “Addiction treatment is provided through a variety of approaches, and denial of a specific level of care does not mean that no treatment is necessary,” Shah said.

Eventually, the federal Affordable Care Act should improve treatment for heroin addicts because up to 5 million people with drug and alcohol problems are eligible for insurance coverage under the overhaul. But it will likely take years before insurance companies fully comply with the law, McClellan said.

“It will almost certainly require lawsuits on behalf of the public to get true parity,” McClellan said. “And it will take real effort at the state level to determine which medications, which kinds of treatment for how long and under what circumstances are going to be available.

“And meanwhile, people will die. That’s not melodramatic. That’s a fact.”

Fast facts

  • WITHDRAWAL: Once in withdrawal, users feel like their bones are breaking. Fluids leak from every orifice. They sweat and get the chills and shakes. The withdrawal itself doesn’t kill, but if addicts can’t persevere, they often go back to heroin, with lowered tolerance, and many overdose.
  • LACK OF BEDS: The number of people using heroin in the U.S. nearly doubled from 2007 to 2012 to some 669,000 people, and more people are also now seeking treatment. But of the 23.1 million Americans who needed treatment for drugs or alcohol in 2012, only 2.5 million people received aid at a specialty facility. There simply aren’t enough beds at treatment facilities to meet the demand. There are about 12,000 addiction treatment programs nationwide, according to the nonprofit Treatment Research Institute in Philadelphia. Of those, about 10 percent are residential facilities, about 80 percent are outpatient programs and about 10 percent are methadone clinics.
  • INSURANCE BATTLES: While most insurance policies state that they allow coverage of up to 30 days in a residential drug treatment center, nobody actually gets those 30 days, said Tom McLellan, CEO of the Treatment Research Institute. The average duration in residential care is 11 to 14 days.
  •  THE COST: A 30-day inpatient stay can cost as little as $5,000, but the average cost is about $30,000. The cost of heroin detoxification alone, which usually takes three to five days, is around $3,000. Most clinics require payment upfront if insurance can’t be used.


  • Larry Crnobrnja

    Heroin abuse is a choice, not a disease.

    • mh1492

      So is smoking should we let them die?
      So is adult onset diabetes should we let them die?
      So is riding a motorcycle should we just let them lie on the side of the road when they crash?

      • SniperFire

        Classic.

        “A liberal is someone who feels a great debt to his fellow man, which debt he proposes to pay off with your money.”

        LOL

        • jz

          We should care about or fellow man, right? We should care about our fellow man. However I think we agree on this. The War on Poverty, Johnson and the Democrats, was and is another failed government policy which also did more harm than good.

    • B4CE

      Not nessecarily, it’s almost cruel how drugs, prescribed or otherwise take control of your mind and body. It becomes, Very quickly, not a choice.

    • rightwingnutjobsareaproblem

      Larry, heroin use is a choice, but addiction is a disease. Eating bad food and not exercising is a choice, but heart disease is a disease. Having unprotected sex is a choice, but HIV is a disease. What type of expertise do you have regarding addiction? Where should we draw the line as far as what insurance covers and what it does not?

      • Larry Crnobrnja

        If you never use heroin, you can’t become addicted to it.

        • Godfather

          Larry does not care. He is just a troll trying to stir up trouble/

          I refer to him as the turd in the punch bowl.

          • SniperFire

            You cannot refute the point, so you insult him.

          • stillsleepyeyes

            So basically your saying……….you stalk turds in a punch bowl

      • SniperFire

        Typical Liberal. Expect everyone else to pay for immoral behavior.

        • rightwingnutjobsareaproblem

          Sniper Fire, you are a typical ignorant conservative. I didn’t say anything about anyone paying for anybody else’s care. I would much rather pay for my own, on my own than to have to help pay for everyone else’s. I was asking a question to get a debate/conversation going. I sure as hell don’t want to have to pay insurance premiums because of the heart attack you will have because you haven’t taken care of yourself and all of the stress you have built up in your body because of the hate that you have for everyone that is slightly different than you. Why don’t you try adding some commentary that has some type of substance rather than using the latest line you heard on last nights episode of The O’Reilly Factor you ignorant pr*ck.

          • SniperFire

            ‘ I didn’t say anything about anyone paying for anybody else’s care. ‘

            Like a typical freeloader, you think stuff is free when the gubmit pays for it, or when ‘insurance companies’ pay for it. ROTFL.

          • rightwingnutjobsareaproblem

            Again you obviously don’t know me. I’m willing to bet I make more a year than you do, therefore I pay more in taxes than you do. I have full medical coverage, so I’m not quite sure what you’re referring to.

          • SniperFire

            You simply have no clue. LOL

          • rightwingnutjobsraproblem

            You’re statements aren’t making any sense. Go have another beer.

          • Pablo Jones

            Why does it matter what you make or someone else makes? Putting it out there and willing to bet on it implies that you think if you make more or pay more in taxes you are better than those that pay less.

