Lora Saczawa doesn’t want to see any more people die.
At times, it feels like she’s a member of a bomb squad, with the final seconds ticking away on an explosive device. Lives are literally on the line.
Saczawa, of Calumet Township, runs a Facebook group called NWI Addiction and Help Group. She’s often the first person families of local drug addicts reach out to for assistance.
Sometimes she can’t help them.
Since last weekend, she’s been attempting to get a heroin user from LaPorte into treatment. A local detox center was full. A safety-net rehab center had a two-week wait to get in.
It’s a familiar routine for anyone who has tried to find drug treatment for a loved one in Northwest Indiana: waiting lists, insurance issues, long travel distances.
“It’s a nightmare whenever I get a call from someone wanting help,” said Saczawa, who started the group after dealing with her own son’s addiction to heroin (he finally got clean after being sent to prison).
“Either they end up going to the hospital and saying they have chest pain or are suicidal and they have to keep them for 72 hours, or they try home-detoxing, or they go back to using.”
Saczawa has even taken to offering tips on Facebook for people who have to withdraw from opioids from home: stay hydrated, eat crackers to keep food in your stomach, take Imodium for the diarrhea, use over-the-counter sleep medication for the inevitable trouble sleeping, listen to music to give your brain something to focus on.
With Northwest Indiana, like the rest of the United States, facing an epidemic of opioid overdose deaths, more Region residents are acutely in need of substance abuse treatment than perhaps ever before.
Since the beginning of this year in Lake County, 36 people have died from heroin overdoses and another nine lost their lives to fentanyl, an opioid 50 to 100 times stronger than heroin that is often mixed in or sold in place of the drug. In addition, 28 people have died from opioids in Porter County, while LaPorte County loses about 15 to 20 residents to opioids annually.
Experts say it’s difficult, but not impossible, to find help locally; it’s particularly hard if the addict has little or no health insurance, which often is the case. One thing is certain: The supply for treatment is not keeping up with the demand for it.
“The harsh reality is there’s way more help needed than there is help available,” said Kevin Glisic, executive director of Moraine House, a Valparaiso halfway house for recovering addicts.
“We’re a 13-bed facility, and if we had 50 beds, they’d be full tomorrow.”
Jails, hospitals pick up slack
With the public resources for substance abuse treatment not meeting the need, it has fallen on local jails to become de facto detox and drug rehab facilities. The Porter County Jail, for instance, has multiple programs: one of the traditional, 12-step variety; another, called therapeutic community, that is more intensive and teaches life skills; and a therapeutic community with a spiritual element called the God Pod.
On any given day, a quarter of the jail’s 430 inmates are in drug treatment. Porter County Sheriff David Reynolds says the recidivism rate for jail inmates who complete the programs are significantly lower than the overall national average.
“Our position is they’re in here for six, nine months, to a year; why not make an attempt to straighten them out?” he said. “So when they get out they’re not breaking into somebody’s car or house or stealing somebody’s credit card.”
Opioid users often show up at local hospital emergency rooms asking for detox — only to be denied, because insurance doesn’t cover the service. But many addicts know a workaround: to say they’re suicidal. That way, the hospitals’ psych wards have to observe the patients for three days and, while they’re there, give them medications that ease withdrawal symptoms.
“We do our best with detoxing and, understand, we don’t really have the medications to detox people from opiates,” said Jake Messing, director of behavioral health services at St. Catherine Hospital in East Chicago. “We use what we can use and do the best we can.”
Messing says his unit refers patients to treatment, but whether they go depends on the motivation of the addict. He often encounters drug users who don’t want to travel or pay a minimal amount of money to get help, when they drove dozens of miles and spent hundreds to thousands of dollars a week to support their habits.
“Sometimes they’ll say, ‘I’ve been clean for three days. I’m good to go. I don’t really need your help,’” Messing said.
That presents another problem: Opioid addicts who undergo detox are considered “opioid-naive,” meaning they have low tolerances for the drug. So if they go and ingest the same amount of the substance they’d been using previously, they’re at increased risk for an overdose. Messing said he has had patients die from heroin shortly after being released from his unit.
“One of the things we do, unintentionally, is kill people,” he said at a recent forum on drug treatment in Northwest Indiana.
This is why the Lake and Porter county jails are looking into giving opioid-addicted inmates, upon their release, Vivitrol, a shot that reduces the cravings for and blocks the high from opioids for 30 days.
Inmates who graduate from the Indiana Department of Correction’s therapeutic community programs are already offered Vivitrol (the DOC also plans to next year start providing prisoners with medication-assisted therapy like buprenorphine — brand name Suboxone — during their stays).
Users turn to safety-net clinics
Addicts who are uninsured or on Medicaid generally have to turn to community mental health centers for help. In Northwest Indiana, there are four: Merrillville-based Regional Mental Health Center, Edgewater Behavioral Health Services in Gary, Porter-Starke Services in Valparaiso and Swanson Center in Michigan City.
The only one with residential drug treatment is Regional, and the waiting list to get in is often weeks long. The mental health center has 18-state funded beds where addicts come from around Indiana and stay for about a month, as well as another seven to 14 beds for local residents whose average stay is about 14 days.
When Indiana expanded Medicaid under Obamacare in early 2015, Regional and other community mental health centers saw an influx of newly insured patients seeking substance abuse treatment.
“We’ve had an explosion in demand for those services over the last year and a half,” said Regional President Bob Krumwied. “We are struggling to find the workforce to enable us to expand.”
Krumwied said he could afford to hire four to six more substance abuse therapists, but universities simply aren’t graduating them. Drug counselors, because they have so many patients on public insurance, have traditionally been among the lowest paid in their profession. A recent increase in Medicaid reimbursement rates, and a law requiring insurers to cover substance abuse care at the same level as physical care, could eventually help reverse this trend. Indiana has the fourth-largest shortage of substance abuse specialists in the country, according to the Pew Research Center.
