Amid an opioid epidemic, New Orleans struggles with shortage of detox beds | NOLA.com
For years, Mike Wattler molded his life around his alcohol addiction, often balancing a habit of drinking a half a gallon of vodka a day and working in construction or as a longshoreman– usually hiding a bottle in his backpack.
But last November, he said, he knew he had to stop.
As he had in the past, the 30-year-old tried to white-knuckle his way through self-detox. He remembers having to call a friend and telling him he wasn’t feeling well. He went over to his friend’s house and within minutes started having a seizure.
Wattler was taken to Tulane Medical Center and placed in a medically induced coma to reduce the seizures for a few days. When he was discharged, he left the hospital with Ativan, a medication used to control seizures caused from alcohol withdrawal. He was surprised, he said.
“I was like, y’all know alcoholic detoxes last for up to two weeks. I have seizures from detoxing, and they’re like ‘Well, try to find somewhere to go,’” he said recently. “I was like ‘Well, I’m going to go get a fifth.’”
Mike wears a bracelet alerting medical professionals he is on Vivitrol, a drug to help prevent alcohol or substance abuse relapses, as he talks about his battles with substance abuse and his efforts to recover in the Odyssey House residential program on Wednesday, January 9, 2019. (Photo by Michael DeMocker, NOLA.com | The Times-Picayune)
It took Wattler another week, but he made it to Odyssey House’s medical detox facility where he was treated to lower his blood pressure, which went up to 170 at one point, and to control his seizures. As of mid-January, he had been in their rehabilitation program for about five and half weeks.
Wattler’s experience reflects a problem for many New Orleans patients battling substance abuse disorders: getting help is not as easy as just showing up in an emergency room. While ER doctors can help save the lives of people suffering the most painful and deadly withdrawal symptoms, it’s often a short-term fix. The best alternative is treatment in detox-specific programs, designed to manage the most acute and potentially dangerous physical effects of stopping drug use and transition patients into long-term addiction recovery.
But there are only 155 medical detox beds in four facilities in all of Orleans, Jefferson, and St. Tammany Parishes, despite a growing number of drug related overdose deaths in recent years in the area.
“There is an epidemic going on and New Orleans is not built for the amount of people seeking recovery,” Wattler said.
Group rules are listed on a wall at Odyssey House detox center in New Orleans on Thursday, December 13, 2018. (Photo by Brett Duke, NOLA.com | The Times-Picayune) NOLA.com | The Times-Picayune
NO STAND-ALONE DETOX UNIT AVAILABLE
The metro area’s four out-patient detox units provide 24-hour managed care for people in the early stages of withdrawing from alcohol and drugs. But experts agree that 155 beds are not enough for a region this size. Only 117 of those beds are available to uninsured or Medicaid patients.
To put this in perspective, in 2017 there were 219 drug overdose deaths in New Orleans alone. That same year, in Jefferson Parish, 173 people died of drug overdoses.
New Orleans has not had a hospital-based stand-alone medical detox unit since 2012, when the former Interim LSU Public Hospital had to shutter its 20-bed detox unit due to budget cuts.
Longer-term treatment beyond the emergency room in some local hospitals is limited to patients who have a dual diagnosis of a psychiatric and substance abuse disorder. For example, a patient walking into the emergency room at University Medical Center would have to be diagnosed with both in order to be admitted into the hospital’s 15-bed addiction disorders unit, according to a UMC spokesperson.
The region’s largest medical provider, Ochsner Health System, has no dedicated detox beds. A spokesperson for the health system said they will detox seriously ill patients who are experiencing withdrawal in their medical units, and in their psych units in case of a dual-diagnosis.
A Tulane Medical Center spokesperson confirmed that because of the frequent need for medical detox services, they provide them at nearly every inpatient unit and their intensive care units.
“Patients are placed on a unit based on their diagnosis and our physicians treat the patients’ medical symptoms on that unit until the acute phase of detox is complete and the patient is stabilized,” according to the Tulane spokesperson.
Michele talks about her battles with substance abuse and her efforts to recover in the Odyssey House residential program on Wednesday, January 9, 2019. (Photo by Michael DeMocker, NOLA.com | The Times-Picayune)
‘HELL ON EARTH’
Although medical detox is not necessary for all substance abuse issues, it is vital for patients battling opioid or alcohol withdrawal, for whom symptoms can come on quickly and are potentially deadly.
When Michele Vinetti, 50, was withdrawing from suboxone, a medicine used to reduce symptoms of opiate addiction and withdrawal, she began feeling symptoms four days later. Suboxone withdrawal can last a month and cause nausea, muscle aches and headaches.
“It was hell on Earth,” she said. “I was nauseous, I couldn’t sleep for four days.”
She checked in at Odyssey House on Jan. 2. A couple weeks later she was still detoxing, and doctors were slowly putting her back on psychiatric medication to treat bipolar disorder, she said.
Vinetti has relapsed 17 times and even so, this was the only place in New Orleans where she knew she could get help.
Experts say that having access to this first vital step in treating substance abuse is essential, in order to get patients immediately connected to long-term treatment options.
“Without quick access to medical detox, it is easier for patients to fall out of the system and not seek out help,” said Arvin Singh, chief operating officer at Odyssey House, which like a handful of other organizations in recent years has tried to address the need by opening up more detox beds.
Arvin Singh, chief operating officer at the Odyssey House detox center in New Orleans on Thursday, December 13, 2018. (Photo by Brett Duke, NOLA.com | The Times-Picayune) NOLA.com | The Times-Picayune
A year ago, Odyssey House, which also has a long-term drug rehabilitation program, moved its detox unit to a small one-story building on Washington Avenue. The facility opened as a 20-bed unit. This month they expanded to 40 beds.
Singh said the expansion will allow them to boost their intake capacity to 12 people daily. There is a lot of demand for their services, he said. In December they were booking people ahead of time.
Across the river in Algiers, Qualis Care, a combination residential and medical detox unit opened last year with 50 beds for men and women. Initially the center, which has another location in Tennessee, only accepted private insurance. Four months later, they expanded to accept three types of Medicaid plans.
“We had to,” said Desmond Oconner, Qualis’ clinical director. “It’s overwhelming. Just yesterday I had five new clients that came in.”
River Oaks Hospital in Harahan also accepts Medicaid patients in its 27-bed unit, where it offers a variety of programs including substance abuse treatment and medical detox. In New Orleans East, Townsend Recovery Center opened a unit in New Orleans East General Hospital, where it is able to provide both services for up to 38 patients at a time.