          • rightwingnutjobsraproblem

            Making the point that I’m not this “freeloader” that Sniper Fire is referring to.

          • Larry Crnobrnja

            ” I was asking a question to get a debate/conversation going.”

            Comparing the use of heroin, which is most frequently accompanied by stealing, to eating food? Seriously?

          • elvis

            it is the ILLEGALITY of heroin which promotes stealing sir

          • Larry Crnobrnja

            Not at all. It’s the use of heroin that promotes stealing.

          • Larry Crnobrnja

            Why is it when a lefty is challenged about anything their first reply is to attack with some comment about Fox?

            Is that something out of Rachel Maddow’s playbook? LOL
            (see the stupidity of that comment?)

  • Mark B

    We are expected to feel sorry for these people now , when their loved ones didn’t care for them before ? If they are on Heroin , its time for tough love or soon it will be Tough Luck.

  • SniperFire

    ‘Some users overcome their addictions in spite of the obstacles.’

    What twisted logic. LOL

  • alreadyfedup1

    If you have a death wish use Heroin. You know what your getting into when you use it.

    • Pablo Jones

      If you have a death wish, put extra into the syringe and get it over quickly.

  • Christine Camarillo-Winrod

    Beginning to combat the heroin abuse issue needs to begin at home with education and awareness. And thanks be to God, as a parent, I haven’t had to personally deal with this. Nonetheless, it is an issue with many youths today and as parents and concerned citizens, we need to teach our youths the dangers of this and all addictive drugs. Support your local community groups advocating for education on the issue and local law enforcement departments dealing with the issue daily.

    • Mark B

      The only thing law enforcement will do is label you a criminal and make it harder for you to recover

      • Marnie Butler

        That is just another obstacle that can be worked through with education. Right now, we are losing a WHOLE GENERATION of kids to this EVIL drug – not just locally but NATION WIDE! These people did not say “I want to be a drug addict when I grow up”! Ignorance does nothing to help. Heroin addiction is currently a NATION WIDE EPIDEMIC! Most heroin addicts were introduced to highly addictive pain medications because “someone told them they could get a great high”. These pills that were taken do fall within the Opioid family unknowingly the person is falling into the start of addiction. Before they knew it, they were ADDICTED! Once the pharmaceutical companies put a coating on the pills, these people who are now addicted turned to Heroin because it was cheaper for the same high. Unfortunately – this is harder for addicts to get the right treatment to get clean and stay clean. Did you know 30% of the population has a pre-disposition to substance abuse addiction? Did you know the brain takes approximately 38 weeks or longer to heal from heroin addiction? Do you know that a few of the types of pharmaceutical blockers available that cause them to be addicted to that med? Do you realize that heroin gets down into their muscle tissue and bones? The bottom line – this is a MAJOR problem that needs to be addressed. There needs to be more to help the addict IMMEDIATELY and when they are asking for help and they need long term treatment! I wish people would get educated because it does effect our society as a whole! We are all paying for this epidemic one way or another from rising prices, to theft – and ultimately some families lose their loved ones to death. ADDICTION is a DISEASE! GET EDUCATED!!!

        • SniperFire

          These people did not say “I want to be a drug addict when I grow up”!

          Sure they did.

          • Marnie Butler

            Then you must be pretty ignorant and uneducated to make a comment like that. Here is a link where you can learn more about how addiction is in fact a disease! http://www.robbysvoice.com/resources/loved-ones-group/

          • Godfather

            so wrong. most of them got hooked on pain pills from going to dentist, ect.

            I think you should show a little respect.

          • SniperFire

            Sorry. Not buying it. It is a person’s choice to sick a needle in their veins and deliver the payload. You cannot argue that.

          • Mark B

            If they have medical insurance to get prescribed enough pain Meds to become addicted , then they should have medical insurance to get addiction help .

        • Mark B

          Maybe if the amount of Money spent enforcing marijuana prohibition was spent on Heroin prevention we could make progress. But Billions are being wasted enforcing prohibition of a very safe , non addictive weed. but on a large scale heroin is being ignored .

    • Pablo Jones

      Kids are made aware of the dangers. They go through D.A.R.E., but the majority of them still try/do drugs when they get older.

      • Cassie

        I stopped taking the D.A.R.E program seriously after I saw a drug dealing being arrested while wearing one those t-shirts.

  • Marnie Butler

    ADDICTION is a DISEASE!!! Heroin is a very powerful substance even if used ONCE! Get educated!

    • SniperFire

      Nonsense. Addiction is a mental weakness, and calling it a ‘disease’ only encourages the weakminded to abuse it because, ‘hey, the Liberals say it isn’t my fault!”

