Fayetteville lacks support system to combat painkiller problem
Posted July 17, 2013
Fayetteville, N.C. — Fayetteville pastor James Sizemore can rattle off the places he has taken painkiller addicts to get help: Wilmington, Raleigh, Myrtle Beach, Rock Hill.
Making a 300-mile round trip, he said, is easier than finding help in Fayetteville.
Sizemore, who leads a community church in Massey Hill, said he has been trying for nine years to get help for nearly 1,000 people.
He has waited for hours with people and made multiple phone calls on their behalf, but he has never succeeded without leaving Cumberland County.
“It’s a horrible situation in this town, horrible, trying to help people that have a drug problem,” he said. “It just doesn’t happen.”
Sizemore, mental health officials and other advocates for painkiller addicts say a major reason the problem continues to spiral out of control here is a broken, inadequate support system.
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The Fayetteville region has experienced a surge in painkiller prescriptions since 9/11, after soldiers began returning home wounded from war. It leads the state in the sale of oxycodone and is third in hydrocodone sales. That has been accompanied by a rise in overdoses, crime and addiction.
Yet Cumberland County has just eight beds available for detoxification and only one state-funded halfway house for people who need more than a week of detox to get their lives on stable footing.
The numbers spell out the problem: Of the 4,372 people treated in the Cumberland County mental health system last year, 45 percent reported that their main problem was substance abuse. Statewide, fewer than 30 percent of patients treated by the public mental health system were treated for substance abuse.
The number of people in Cumberland County admitted to mental health services for drug and alcohol abuse has risen 148 percent in the past five years. In that same period, funding for services grew just 23 percent.
The Roxie Avenue Center for detoxification and Myrover-Reese Fellowship Homes halfway houses are overwhelmed by demand, yet funding cuts leave them unable to use all of their available beds.
Sandra Norfleet, a Roxie Avenue Center addiction specialist, said the county needs at least six more halfway houses just to serve patients after they complete about a week of detoxification treatment at Roxie.
And drug abuse counselors and advocates say the 16 beds at Roxie are not nearly enough. Yet the center has had only eight beds available since November, when Cape Fear Valley Health System took over the center’s management to prevent county layoffs in the mental health system from closing it.
State mental health reforms required the county to find a private provider to take over the Roxie center. The county tried for several years but never found a business willing to operate Roxie, likely because it loses money every year.
Budget cuts have kept about half of the 41 beds at Myrover-Reese from being used. The cuts have reduced the treatment time for some Myrover-Reese residents in half — from six months to 90 days.
The number of beds in use would be even lower if Myrover-Reese did not have a contract with the Department of Veterans Affairs to help as many as a dozen homeless or addicted veterans.
Terri Rose, director of Myrover-Reese, said demand would easily fill every bed if funding were available, and further budget cuts could put her out of business.
“We’re in the limbo of whatever comes down the pike,” Rose said. “We’re going to have to come up with other forms to generate revenue: More fundraisers, more donations, alumni contributions, and a hope and a prayer.”
Hank Debnam, the county’s mental health director until the state merger took effect this month, said funding has always been a problem.
“It’s always been about the money,” Debnam said. “The need is out there. It’s just hard to accommodate that need if the funding is not in place to take care of those folks.”
Much of the blame for cuts and confusion goes to the state’s dismantling of the mental health system, which now requires counties to monitor private services instead of providing them.
The state cut about $20million from its mental health and substance abuse services budget last summer, including $300,000 from Cumberland County.
Meanwhile, federal budget cuts to the military have slashed substance abuse services on Fort Bragg and other installations by 20 percent this summer as mandatory furloughs for employees take effect.
A Fort Bragg spokesman said the cuts require the drug and alcohol abuse office to close on Fridays. The spokesman said the effect will be minimal because it is the office’s slowest day and the emergency room at Womack Army Medical Center will still be available.
A state Senate budget plan for the upcoming year would shutter the state’s three treatment centers, including Walter B. Jones Alcohol and Drug Abuse Treatment Center in Greenville, which serves 38 eastern North Carolina counties, including Cumberland.
The center this year opened an 80-bed inpatient treatment facility for opiate addiction that serves all of North Carolina. A state spokeswoman said it is difficult to gauge what the level of demand from each county will be for those services because they are so new. No one from Cumberland County was there last week.
