Some struggling with heroin leave Delaware to get help

DELRAY BEACH, Fla. - Marc Blum couldn’t get treatment for his heroin addiction in Delaware, so he violated probation and flew to Florida.

Now, the act that Blum insists saved his life has him facing up to three years in prison for misdemeanor crimes of theft, criminal trespassing and using a credit card unlawfully. He's clean now, living in a halfway house in Delray Beach. But Blum knows that something as simple as a traffic stop could send him back to a Delaware prison.

Marc’s mother, Karen Blum, hasn't seen her 24-year-old son since he put himself on a plane 18 months ago. Because of the lack of treatment centers here, she knows Marc would have never beaten his disease had he stayed in Delaware.

“I can hear a difference in him today. But I can tell you, he was not going to get what he got in Florida,” she says. “My son would have died here. I'm convinced of that.”

The Blums are among hundreds of Delaware families frustrated with an antiquated addiction treatment system that Rita Landgraf, secretary of Delaware's Department of Health and Social Services, says lacks the individualized care necessary to treat addiction and prevent relapse.

With only 95 inpatient residential treatment beds in the whole state, many who want to get better can't do it here. They are forced to seek help out of state at facilities their insurance may or may not cover.

South Florida is dubbed the recovery capital of America. It has sober living facilities, addiction treatment clinics and pristine beaches that help patients addicted to heroin rebuild their lives. People from Delaware – and across America – flock to the Sunshine State's small beach towns for help.

Landgraf wants Delawareans to have the same options.

“Those are the people that cycle back and forth all the time,” she says. “It’s not good for them as humans, and it’s not good for us as investors. We’re looking at the limited resources we have. …  We’re saying, how do we also invest in those who have the highest level of vulnerability for risk?”

Nationally, 160,000 people have died from drug overdoses in the past 15 years, and an additional 7.9 million Americans 12 and older need treatment for addiction and are not getting it. In Delaware last year, 228 died of drug-related overdoses.

Heroin: Delaware's deadly crisis

A program announced Friday by New Castle County police and other leaders aims to make treatment more accessible here. Dubbed Hero Help by New Castle County Police Chief Elmer Setting, it sets aside 10 beds in New Castle County Kirkwood NET Detoxification Center for people arrested on low-level charges who want help. They will get treatment, counseling and addiction support. If they get through the 60-day treatment, charges against them will be dropped.

It’s a good start, many say, but the state needs more than 10 beds, experts and state leaders agree.

The state needs more funding for inpatient treatment beds and better "step-down" care so those who suffer from addiction can scale back their level of treatment to outpatient and sober living facilities.

“We should be supportive of this disease based on what we know from watching it for decades and the probability of remission,” Landgraf says. “You don’t treat it with punitive measures. We don’t do that for any other disease so why are we doing it with this one?”

For years, people with addiction have been treated as criminals in the medical and law enforcement communities. It is only recently that officials have acknowledged addiction and treated it as the disease it is.

Dr. Richard Saitz, a professor at Boston University Schools of Medicine and Public Health, says the biological components behind addiction, often coupled with underlying mental health disorders, are proof that the notion of people "choosing" to use drugs is outdated and stigmatizing.

“No one would choose addiction,” he says. “Even if the first use is a choice, repeated use leads to brain changes that reduce the capacity to stop … which ultimately shows that it’s not a choice.”

More leaders like Landgraf are talking about the disease in terms similar to cancer and diabetes. Remission and relapse are now an active part of the conversation when determining best approaches to addiction treatment and aftercare. Those with addiction have a 90 percent relapse rate, Landgraf says.

“When people are relapsing with cancer, the medical community wraps themselves around them,” she adds. “In addiction, we go, ‘Bye-bye. You didn’t meet your program, shame on you.’  And in reality, we should be doing just the opposite.”

Karen Blum and her son Marc know the “fail first” approach well. It’s a practice used by insurance companies to pay for the minimum level of care until a patient relapses and requires more treatment.

