Slashing Detox


By David Abel  |  Globe Staff  |  4/28/2003

When all else fails, they come to Ludy Young. They come confessing their crimes, they come and kneel before her to pray or beg for help. One woman, nearing withdrawal, recently burst into tears, pleading with her: "Please, please, I need your help. I need a bed."

Increasingly, however, the emergency room counselor whose office is a spare basement room at Boston Medical Center finds she can't help.

"This is the end of the line for a lot of people," Young said. "You know there's nowhere else for them to go, and it makes you feel helpless, like your hands are tied."

Less than a month after the state cut health coverage for 36,000 of its poorest residents and slashed nearly 50 percent of the beds at detox facilities throughout Massachusetts, those suffering the worst addictions to alcohol and drugs already see the difference: It's getting harder for them to sober up.

Before the budget cuts took effect on April 1, the state subsidized 997 beds, which last fiscal year helped some 45,000 patients get sober - at least for a little while. Now, only about 500 beds remain, and by the end of the fiscal year, the number will drop to 420.

"This just hit the streets, so the effects are only now becoming apparent," said Elizabeth Funk, president of the Mental Health and Substance Abuse Corporations of Massachusetts. "But we expect to see an increase in deaths, arrests, domestic violence, child abuse, and emergency room visits."

At Boston Medical, there has been about a 25 percent increase in addicts seeking help at the emergency room.

Across the street, at the Boston Public Health Commission's central intake, social workers used to be able to find a detox bed in about a half-hour; now, it can take as long as a week.

And uninsured addicts say they've been left to compete for the few remaining state-subsidized detox beds.

It took Andrew Schena about two weeks to land a bed at Andrew House, a detox facility on Long Island where, of 30 beds, only five are available to the uninsured. After a year of feeding his addiction to Percocet and OxyContin, and on the verge of getting thrown out of his apartment, the 38-year-old unemployed construction worker decided it was time to clean up.

But like a growing number of addicts who lost their Medicaid benefits this month, Schena found it wasn't as easy as checking himself into the closest hospital. Lacking insurance, he went to Room 5 at BMC, central intake, and they couldn't help. He spent the next week-and-a-half waking early and calling around to local detoxes, asking if they had a bed.

When he finally landed one after two weeks, he said: "It was like winning the lottery."

Things could get worse next year.

A plan recently proposed by the House would cut 10 percent of the $37 million the state now provides for substance-abuse programs.

A provision in the House proposal would also forbid the state from awarding contracts to any social services agency that provides methadone treatment, a move that would end aid to nearly all the state's remaining detoxes.

The reason for the cuts, House officials say, is the state's looming deficit of $3 billion. Part of a raft of other cuts, they include the curtailing of everything from education programs to prescription drugs for the elderly.

"Nobody takes pride in these cuts, but the state is facing a historic decline in revenue," said Charlie Rasmussen, a spokesman for House Speaker Thomas M. Finneran. "Tough cuts had to be made."

But with a growing number of people using heroin and some 15,000 state residents receiving methadone, public health officials warned that if the House's proposal becomes law, it would be catastrophic and ultimately exacerbate the budget problems.

"This is huge," said Deborah Klein Walker, associate commissioner of the state Department of Public Health. "The problems now would get much worse."

To a group of men on the streets near Downtown Crossing, any potential pain pales compared with their current woes. Several said they're already getting unwelcome messages from the detoxes they've relied on for years.

The message Jeff Oldfield got during one recent effort to sober up: Don't come back. Two visits a year, he was told, would be the limit.

And rather than staying five to seven days, the detox told the 44-year-old homeless alcoholic he could stay at most three days, to make room for other uninsured addicts.

"I'm one of the people you could blame for all these problems," said Oldfield, adding that he's been to detox about 200 times. "But this is a disease. You relapse and relapse and relapse. It's hard to beat this."

What will he and others do?

Oldfield's friend William Gaskell said that after a while, "Jail is the only option."

Still, some will try to beat the odds and sober up on their own. Others, when their money runs out, will steal to feed their addictions. And some will keep trying for the few detox beds remaining.

The rest are likely to end up seeing Ludy Young or emergency room counselors at other hospitals.

They are coming in droves now, some already beginning the sweating, vomiting, and delirium of withdrawal.

With so few detox beds available, Young's office has started a waiting list. And with most of the beds now taken every night, she and her colleagues are looking to facilities across the state. Recently, a bed became available in Brockton, so the hospital sent the patient there in a cab, picking up the tab.

"It's very frustrating," Young said. "You want to help, but sometimes there's nothing you can do."

David Abel can be reached at Follow him on Twitter @davabel.

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