For people addicted to opiates — or any other substance — there are many barriers to successful recovery, despite the quality of resources that may be available. In Homer, not only is there a lack of care for existing addicts, but there also is a lack of a coordinated approach to prevention.
“We don’t have enough facilities for residential rehab. We don’t have enough detox facilities. We don’t have enough people with addiction training,” said Dr. Sarah Spencer, who specializes in addiction treatment. “Medicaid won’t pay for drug testing to monitor their treatment so they are stuck with that bill and that can be a barrier for treatment.”
The Homer City Council held a work session Monday to establish how the city can assist community members and groups with the heroin and opioid issue.
Dr. Spencer of South Peninsula Hospital, Haven House Director of Prevention and Resilience Coalition Coordinator Rachel Romberg, Homer resident and former addict Megan Anderson, Kenai Peninsula Youth Court Executive Director Ginny Espinshade, defense attorney Andy Haas, concerned citizen Ken Castner, Homer Police Chief Mark Robl and South Peninsula Behavorial Health Services CEO Dave Branding participated in the roundtable with the city council. The group established a need to address heroin and opioid addiction in Homer as an issue of health, instead of an issue of criminality.
“The overall result was we need to do something; we need to do something quickly,” said Mayor Beth Wythe.
Although substance abuse in Alaska is notably more prevalent than in the rest of the nation,
solutions for addicts amount to resources spread incredibly thin across the large state. In 2012, the overdose rate for prescription opioid pain relievers was double the national rate for the United States and the heroin-associated overdose death rate was more than 50 percent of the national rate, according to the Alaska Department of Health of Social Services. Since 2012, the number of opioid pain reliever overdose deaths rose by 9 percent and heroin-associated overdose deaths rose by 71 percent in Alaska.
The nearest in-patient detoxification facility to Homer is in Anchorage and the waiting list is huge, Spencer said. In fact, the Ernie Turner Center is the only in-patient detoxification facility in Alaska.
It has 12 beds.
Ernie Turner Center is run by the Cook Inlet Tribal Council in partnership with the Alaska Department of Health and Social Services, according to the CITC website. The residential treatment program accepts individuals seeking detoxification from a variety of substances, including heroin and opiate painkillers. Ernie Turner Center is the only facility in Alaska with an in-patient detoxification program listed on the Substance Abuse and Mental Health Services Administration’s website.
Serenity House Residential Treatment in Soldotna, which is run by Central Peninsula Hospital, is a 12-bed residential facility, but does not offer detoxification. Patients can enter Serenity House’s 28-day program after they complete detoxification, either through a residential program or medically assisted outpatient detoxification.
Spencer offers medically assisted detoxification using medication to help with nausea symptoms or a short-term buprenorphine treatment for individuals planning to go into a residential program like Serenity House. Hospitals will not admit individuals for opiate detoxification unless there are other health complications, such as a heart condition or pregnancy.
“Opiate detoxification is painful, but not life-threatening, so you won’t qualify for a bed,” Spencer said. “We might take people who are detoxing from alcohol, because that can be life-threatening, but we can’t take someone into the hospital just because they’re uncomfortable and we don’t have a unit that’s just for people to detox.”
Outpatient detoxification can be challenging for addicts living in unstable conditions, such as homelessness, Spencer said. In-patient detoxification allows individuals to remove themselves from the environment in which they use. After a person finds a way to successfully detoxify, having a bed in a residential setting is the next challenge. Alaska has a major shortage on residential rehabilitation beds as well, Spencer said. The complications in treating addiction do not stop with beds either.
Spencer is the only certified addiction specialist in Homer and is one of two doctors on the Kenai Peninsula who are actively prescribing buprenorphine, she said. The other doctor is in Kenai.
For those who choose to treat their addiction through outpatient care, Spencer prescribes buprenorphine for long-term addiction maintenance, though it must be used in tandem with counseling. South Peninsula Behavioral Health Services, known in Homer as The Center, offers integrated mental health and substance use disorder treatment, said Kathy Carssow, the adult and emergency services program director at South Peninsula Behavioral Health Services. The Center offers counseling to individuals struggling with addiction, as well as their family members or children.
“It goes way beyond what you’d think of as counseling. It’s very individualized,” Carssow said. “We provide everything from psychotherapy and psychiatric care to case management to prevention.”
The Center accepts Medicaid in addition to having a sliding payment scale for individuals who do not qualify for Medicaid but cannot afford health insurance, Carssow said. For help applying for Medicaid, Seldovia Village Tribe Health and Wellness, Kachemak Bay Family Planning Clinic and the state unemployment office have people who can assist in the process.
The Center also offers a children and family program called Parenting with Love and Limits for parents with adolescent children, Parent Motivation Therapy, Parenting Insight, and a 24/7 emergency services with a mental health clinician. During off-hours, the clinician can be reached through South Peninsula Hospital, Carssow said.
“If we can provide the support to family members of users, then it makes a huge difference with recovery,” Carssow said.
Both Spencer and Carssow expressed that they would like substance abuse and mental health services to be located closely together, so that doctors and counselors can work in tandem to introduce patients to one another, instead of just handing out referrals.