Marc tried to get help at Kirkwood NET Detox, a facility where those with addiction often go to withdraw in a safe place. When he wasn't using and needed support, he was turned away. Blum says he was told that he must be coming down from opiates in order to get treatment, which often prompted him to use again to gain entry to the facility.

“Once again, he’s being sent out to the streets to get high only to be able to get treatment,” Blum's mother, Karen, says, “knowing every high can be his last.”

The detox center offers 16 beds for “clinically managed and medically monitored inpatient detoxification,” according to the state. Also available are a dozen 23-hour screening beds, called loungers, to help professionals determine what level of treatment individuals need. Intensive outpatient treatment is also available for up to 100 people at a time.

A detox center in Harrington, run by Connections Community Support Programs, offers similar services.

Delaware commission to target heroin overdoses

Those with addiction say these services don’t do enough after initial treatment to stave off a relapse.

Cathi Miklus of Delaware City watched her daughter cycle in and out of rehabs, prison and counseling. Each time, within a few weeks or months, she would be back to her old habits. Miklus says that stemmed from few follow-ups and a lack of extended care facilities in Delaware.

Like Marc Blum, it took her daughter four stints in a Florida rehabilitation center for change to take hold. Miklus’ 26-year-old daughter has now been clean from heroin for 18 months and still lives in Florida. With so many old vices waiting for her in Delaware, it’s likely she won’t ever come back, her mother says.

“I always thought I would bury my kid,” Miklus says. “I never had the hope that she would live. I never thought that she had the potential to make it through.”

As Delaware heroin deaths rise, more treatment options sought

The demand for more inpatient treatment beds remains a large part of the addiction conversation, says Cathy McKay, president of Connections Community Support Programs. Medication-assisted treatment involving the use of suboxone or methadone, which stave off the effects of withdrawal, are now considered the standard of care. Patients show up, take their medication and go back to their daily routines.

Connections now sees about 1,500 statewide daily for medication-assisted treatment, McKay says.

“We spend a lot of time trying to educate people that methadone won't get you high,” she says. “It’s a controlled dose. And this way, you’re not using contaminated needles. You’re not out there running around getting into other kinds of trouble. It’s a public health and public safety issue.”

Many who have gotten clean in Delaware say that recovery requires a combination of treatment, after-care and community support.

Erin Goldner, a 33-year-old woman from Wilmington, credits the 12-step program, better known as Alcoholics Anonymous or Narcotics Anonymous, for giving her the support she needed to give up alcohol and heroin.

Most treatment options in Delaware require patients to engage in a 12-step program to create a sober support network otherwise unavailable to them.

“Twelve steps changed my life,” Goldner says. “I wanted to die, but the steps showed me how to find a higher power, and I just wasn’t hopeless anymore.”

Delaware’s network has been unable to keep up with the number of addicts, Landgraf says, but DHSS is working to change that. The state increased the number of residential treatment beds from 78 to 95 in the 2016 fiscal year, which cost the state an additional $800,000.

There are plans to double the number of sober living residential beds (a type of group home where addicts live together and support each other's recovery) from 60 to 120, Landgraf says, as well as double the number of residential treatment beds for young people ages 18 to 25. Connections also is opening more sober living facilities across the state.

Getting more residential treatment facilities is a struggle, says Dave Humes, an advocate and board member of atTAcK addiction, a grassroots organization fighting opiate use. Too many Delawareans are forced to leave the state for treatment, he says.

“We can send people away [out of state], but unfortunately, we're sending them all away,” Humes says. “We need to try to attract some of these big treatment facilities.”

RESOURCES: Help for Delaware families, those impacted by addiction

Those in the throes of addiction and recovery have their own ideas about solving the crisis.

Miklus wants 15 new drug counselors in hospitals; more people in schools to teach kids about addiction; and more people at the Rockford Center, a private mental health facility near New Castle, to help identify those who need help.

Goldner would like to see a new sober living facility in New Castle County, one that will offer women and children a safe place to recover.

Karen Blum wants experienced and well-trained technicians working in Delaware, but more importantly, she just wants people to listen.

“What would have helped [Marc] were people listening,” she says. “It's like falling on deaf ears.”

