Addicts overwhelm Kentucky's drug treatment options

Rachelle Autry’s five-year addiction to painkillers and heroin left her jobless, homeless, alone — and in desperate need of help.

But her search for a residential drug treatment center led to one dead-end after another. There were none near her home in Grant County, and she faced a 21/2-month wait for a bed at The Healing Place in Louisville, two hours away.

All the while, she sank ever deeper into her addiction, once accidentally overdosing on heroin.

“I almost died waiting for treatment,” said Autry, a 30-year-old mother of three who finally got into The Healing Place last year. “I couldn’t stay clean.”

Her story is not unusual. In a state plagued by one of the worst prescription drug abuse problems in the nation, where nearly 1,000 people a year die of overdoses, a Courier-Journal investigation has found that Kentucky’s treatment options are woefully limited, especially for hard-core addicts in need of the most intense care.

• Only 40 of Kentucky’s 301 treatment and recovery sites offer 24-hour residential care, which experts say may be the only hope for the most severely addicted. And those 40 centers are concentrated in just 19 of the state’s 120 counties, mostly in urban areas, meaning addicts in rural counties often must travel hours for help.

• Nearly 80 percent of Kentucky sites listed by the U.S. Substance Abuse and Mental Health Services Administration — 235 — are for outpatients only, typically offering one hour of care a week. The other 26 include a mix of non-residential types, or another type, such as hospital detoxification.

• Kentuckians tend to get less intensive treatment than Americans overall. Two-thirds of the 21,474 Kentuckians admitted for treatment of any drug addiction in 2009 entered once-weekly outpatient care, compared with 46 percent nationally. Less than 5 percent entered residential care, compared with 17 percent nationally.

• Treatment shortages are most severe in Appalachian counties with the state’s highest overdose rates. Six Kentucky counties that rank among the 10 highest for overdose deaths have just one outpatient center or no center at all.

• The state’s overwhelming need for treatment means that addicts face waiting lists even in the two counties with the most centers — Jefferson with 32 and Fayette with 25.

“We absolutely do not have the treatment we need, not even close,” Attorney General Jack Conway said, adding that experts say Kentucky has less than a third of the treatment beds it needs. “We need more beds.”

Despite that need, Kentucky’s behavioral health department budget for substance abuse has remained virtually unchanged for a decade, providing $29 million for contracted treatment centers in 2012.

Kerri Richardson, spokeswoman for Gov. Steve Beshear, said there was a conscious effort to maintain the funding “even as other state agencies saw deep, painful cuts of up to 40 percent over the past five years.”

But one state agency where treatment funding has increased is the Department of Corrections, which saw its substance abuse budget rise more than 600 percent since 2007, to about $7 million.

Case for spending

Researchers, advocates and drug-abuse experts said making treatment more available would not only save lives — it also would save money.

A 2006 California study found that for every dollar spent on treatment, the state reaped $7 in benefits, mostly from reduced crime and increased earnings. More recent research has found similar benefits. Other states, such as Oregon, have taken such research to heart, making drug treatment a priority and increasing state funds for it even in tough budget times.

Kentucky has taken a step to ease its treatment shortage by opening 10 Recovery Kentucky centers since 2007, tapping funding sources such as the U.S. Department of Housing and Urban Development and the state Department of Corrections.

Those residential centers, where recovering addicts help their peers, are part of a state initiative modeled after The Healing Place in Louisville and The Hope Center in Lexington that seek to reduce chronic homelessness by helping people recover from substance abuse. Four more are planned.

State officials also recently announced that they received $3.6 million in federal grants for bolstering treatment, the majority going to providers in Whitley and Campbell counties to help at-risk adolescents with mental health and drug-abuse problems.

“Despite a historic recession, Kentucky has expanded its support of substance abuse treatment programs over the past few years as part of the administration’s overall effort to combat drug abuse,” Richardson said.

But officials and experts agree Kentucky still falls far short of offering enough treatment. Beshear said the number of people seeking help for painkiller addiction has risen 900 percent in a decade, and many treatment professionals expect the state’s new prescription drug law will lead even more to seek help.

“If you take away all of the pill mills, those people don’t magically stop using and get better,” said Michele Flowers McCarthy, community and government liaison for SelfRefind, a network of clinics offering medication-assisted treatment.

