The heroin treatment many in Delaware don’t know about
Brian Laurenzi and Amanda Lofland once called a four-person tent home.
It was strategically tucked into a wooded area near an outpatient treatment facility in Long Neck where they could be treated for heroin addiction. And each day for nearly five months, the couple would make the short walk to Connections Community Support Programs, Inc. for their daily dose of methadone, a medication-assisted treatment (MAT) to stave off withdrawal.
After slugging down methadone the way one gulps a big dose of cough syrup, Brian and Amanda would mount a small scooter and make the 5-mile drive to work at the Mountaire Farms chicken plant in Millsboro. Determined to save what little money they could to move out of the woods and start a new life, the couple avoided old friends with whom they once shared heroin.
But they experienced anguishing pain before seeing a path without opiates: Each endured a couple of stints in state prisons, losing not only years of their lives but also their first child to foster care because the state deemed them unfit to properly care for her.
Today, with more than 14 months of sobriety behind them, Brian and Amanda are doubtful they would have escaped the clutches of heroin without the help of intensive outpatient therapy and methadone, a medication now considered the nationwide standard of care in treating addiction.
Yet treatment providers such as Connections CEO Cathy McKay say the state of Delaware doesn't adequately support medication-assisted treatment. She argues that the state doesn't educate potential clients on the benefits of MAT, and that it spreads its scarce resources on a 'holistic approach' –– including residential treatment beds, 12-step programs and sober living facilities –– that, individually, are not recognized nationally as a standard of care.
“Philosophically, in this administration, there’s been opposition to medication-assisted treatment,” McKay said. “But it’s the standard of care. … It gives you an opportunity to live a life that makes sense.”
The state Department of Health and Social Services insists that it does support medication-assisted treatment –– although it ensures the treatment is coupled with counseling and other services to help those with addiction recover.
“If we weren't supportive (of MAT), we wouldn't pay for it,” said DHSS Secretary Rita Landgraf, adding that treatment providers aren’t supposed to offer medication-assisted treatment without combining it with other services.
About 9,000 Delaware residents are currently receiving treatment through state-funded programs for heroin and opiate addiction, but state officials estimate only 10 percent of those with addiction seek treatment – some because they're not ready for help, others because they don't know where to find it.
That means Delaware is home to 90,000 people suffering from drug and alcohol addiction, a population the state poured $12.54 million into last fiscal year. The state spent nearly $1 million on the medicine used in MAT last year. No new funds were allocated for addiction treatment in the coming year.
There is a disconnect between those seeking care and those providing it. The state funds services, available in all three counties, including 95 adult residential treatment beds, 16 young adult residential treatment beds, 120 beds in sober living facilities and up to 200 outpatient detox slots, as well as outpatient treatment and 23-hour medical assessment beds or "loungers."
Yet many in the throes of addiction don't know the services exist.
“You have to understand you’re in a relationship with the drugs,” said Brian, adding that before securing the tent to sleep in the woods, he and Amanda used to walk more than two and a half hours to the clinic to seek treatment. “Connections was like our backbone.”
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Experts argue that medication-assisted treatment –– which can be taken in the form of a pill, liquid or injection –– is the key to recovery.
In Kent and Sussex counties, where treatment facilities are spread out and sometimes hard to access for those lacking transportation and money, the option is even more crucial. Treatment providers can offer a daily dose of medication, coupled with therapy and counseling, while allowing patients to hold down a job, find housing and return to everyday society.
Despite the negative stigma that has surrounded methadone clinics, also used to treat alcoholism, McKay and doctors across the country stress that medication-assisted treatment is not replacing one drug with another. Doctors equate it to taking high blood pressure medication or insulin for diabetics.
“It is not the evil that people think it is,” said McKay, adding that most insurance providers won’t support long-term residential treatment, which is what many in the addiction field still believe is the best treatment option. “We need to stop talking about what doesn’t exist.”
