Lack of resources blocks treatment

By Marshall Allen

Monday, July 28, 2008 | 2 a.m.

She’s a mother of three, a hairdresser and on the brink of divorce, and this is how addicted she is to prescription narcotics: She gets so stressed just at the thought of quitting the drugs, she sweats and trembles, making her customers uncomfortable.

So she pops Xanax to relax.

She’s got no insurance and is struggling to find treatment that won’t cost a fortune. The only two options in Las Vegas — Westcare and the Salvation Army — are at capacity. “Call back tomorrow,” they tell her.

“I’m literally hanging by a thread,” she says, and there’s no mistaking the desperation in her voice. “I don’t know what’s going to happen here. I really need to clean up my life soon. If I can’t do that, there’s no hope.”

She is not alone in her plight. The number of prescription narcotic addicts in Nevada is rising, overwhelming a treatment system burdened by tens of thousands of drug and alcohol addicts. In the past year, more than 2,000 addicted Nevadans have been added to wait lists for inpatient substance abuse programs funded by the state. By comparison, the number was 1,162 in 2002.

Many of them drop off the list and never get treated.

Substance abuse experts generally agree that addicts are best served when they’re admitted to residential treatment facilities, where they can detoxify and learn about the emotional and physical factors that cause addiction.

Substance abusers who have money can always find treatment — which usually lasts at least 30 days at a minimum cost of $10,000. But addicts commonly don’t seek help until they’ve burned through their bank accounts and burned bridges with loved ones who may have been able to help them pay for treatment. Health insurance may provide limited coverage for substance abuse, but many addicts are uninsured.

The thousands on the state’s wait list for treatment represent only a portion of the overall need, said Chuck Bailey, health program specialist with the state’s Substance Abuse Prevention and Treatment Agency

Most of the addicts are dealing with traditional problems — alcohol or street drugs. But experts and a Sun analysis of government data show the use of prescription narcotics in Nevada has reached crisis proportions. Nevadans are the No. 1 users per person in the nation of hydrocodone, also known as Lortab or Vicodin, and the No. 4 users of oxycodone and other narcotics, the Sun analysis showed.

There’s been a concurrent — but difficult to quantify — rise in prescription drug abuse and addiction, experts say. Nationally, a 2006 government survey concluded that an estimated 5.2 million people 12 and older took narcotic painkillers for nonmedical purposes 30 days before the survey, up from about 4.4 million in 2002.

The Nevada Substance Abuse & Treatment Agency reports that in 2006, about 191,000 Nevadans were in need of substance abuse treatment for alcohol or drugs and that between 23,000 and 40,000 of them were receiving treatment. More might seek treatment if there were more openings in various programs, or if new programs were created.

Of the 550 beds statewide for inpatient substance abuse treatment, 375 are in Clark County.

“There clearly is a shortage, there always has been,” said Greg Weyland, deputy director of the Nevada Substance Abuse & Treatment Agency.

Alcohol abuse is the biggest problem. Generally, the number of people abusing street drugs is declining as the number of people abusing prescription narcotics is rising. In 2007 the number of deaths involving prescription narcotics exceeded those involving street drugs or those caused by car accidents, according to a Sun analysis of Clark County coroner’s office data.

Dr. Michael Levy, who runs the Center for Addiction Medicine in Las Vegas, blames the shortage of affordable treatment facilities on insurance companies that provide little reimbursement for substance abuse even as research shows that substance abuse is a chronic medical disorder like diabetes or other similar physical ailments.

“We’ve taken a disease and put limits on how to treat it,” Levy said. “We don’t do that with any other area. Intellectually, philosophically, there’s something wrong with that type of approach. More providers would show up if insurers were to cover it.”

Nevada requires group insurance plans that cover more than 15 people to provide substance abuse treatment — a minimum benefit of $9,000 per calendar year for patients admitted to a certified facility, and at least $2,500 of counseling per calendar year for outpatient treatment. Medicaid, the state’s insurance for the poor, covers detox but not inpatient treatment programs.

Addiction specialists say they often tussle with insurers over reimbursements for inpatient treatment beyond a few days in detox, because the insurance companies argue that it’s not medically necessary.

Requiring surgical and medical health insurance coverage to provide parity for substance abuse and mental health treatment has been the subject of a national debate for more than a decade. Proposed congressional legislation would require insurance plans, if they provide any mental health or substance abuse coverage, to provide it at the same level of benefits as for medical and surgical coverage.

Many addicts are beyond the debate about insurance parity because they’re uninsured, which leaves them making repeated calls to Westcare and the Salvation Army for help. The Salvation Army’s clientele is mostly people who are homeless, mentally ill or referred by the criminal justice system.

The Salvation Army has 79 beds for men and 32 for women, and about 30 people are on the waiting list for the six-month program. A day program was launched in April to help up to 25 others.

Two 24-year-olds, Brandon and Duard, joined the day program a month ago. They’re addicted to the narcotic painkiller OxyContin, and say they know many addicts on the street who are searching for treatment.

They lament that people they know call the facilities for help, but are denied because there’s no room.

“People are out there wanting to get help,” Brandon said.