Drug abuse professionals say addicts risk a downward spiral into broken families, crime and death.

“You have to have options or they will die or sit in jail,” said Karen Kelly, president and chief executive officer of the Eastern Kentucky anti-drug organization Operation UNITE. “We can’t afford that. ... People are dying every day.”

Tale of two counties

Powell and Knott counties in Eastern Kentucky show how badly a community’s prescription drug problems and its available treatment can be mismatched.

Powell County, home to Natural Bridge State Resort Park and Red River Gorge, has an overdose death rate of 51 deaths per 100,000 people for 2005-09, more than twice the state average of 21.3 — yet it has no treatment center.

Knott County, two hours away in the heart of Appalachian coal country, has the state’s eighth-highest overdose death rate at 45 per 100,000 people, and only one outpatient center.

By contrast, Warren and Christian counties in Western Kentucky — which each have nine treatment centers — have death rates roughly half the state average. Jefferson County, the state’s most populous, has a death rate slightly below the state average and the most centers with 32.

Robert Matthews, chief deputy for the Powell County Sheriff’s Office, estimates that 75 percent of crime in his forested rural county — population 12,600 — is drug-related.

“I don’t know of any family that’s not affected by drugs,” he said. But “we don’t have any options as far as where to send people for rehab. … We don’t have any treatment at all.”

The closest centers are in Mount Sterling, more than 30 minutes away, or Paris, nearly an hour away. And only one site in either place is residential.

“We’ve seen people stay in jail three to six months before they can get a bed at a rehab,” Matthews said.

Officials pointed out that Powell has a drug court, which lets eligible offenders complete a substance-abuse program in lieu of jail, receiving some counseling and enrolling in a self-help program such as Narcotics Anonymous.

The county also has a resource officer in the schools who works to prevent and deal with drug use, and a ministerial association with an anti-drug task force.

But prescription drug abuse still rages.

In Knott County, where the closest residential center is two hours away, some addicts and their families are so desperate for help that they seek treatment referrals from anyone connected with the fight against drugs — visiting the office of Drug Court Program supervisor Glenda Shrum and calling Lola Patterson, manager of the Knott Drug Abuse Council, at home.

“I’ve had them call me in the middle of the night,” Patterson said. “They need treatment, and they don’t have a couple of months to wait.”

Five years ago, Patterson said WestCare, which operates a residential center for men in Ashcamp in Pike County, contacted Knott County Fiscal Court about locating there.

But though the county offered an old school building free of charge, WestCare decided against Knott because, officials said, there was minimal funding to pay for treatment, and Kentucky’s Medicaid program doesn’t pay for residential treatment.

“It’s a very challenging situation,” said Leslie Balonick, senior vice president of the WestCare Foundation. “ ... Community treatment is not adequately funded to deal with the epidemic in Eastern Kentucky and throughout Appalachia.”

Patterson said she still hopes to have a treatment center in her county. “We’re desperate for it here, and I don’t care to admit desperation if it helps. We have all but begged for it.”

Shrum said she worries Knott County’s “overwhelming” addiction problem will only fester. Without treatment, she said, “You can either lock (addicts) up or lower ’em into the ground.”

The waiting game

In the meantime, addicts precariously wait for help, treatment professionals say.

Crystal Copley of Louisville said she attempted suicide by taking 40 aspirin while she waited for a month to get in to The Healing Place.

“I couldn’t see any way out,” the former nurse said. “I thought I was doomed.”

Pauline Gibson, a Xanax addict and mother of two from Knott County, said she called “every rehab in the state of Kentucky” for weeks to find a treatment center, finally lying to get into a psychiatric center in Paris, where she detoxed for six nights in early September.

“If you tell them you’re suicidal, you’ve got to get in; but I don’t want to lie to get in,” said Gibson, who said she’s staying sober on her own now.

Brittany Crouch, 25, of Frenchburg, sought help after prescription drug abuse reduced her to a desperate addict who shot up painkillers, and left needles on the floor of her brother’s home, where she slept on a couch.

She said she called almost all of Kentucky’s residential drug treatment centers for three months — finding every one full, with a long waiting list.