The state and treatment providers agree that Delaware is not likely to get more residential beds for in-patient treatment anytime soon. And McKay attributes the lack of beds to insurance providers that don't pay for long-term treatment until all other options fail.
Many Delaware treatment providers already offer medication-assisted treatment, which is typically covered by Medicaid and other insurance providers.
In Millsboro, the Connections center provides medication-assisted treatment for more than 600 people daily, with numbers almost equally as high at its center in Newark. McKay says they have room to grow and offer treatment to more people, but the support – and the awareness – isn't there.
For Brian, a daily dose of methadone helps him stay grounded and on track. It’s allowed him to keep a job, save money and rent a three-bedroom home in Seaford with his nearly 6-month-old son Braylyn and his girlfriend, Amanda.
“Just going from absolutely nothing to everything I have now, it’s ineffable,” he said. “I don’t even recognize myself sometimes.”
In a small conference room in Georgetown, six people recovering from addiction sit around a table. One by one, they share with a counselor what they plan to do for the rest of the day after leaving Intensive Outpatient Treatment at Aquila, a treatment provider with locations throughout the state.
It’s all part of reminding those with addiction how to lead their lives without drugs. Counselors like Brandi Ciamarra and Rhonda Dukes want their clients to have a sense of purpose and something to do when they leave Aquila’s doors. If counselors can stabilize clients from the first day, they can prevent relapses and begin to treat the root causes of addiction like depression and anxiety.
“More beds isn’t the answer,” Dukes said. “We don’t want to remove them from society, but many don’t know outpatient is an option.”
Michael Castrogiovanni tried many treatment services, both in Delaware and out of state. Today, he’s still rebuilding his life following an opiate addiction that left him popping up to 20 Oxycotin pills per day. From the first experience, the 24-year-old Delmar native knew he liked the way painkillers made him feel, and now he’s struggling to navigate life without them.
“The most refreshing thing (about therapy) was hearing that addiction is a medical diagnosis,” Castrogiovanni said. “There is no moral deficiency, and I was like, ‘Thank God.’ Because of that information, now I know I don’t have to be that person.”
There remains a large concern throughout the state that residents don't know what services are available to them –– in spite of a $500,000 New Castle County ad and outreach campaign launched in 2015.
State officials believe those with addiction may be misinformed or looking for information in the wrong places, while providers worry that the focus on residential, inpatient treatment has kept many from finding the services actually supported by insurance companies.
Those in the throes of addiction say they genuinely don't know where to turn – too many say the answer they get is "no" when they try to get clean. Frequently, it's when people wind up in jail or in front of a judge that services like Connections and Aquila are presented as options.
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Donna Osman quietly fought her opiate addiction for more than 20 years before she found help at Connections.
The 64-year-old, who popped handfuls of painkillers to soothe her aching knees desperately in need of surgery, didn’t know where to look in southern Delaware. It was only after she got her knees replaced and doctors began weaning her off medication that she knew she was hooked on opiates.
Over the years, she stole from friends, family and others to feed her addiction –– spending thousands of dollars for painkillers that can go for $30 per pill on the street.
“I had people suggest heroin since it was cheaper,” Osman said. “But I said it’s bad enough that I do pills. I’d be afraid to touch the stuff.”
Osman now takes Suboxone, a brand of buprenorphine which is used to stave off withdrawal symptoms. Her body aches, Osman admits, but she says life is about feeling pain.
“I have so many feelings now,” she said, straining words through tears. “I wish people would realize, if you do everything you’re supposed to do, it’ll work.”
In spite of efforts in communities nationwide, America's deadly heroin epidemic marches on with lethal consequences, killing more people than the AIDS epidemic ever did, according to The White House National Office of Drug Control Policy.
Last year, 125 people died from heroin overdoses in Delaware – a 7 percent increase over 2014. Eighty-three deaths were traced solely to heroin, and another 42 were tied to the potent painkiller fentanyl, typically mixed with heroin to accentuate the high. The Delaware Medical Examiner's Office says another 105 died of prescription drug and cocaine overdoses.