“We just started the program, and it’s the first of its kind,” said Julie Henry, spokeswoman for the state Department of Health and Human Services. “We’re really excited about it.”
But if the cuts in the state Senate plan are adopted, it will close along with the other centers.
Debnam and Cumberland County commissioners say the community’s mental health services, which include substance abuse, will most likely deteriorate further before they improve.
“It’s broken, and I don’t know what the solution is,” said Jimmy Keefe, chairman of the county Board of Commissioners. “It’s such a very complicated system to get care, to get reimbursed and to get help.”
Commissioner Charles Evans, who is open about his past struggles with drug abuse, said the city and county have their priorities all wrong. The state mental health reform deserves plenty of blame, he said, but Evans thinks treating addicts and fighting substance abuse should be a top priority. Many drug and alcohol abuse patients do not qualify for Medicaid and cannot afford treatment, so their treatment is paid for from a pot of state and county money that can be depleted quickly. The county set aside $4 million in mental health funding this year, more than half of it to open a crisis-intervention center.
Evans bristles when he thinks of public money supporting the chamber of commerce and the Airborne & Special Operations Museum while people have trouble getting the help they need to recover from addiction. And he does not understand how leaders can discuss building an arts center downtown while the growing prescription drug problem fuels crime and tears apart families.
“It adds to the quality of life, which we probably need,” Evans said of an arts center. “But how good is it if we have guests visiting here and people are breaking into their cars trying to get whatever belongings they can out of the car to get their next pill or whatever substance they’re using?”
State legislators’ decision this year to refuse to expand Medicaid coverage — a key provision of federal health care reform — will keep an estimated 500,000 low-income people in North Carolina from being able to join the program.
Debnam, the former mental health director, said expanding Medicaid would have helped make up for state cuts to mental health because the federal insurance program would have picked up the costs for thousands of people.
The federal government estimates that 14 percent of people eligible under expanded Medicaid rules will have substance abuse disorders. That comes to about 70,000 North Carolinians and about 2,700 people in Cumberland County who would have been able to sign up for Medicaid.
“When you reduce the state service dollars and you don’t expand Medicaid, you’ve got this imbalance,” Debnam said. “The need out there is still there, and it’s probably going to be greater, but the supply is not there.”
Dave Richard, director of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services, said North Carolina’s broken Medicaid system needs to be fixed before it is allowed to expand. If the state had decided to take on those patients, Richard said, it is doubtful they would have received meaningful help.
Critics say it makes no sense to cut money for drug and alcohol abuse treatment because it will lead to millions more being spent to treat drug overdoses and pay for other problems caused when addicts cannot get help. Drug addiction has been linked to higher rates of crime and disability.
Fayetteville has the fifth-highest property crime rate in the United States, and federal disability claims in Cumberland County have nearly doubled since 2000, slightly faster than the state average.
The average cost of an inpatient hospitalization for an overdose is $16,970, according to figures from the overdose prevention group Project Lazarus. The group calculated that overdoses cost the state nearly $99 million in 2008. Using the same estimate, the 2,800 overdose patients treated during the past five years at Cape Fear Valley Medical Center would have cost more than $47 million.
Doug Webster, director of behavioral health services for Cape Fear Valley Health System, said the county undoubtedly needs more services for drug and alcohol abuse.
The state is moving toward more outpatient services in part because inpatient care is expensive and relapse is common, Webster said.
“If we had more levels of care, a number of people might not reach the level of Roxie (the county’s detox center),” Webster said.
Among those levels of care seeing growing use are outpatient programs that often use replacement drugs paired with therapy, which can be expensive for addicts who do not have health insurance.
Officials say Fayetteville has a shortage of those services, which include methadone, Suboxone and other drugs that help wean people off painkillers. And critics say those services merely trade one drug for another.
Other cities in North Carolina have nonprofit residential treatment services that many addiction specialists here envy.
In Raleigh, a nonprofit center called the Healing Place provides free shelter and assists with substance abuse recovery for as many as 180 men and 99 women at a time. Modeled after a shelter in Louisville, Ky., the program typically graduates residents after a year or two. Many of the shelter’s services are operated by people who have been through the program, so newer patients see that success is possible. The Healing Place does not turn people away and allows them to enter its detoxification program as many times as needed, said Chris Budnick, the vice president of operations.