The increase in insured Americans is also why, in part, several new for-profit rehab centers have been popping up in the Region (Recovery Works, a 42-bed facility in Merrillville, is set to open this week). Many of those, however, do not accept public insurance.
Overall, the majority of treatment facilities in the Region just have outpatient services, mostly due to insurers’ prohibition on paying for long-term residential care. There also are an increasing number of doctors offering medication-assisted treatment, namely Suboxone, a drug that blocks opioid withdrawal symptoms as well as cravings for the drug.
The combination of medication and counseling or support groups is how many local opioid addicts get their lives back in order.
“The state tried to get people out of inpatient and get them functioning,” said Carmen Arlt, program director of the Porter-Starke Services Recovery Center in Valparaiso, which offers methadone and counseling.
“That’s the whole idea of medication-assisted treatment: People are able to stay at home, engaged with their families, keep their jobs. With the help of Narcotics Anonymous and support groups, they do well.”
Loved ones struggle to find help
David Lee, the founder of Lowell-based Heartland Recovery Center, says treatment is available, but addicts’ loved ones, who are usually the ones searching for help, don’t always know where to look.
“Within 100 yards of my center, I would venture to guess there are 50 homes,” he said. “If anybody in those homes did a search online for drug or alcohol rehab, it wouldn’t show up at all. They would think the only treatment options are in Florida or California.”
There really is no central repository of treatment providers in Northwest Indiana. But Lee says rehab centers like his have an “invisible list” of places they can refer to.
“I would say 95 percent of the people who walk in our door or call, no matter what their financial situation, we’re able to place them or find them an option within 24 hours,” he said.
The bigger issue, he said, is the willingness of the addict, whose “temporary crisis” — say, getting kicked out by a spouse — may have subsided in a day. Opioid addicts also often return to using because the withdrawal is so severe. It’s been described as the “flu on steroids.”
Noah Back, of South Haven, didn’t know where to turn when he discovered his son was hooked on heroin. He called drug abuse hotlines and the county courthouse, but didn’t get anywhere. He tried to force his son into treatment, but learned that Indiana isn’t among the states where parents can involuntarily commit adult children to rehab. He wasn’t even sure where to go for support. He finally met a former user, who told him his son’s addiction would end in one of three ways: recovery, jail or six feet under.
Jared Back died of an overdose 10 years ago Saturday. He was 25.
“The graveyard he’s buried in, there are five other people buried there who he associated with,” said Back, who now attends a support group for loved ones of addicts the first and third Friday of the month at the Porter library.
“They were all heroin deaths. Can you imagine that?”
Political support increasing
In 2014, Indiana was tied with Arizona and Missouri for the 15th-highest drug overdose death rate in the country, with 18.2 people dying from overdoses for every 100,000 inhabitants, according to the Centers for Disease Control and Prevention.
Despite the need, Indiana spent just $10.3 million on substance abuse in 2013, ranking it 37th out of the 47 states that submitted data to a Pew Research Center study. For comparison’s sake, Illinois ranked eighth, spending $86 million in 2013. Ironically, many Northwest Indiana residents who can’t find or afford treatment here end up getting it in Illinois because of that state’s more robustly funded drug treatment system.
But more state resources could be on the way in Indiana. With the opioid crisis reaching epidemic proportions, increasing funding for treatment has bipartisan support. So does the idea that addiction should be treated like a disease rather than punished.
Last year, Gov. Mike Pence, a Republican, formed a drug abuse task force that has been holding meetings across the state and will release its final recommendations in December. Both gubernatorial candidates, Democrat John Gregg and Republican Eric Holcomb, support a boost in treatment funding.
State Sen. Jim Merritt, R-Indianapolis, said next year’s legislative session should see a bevy of proposals for tackling Indiana’s substance abuse crisis. Some of his ideas include expanding the Recovery Works jail diversion program from just felons to those convicted of misdemeanors, giving local governments more discretion to start needle exchanges, making drug felons eligible for food stamps, auditing state prisons, hospitals and treatment centers to find out where rehab beds could be added and offering grant opportunities for local treatment programs.
Merritt hasn’t determined the financial impact of his proposals but said: “It’s not going to be cheap.”
An exhausting ordeal
Four years ago, Casey Martino decided he was sick of watching his mom cry. He was born with a spinal deformity and prescribed pain pills from an early age. In his late teens, he started abusing them.
He tried to get into treatment but couldn’t afford it. So, he says, he locked himself in a room, ignoring all his using buddies, for three weeks. Even though quitting cold turkey was extremely difficult, he considers himself lucky.
Since he got clean, Martino has lost 10 people he knows to drug overdoses, mostly heroin.
“If there was more treatment, I think a lot of my friends would still be here,” said Martino, 35, of Hammond. “A lot of them were crying out for help but didn’t know where to get it.”
Bonnie Pugh, of Chesterton, is still trying to help her two adult sons get sober, seven years into their addictions to heroin.
She has run into waiting lists, insurance denials and facilities that charge $30,000 a month. She has gotten them into short-term detox, but they’d start using again right after they got out. They’ve tried Suboxone and sober-living houses and treatment programs behind bars, but nothing worked.
Pugh wishes there were more long-term treatment facilities around. She says heroin addicts like her sons need acute rehab of a kind that’s hard to find in the Region.
“I had always hoped as time went on, with more awareness and more people knowing we had this huge heroin epidemic, that more treatment and options would come up,” she said. “That has just not happened.”
“I usually ended up frustrated and in tears trying to find help for my sons,” she added, the exasperation in her voice undeniable. “There’s just not enough readily available help.”