She finally managed to get a bed at Chrysalis House, a treatment center for women in Lexington, 11/2 hours from her home. She said she stayed for a couple of months but left after having a conflict with another woman. She said she learned coping skills there and has managed to stay off drugs.

“If I had one wish,” Crouch said, “it would be to never want a pill again.”

The waiting lists, which can vary over time, are longest at residential centers, especially those where addicts stay for at least 30 days.

Most Recovery Kentucky centers, which can be free to clients, usually have waiting lists of three months, and addicts must call weekly to stay on the lists. The waiting list at the Morehead Inspiration Center, a recovery center for men, is four to six months long.

People in prison generally face shorter waits for residential care, partly because the state Department of Corrections contracts with Recovery Kentucky for 60 percent of their beds.

Bridget Bingham of Knox County, who served time for drug trafficking in 2011, said it was a matter of hours between making parole and getting to The Healing Place, where she’s managed to stay sober.

“Everybody should have this opportunity,” she said.

Outpatient care is usually easier to access; there are no waits at SelfRefind clinics, for example. These clinics, at 11 locations in Kentucky, offer Suboxone medication treatment for opiate addiction, along with counseling, evaluation and assessment.

But Diane Hague, director of Seven Counties Services’ Jefferson Alcohol and Drug Abuse Center, said there’s generally a four-to-six-week wait for their intensive outpatient program. Such programs may combine group and individual counseling and education three to four times per week for nine to 12 hours each week.

“There’s not enough detox at all to handle ... the narcotics,” Hague said. “There’s not enough halfway houses. There’s not enough intensive outpatient.”

More obstacles

Cost is another stumbling block. Programs average $2,500 a person in Kentucky and can run more than $1,000 a month for residential care.

And while private insurance plans may offer limited substance-abuse coverage, not all treatment centers accept it. Kentucky Medicaid, the state-federal program for the poor and disabled, generally doesn’t cover drug treatment — with a few exceptions, such as for pregnant women.

A new Medicaid program will pay for outpatient treatment for 5,800 Kentuckians, but advocates say that will only meet a fraction of the need.

State Rep. Linda Belcher, a Shepherdsville Democrat who was on a legislative committee overseeing the Kentucky’s tough new implementation of the prescription drug law, said she sees value in covering more drug treatment under Medicaid, but “I don’t know how we’re going to pay for it.”

“I really think treatment is so important,” said Belcher, who was defeated in the November general election. “There need to be conversations” about fuller Medicaid coverage for it.

In Eastern Kentucky’s 5th U.S. House District, Operation UNITE offers vouchers to help low-income addicts pay for care. The drug-fighting program pays $3,000 for short-term residential treatment and $5,000 for treatment lasting 90 days or more, and the money goes directly to the center.

“We’ve got a lot of people waiting” for vouchers, said U.S. Rep. Harold “Hal” Rogers,” the 5th District Republican who launched Operation UNITE. “That’s one of the most difficult things to deal with.”

Promise of treatment

Kelly, the Operation UNITE CEO, said ensuring addicts can get help, especially in hard-hit Appalachian areas, would go a long way toward easing Kentucky’s prescription drug abuse problem.

“If someone has cancer, you try to cure it. Addiction is no different,” she said. “You need law enforcement, prevention and treatment. It’s a three-legged stool, and without all three legs, you fall over.”

Studies show that 40 percent to 60 percent of people who undergo any drug treatment are sober a year later, comparing favorably with treatment for other chronic diseases.

But relapses are common. According to the National Institute on Drug Abuse, the overall relapse rate for drug addiction is 60 percent. Multiple courses of treatment may be needed, advocates say, another reason treatment and recovery centers need to be more accessible.

Several recovering addicts said such centers have helped, not only by giving them the tools for sober living but also by encouraging fellowship. Copley, the Healing Place client, said the best part of her recovery has been helping other addicts.

“It’s a beautiful thing when you watch someone walk through those doors broken and desperate ... and then you see the light go on,” she said.

Autry, the Grant County client, said the Healing Place sparked that light in her, through peer mentors, classes and recovery groups — ultimately saving her life.

“They tell us all the time we’re miracles,” Autry said. “I believe that today.”

This series was first published in the Courier-Journal on December 17, 2012
Photo Credit: Alton Strupp/Courier-Journal