The numbers continue to surge this year, Landgraf said. Already, more than 55 people have died from an overdose from drugs or alcohol across Kent and Sussex counties, with even higher numbers in New Castle County.
In Delaware's upcoming fiscal year budget, no new dollars were allocated to funding addiction treatment and services, which Landgraf said could harm the state's ability to offer and fund programs, especially those downstate. DHSS has plans to fund more sober living facilities downstate for men and women, while adding family services to counseling offerings at treatment centers.
"We're still treading (water) here,' " Landgraf said, "and sometimes we're drowning a little bit in this level of work."
The White House National Office of Drug Control, with the support of President Barack Obama, recently pushed for $1.1 billion in federal funds to aid state programs aimed at increasing medication-assisted treatment. Delaware could see up to $4 million should Congress approve it, and Landgraf said the state has every intention of applying for the funds –– although no proposal has been drafted yet.
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Michael Botticelli, director of the White House Office of National Drug Control Policy, acknowledges that no one solution will solve the entire epidemic. But medication-assisted treatment has clearly demonstrated that it helps achieve successful outcomes, he said.
"We know what works here," Botticelli said in reference to MAT. "It's the standard of care."
Many out-patient services in the state are underutilized and not at capacity, said both McKay and Dr. Mandell Much, director of clinical services at Aquila. Aquila has the ability to treat many more patients than they are now if more state funding and support were available, he said.
As the state continues to provide resources to these providers, Landgraf stressed the importance of using the time when patients pick up their medication as a way to check in, offer counseling and perform urine screens to make sure relapses aren't occurring.
“Probably for those who have been unsuccessful in their recovery, those with multiple relapses –– for a certain part of our population, I believe it’s very appropriate,” Landgraf said. “What’s inappropriate is only offering MAT.”
Dillon Walker now works six days a week. He owns a home with his girlfriend and he’s there for his 18-month-old son Ezekiel, who likes being called Zeke.
Unlike Walker’s own childhood, the 23-year-old Rehoboth man is there for his son after methadone gave him a second chance at life. His father committed suicide when Walker was 12, a moment that caused him to shut off his emotions and “become a man,” he said.
After years of cocaine and heroin use – and now, with the help of Aquila – he’s learned that his life is valuable, and he doesn't want his son to grow up without a father. Everything went wrong for a long time, Walker said, but treatment and MAT has given him the opportunity to make it better.
“My life’s not over,” Walker said. “It wasn’t over then. It’s not over now.”
As his son runs laps around him, Walker smiles. His boy has blonde hair and blue eyes and giggles when fingers brush his stomach. For Walker, Zeke represents a beacon of clarity about what matters in life.
“You have to find whatever your purpose is, that one thing deep down inside you that will help you stay sober,” he said. “If you do that, that’s what makes a difference.”
Those in treatment admit that no amount of medication or therapy makes the days of using disappear. Some are wistful of those memories while others are angry at themselves for ever picking up a needle. Nearly everyone is glad to be rid of their addiction and its powerful lure.
“If I was rich and I could have afforded it, I would have did it 'til I was dead,” Brian said of heroin.
His life is much better now, made richer by his girlfriend and baby boy. Shedding the life of drugs was difficult, and Brian is determined to never return to living in the wooded grounds of Long Neck he once called home. Last week, the couple returned to the woods for the first time in more than a year to find the four-person tent still standing in overgrown brush and weeds, a blanket inside.
“It’s almost surreal,” Brian said before shaking his shoulders as if a chill ran through him. “It’s time to get out of here.”
Today, Brian wants to help others escape the destructive vice of heroin. And for now, methadone occupies an important chapter in the narrative that defines their lives.
“It’s just better,” he said. “It works for us. Otherwise we’d probably be living on the streets somewhere. But it’s not a magic drug. You have to work at it.”
Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.