Spencer also prescribes Naltrexone, a once-a-month shot for addiction maintenance, which requires the individual to be off substances for two weeks. The shot is ideal for addicts leaving a residential program or jail, Spencer said.
Before Spencer began practicing in Homer, Dr. Michael Merrick in Kenai was the only option and his wait-list could be six months long, Anderson said. Individuals seeking help had to call in once a week to maintain their spot on a list to make an appointment. Those who missed a call were bumped back to the bottom of the list. Once an appointment was obtained, they might wait another month or two before they were seen.
“I saw a couple people go through this. They made their phone calls, they got appointments set up,” Anderson said. “One of them ended up getting arrested, I think two days before his appointment, for possession and has been in and out of the jail system — overdosing, getting high — ever since.”
Though there are multiple gaps in care that allow addicts, even those who desire help, to fall through the cracks, Homer also lacks prevention programs that will prevent future addiction. Groups like Haven House, the R.E.C. Room and the Resilience Coalition are working to educate the community, but there is no one working full-time in substance abuse prevention in Homer, Romberg said.
“I feel like that affects our ability to really address the issue,” Romberg said. “I think we’re really missing in this community a real champion, a real focus on substance abuse, because while we can address it a little bit … we really don’t have a specific focus on the prevention side of things.”
Homer’s schools are in need of prevention education, Anderson said. Starting with high school freshman or eighth-graders may be too late to start addressing the issue.
“When I was in this loop, I think 14 was the youngest I ever knew of someone getting high. I think it’s important that we keep focusing on the schools, younger and younger,” Anderson said. “This is something a lot of people think … it’s going to encourage drug use, but all it does is educate people. And that’s what needs to happen. That’s what prevents things from getting out of hand the way things have.”
The Resilience Coalition applied for a drug-free community grant that they hope will provide funding to hire a person whose sole job is thinking about prevention, reducing community factors that contribute to drug use, and organizing coalitions and groups to work on prevention of teen access to drugs and educational programs, Romberg said. In addition to creating such a position, the community is in need of other outlets for teens. Romberg believes that having a safe indoor space for teens to play sports and other recreational activities in the evenings and at night would also help reduce drug use.
Though Homer is light on substance abuse prevention, community groups have been mobilizing in an effort to help existing drug users. Spencer held a talk on opioid overdose on April 9 and trained the group of 40 people in attendance how to administer Naloxone, a drug that prevents opioid overdose. Homer police officers now have Naloxone kits and can administer them if called to an overdose, Robl said. Individuals cannot be arrested on drug charges if they call the police for help in an overdose situation, Spencer said at the opioid overdose training.
Spencer also is working with community members, including Robl, to create a syringe exchange program. The group hopes to have the program running by the summer, Spencer said.
The program would provide clean syringes to users and allow them to dispose of dirty needles, which often end up on the beaches in Homer. In addition to providing syringes, the program would educate users about health, addiction treatment and counseling opportunities. By providing clean needles, syringe exchange programs reduce hepatitis C in the addict population by 30 percent and reduce the transmission of HIV by a third, Spencer said.
“HIV in Alaska is not very common, but all it takes is one person that’s positive to come into a group of people who are using and then everyone can get it. Hepatitis C is more contagious than HIV and more common,” Spencer said. “Now there is a cure (for hepatitis C) so we’re trying to get the word out and have people get tested.”
Approaching addiction from this angle does not enable drug use but rather allows for education and reduces harm to the community. Preventing disease spreading through the addict population reduces the cost of healthcare. Fifty percent of IV drug users get hepatitis C within their first year of using, Spencer said. The cost of providing needles is $500 for a year. The cost of treating hepatitis C is about $100,000 per person, depending on complications and medication. The new cure is costly as well, Spencer said.
At the close of the city council work session on heroin and opioids, Wythe asked the participants how the city council could assist their efforts in the next 30-45 days. Requests included writing a letter of support for the drug-free community grant and supporting efforts to establish educational programs in schools such as West Homer Elementary.
The council plans to have another work session at the end of that time period to access their next step. The council’s goal is to find a long-term solution for Homer, while addressing the issue on the short-term.
“It’s going to take a community if we’re really going to make something happen,” said council member Heath Smith.
Anna Frost can be reached at firstname.lastname@example.org.
How you can help right now with prevention efforts
South Peninsula Behavorial Health Services (The Center) is seeking help from the community for its drug-free community grant proposal. All letters or data are needed by the morning of Saturday, April 16. Information can be emailed to Dave Branding at email@example.com.
1) Consider writing a brief letter of support as a key community stakeholder. The letter should demonstrate willingness to partner and coordinate among entities for the purposes of building community capacity to address the priority areas of this grant and implementing prevention strategies.
2) Consider being a sector representative and if so, express your willingness as well as which sector(s) you represent in the letter.
3)Share any data you have on the problem in our community or even a brief narrative from your perspective. The Center promises strict confidentiality in the inclusion of any stories or observations.
4) Tell others and invite their input and response in support of this community-wide prevention initiative.