Budnick said people who had been through the Healing Place paid more than $3 million in taxes in 2012.
“Instead of taking from the community, we see people not doing that and now contributing,” Budnick said.
In January 2010, Budnick made a presentation to Fayetteville leaders considering opening a version of the Healing Place here. Budnick said it seemed that people in Fayetteville, as in other places where he has made presentations, were shocked by the startup costs.
Webster, who offers effusive praise for the Healing Place’s programs, remembers the discussions about opening one here.
“You’d need 50 to 75 people in their approach, which we’d have in this community,” Webster said. “We looked at it for here, but you need about $1million in funding and people who know what they’re doing, and we don’t necessarily have either.”
Robert Gochnauer manages Hope House in Wilmington, an organization with more than two dozen halfway houses in that city. Gochnauer said the startup costs for halfway houses make it far more difficult to open one today than a decade ago. Banks are less likely to make loans with good terms, and the homes are not big moneymakers, he said.
If Wilmington had as few options for recovering addicts as Fayetteville, Gochnauer said, “we’d have 1,000 more people on the streets and all that goes along with that.”
The frustrating process for getting into treatment in Fayetteville keeps many people away.
Someone hooked on painkillers cannot walk in the front door of the Roxie Avenue Center and expect to be admitted.
Patients must first go to either the county’s outpatient mental health center before 10 a.m. on weekdays or to Cape Fear Valley Medical Center’s emergency department to be medically evaluated. Webster said that will change as soon as he can hire more staff members.
At the emergency department, Norfleet said, most patients wait at least five hours before being transferred to Roxie for detoxification.
“It’s sad when you have to go out to the lobby and you see someone ready for help and you have to send them somewhere else,” Norfleet said. “We just need to be ready and able to provide those services at all times. Right now, we’re not.”
Webster said he hopes to restore Roxie to 16 beds by October and move a new evaluation center there by the end of the year. When that happens, he said, doctors will assess patients at Roxie and allow them to go directly to the center for treatment.
The move will make getting treatment easier and is likely to save the emergency department hundreds of thousands of dollars a year because it should reduce the number of substance abuse patients who use the emergency department, Webster said.
But staff shortages have been a problem for years. A 2009 assessment of the county’s mental health services said past recruitment of licensed employees had not been successful.
Myrover-Reese is the only state-funded halfway house in the county that accepts referrals for inpatient care, another area where the community suffers from a shortage. In Wilmington, at least a dozen groups operate halfway houses for recovering addicts, and many of those have multiple sites.
Cumberland County’s publicly funded drug and alcohol abuse services are comparable in number to those available in Durham, according to information from Alliance, the agency managing mental health care for Durham, Wake, Johnston and Cumberland counties. But Durham has the benefit of Duke University Medical Center, which offers detoxification and outpatient services through its addiction program and has partnerships with other community substance abuse services.
Cumberland County has nothing comparable to Triangle Residential Options for Substance Abusers in Durham, where addicts spend two years receiving treatment, education and job training before trying to restart their lives. About half of the organization’s revenue is raised by its patients, who do lawn work and provide other services through the program’s businesses.
Fayetteville also lags behind other North Carolina cities in the availability of Oxford Houses, addiction recovery homes for between six and 15 people at a time. Oxford Houses do not receive state funding. Fayetteville has a half dozen such homes. Durham has 13, Greensboro, 17, and Raleigh, 26, according to the organization’s website.
Norfleet, Sizemore and other advocates who cannot find open beds here have to call treatment centers across the state, where they say they often hear the same refrain.
“You know what they tell me? They have to take care of their county first, and they’ll put our patient on the waiting list,” Norfleet said.
Sizemore said he knows entire families in Massey Hill who are hooked on painkillers. He knows people who started taking them as young teens 10 years ago.
He knows painkillers can be effective treatment for some people. He has a prescription for extended-release morphine and a spinal cord stimulator because of his bad back.
Sizemore prays daily that he will not get a phone call letting him know that another community member has died. Those calls are all the more agonizing, Sizemore said, because more access to help could save lives.
“Really and truly,” he said, “as much frustration as I have about this whole entire system, (addicts) absolutely give up because they realize, ‘There’s no way I can get help.’”