      • rightwingnutjobsareaproblem

        If it wasn’t a disease than insurance companies wouldn’t pay for certain types of treatments. Dr’s of medicine would also not define it as a disease if it wasn’t. You obviously do not know a single thing about the topic. People like you should not be able to voice their opinion on any public forum, you should be embarrassed for yourself with the stupidity that you show on these message boards. Go read a book, or learn about something before you comment on it.

        • SniperFire

          ‘If it wasn’t a disease than insurance companies wouldn’t pay for certain types of treatments. ‘

          That is pretty ignorant. Insurance companies have been forced to pay for bad behavior choices over the year. Obamcare is a perfect example.

          • rightwingnutjobsareaproblem

            Coverage for these services has been going on a long time before Obamacare was even a thought, but way to use the Obamacare card.

          • SniperFire

            ‘Coverage for these services has been going on a long time ‘ My point stands. You suck at logic.

          • rightwingnutjobsraproblem

            You blamed it on Obamacare. Typical conservative, blame any and everything on Obamacare.

          • SniperFire

            ‘You blamed it on Obamacare. ‘ Dude. You are a moron. I said Obamacare is an example of how insurance companies are forced to pay for non-disease treatments.

      • Cassie

        But the medical community recognizes addiction as a disease, check the DSM-5.

        • SniperFire

          Only because they be gettin paid, Cassie.

    • Bill Love

      Thats your opinion I think its weak minded people who use the excuse its a disease

      • rightwingnutjobsareaproblem

        It’s also the “opinion” of medical professionals, but what do they know. Definitely not as much as you know on the topic.

        • Bill Love

          Theses are the same people who started the problem in tge 1st place by hand out oxytocin like they where candy because it wasnt that addictive then found out they where wrong now e

          • Godfather

            Bill put a cork in it. You are so off topic.

          • Bill Love

            How am I people got hooked on oxytocin now they cant get it so they go to herion because it cheper. Learn the facts

          • bdid.d

            Again, oxytocin induces labor….

          • bdid.d

            Oh… so these young drug addicts started out on legal rx’s of oxycontin? ( Oxytocin induces labor) Very interesting…

      • Marnie Butler

        FACTS outweigh OPINIONS!

  • CQQL33

    All of this ‘Left’ and ‘Right’ B.S., The Left started this legalization of marijuana and you cannot tell me it doesn’t start there. Now, when the Left has no factual answer they blame it on someone else, the Right. Time to get together folks and stop legalizing drugs that someone can become addicted to…. Also, lets get rid of Obummer Care (it is NOT affordable nor sustainable) and get back to the best heath care system in the entire world. I have heard read where marijuana is not addictive, this my be true as beer is also not addictive. But there are people that are prone to becoming addicted to either or both. Let’s do the right thing and NOT make addictive drugs legal !!!

    • Reagan

      Does this include currently legal drugs that are proven to be addictive? And by the way if you haven’t heard beer can be addictive.

      • CQQL33

        There are many, drugs that can cause addiction but these drugs are controlled by prescription and the doctor. These drugs are needed for various treatments and cures. But they are not able to be purchased over the country without a prescription. Beer by itself is not addictive but there are people that, by nature or make up, can become addicted to it… Marijuana, I have not answer for that, the same personal traits that cause alcohol addiction can cause addiction to marijuana, but I do not believe it is a good thing to make it legal.

    • Mark B

      Then the only right thing to do is once again Outlaw Alcohol

      • CQQL33

        Mark, you are missing the point completely. I do not have time to explain it to you. You probably would not believe it anyway. There are those people that can become addicted to alcohol, trust me

    • wow

      there’s more stupidity in this comment than i may have ever seen.

      • CQQL33

        Feel free to display your ignorance…..

  • Patty Siniard Doman

    We need to have local hospitals provide this service so people don’t have to wait !

  • Angel eyes

    As a recovering her ion addict and now a psychology major in substance abuse yes using drugs is a choice but addiction is a neurological disease. It affect many parts of the brain and like the Nerons and receptors as well as how much dopamine ur body produces anyway sense half of u have no idea what I’m saying… Point is that it takes therapy and sometimes even medication replacement to help some addict recover then it has to be monitored and treatment for life to stay clean just like diabetes treatment for life so please before commenting ur opinions find some facts first

    • SniperFire

      ‘but addiction is a neurological disease.’

      Nonsense. There is no pathology. It is a mental weakness.

      • Angel eyes

        I’m not going to argue with u about it I already know the stereotypes and ignorant comments about addicts. U people have your minds made up with no facts or education to even base it on and that’s ok it’s ur own opinion and everyone’s untitled to their opinions

        • SniperFire

          ‘I’m not going to argue with u about it ‘

          Good decision. You can’t win.

      • Cassie

        Wrong, try picking up a book or talking to an actual doctor about how certain effect the brain and not simply relying on your opinion.

    • Mark B

      Don’t forget to mention that Marijuana has word very successfully in medication replacement for heroin Addicts

    • bdid.d

      It’s really hard to understand you when your spelling is so horrible…