While the state spent $12.54 million on addiction and mental health treatment, it's not enough to keep up with cascading needs. Landgraf hopes to get another $1 million for the next fiscal year.

Humes, who lost a child to addiction, says the state needs to seek federal funds now available after President Barack Obama’s late March announcement, in which the president called addiction a public health crisis.

“It doesn’t do us much good to talk about recovery after folks are dead,” Obama said. “And if we can save a life when they are in medical crisis, then we now are in a position to make sure that they can also recover so long as the treatment programs are available.”

Parents of addicted children often wonder what their kids' lives would have been without heroin.

Moms like Miklus recount days of packing oranges for soccer practice and shuttling her daughter and friends to the mall and other social events. She recalls her daughter’s sweetheart, a star high school athlete, and the visions she had for her.

"She could have really been somebody,” Miklus says. "The somebody she chose to be was a drug addict."

The disease stigmatizes whole families, creating damage that is difficult to repair. Nearly every parent talks of people, friends of their children, who show up loitering near their home, and the precious sentimental items stolen to maintain their child’s drug habit. Some say other children in their families won't talk to their addicted siblings.

“We work to hide it because of the shame and the stigma,” Blum says, noting that her two daughters will always feel the effects of their brother’s addiction. “I could care less who knows. I am fighting this war with him, and I'm never going to give up, ever.”

STORY: Scare tactics do little to deter drug use

Karen Blum worked in the health care industry and witnessed many cycling through the hospital for help. She understood the hurtful looks those addicted to drugs endured while seeking treatment and understood the shameful stigma and the lack of compassion.

"The addict today is everybody's kid," Blum says. “I have daydreamed about writing his obituary. No parent should have to do that."

Setting believes part of the epidemic begins by doctors prescribing opioids for pain. Patients get addicted and move on to heroin, which is less expensive. His officers also are working pill mill cases and investigating clinics that hand out opiates like Vicodin by the handful.

MaryBeth Cichocki, a former nurse working in Delaware, says she used to wish that her son Matt had cancer rather than an opiate addiction.

"I knew that if he had cancer that he would get treatment. I could take him to the hospital. The insurance would pay," she says. "There would be no time limit. And if he relapsed, there would be further treatment."

Matt died in Florida at age 37 after rehabilitation failed. In her last conversation with him, she was convinced he wasn't using. Tears clouded her eyes, and in a choked voice, Cichocki adds:

"If somebody had just helped me, there's a really good possibility that he would be alive today. He did not want to die."

The standard of care is substandard across the country, but in Delaware it is especially so, experts say. Many places don’t offer medication-assisted treatment like Methadone or naltrexone, despite research that proves the drugs effective.

“Just as you think you’re solving one problem, a new aspect of the epidemic emerges,” says Dr. Deb Houry, director of the National Center for Injury Prevention and Control, a division of the Centers for Disease Control and Prevention. “I wish I could say it is improving.”

Marc Blum remembers how it felt to shoot up heroin for the first time. After years of pills, he craved a stronger high, even if it involved a needle.

“It was kind of like the moment that I had been waiting for,” Blum says. “My whole life, I’m trying to get out of myself either by being the class clown or getting into trouble, having crazy stories of being in jail to tell people, just being 'the man.' This took all that away and just worked. I could be myself, but I needed this drug to be myself.”

Recovery has proved to him that version of himself is not who he wants to be.

Now, he's working in outreach for treatment facilities, helping others battle the demons he knows well.

Karen is proud of her son. Despite everything that addiction took from her family, she knows Marc has turned his life around. He now pays his own bills, acts as a sponsor to others in 12-step programs and has taken ownership of his addiction.

“Walking through the fire was the answer for him,” Karen says. “He'll end up back in Delaware at some point, and if they want to punish him, he’ll face that.”

Heroin – and its cravings – will forever be a part of Marc's life. He only hopes that in lifting the stigma around addiction and educating people on just how prevalent and difficult addiction is, Delaware may view this issue differently.

“When I made the final decision to get sober and change my life, you have to take a look at it and own everything that you did that was wrong," he says. “It’s part of the steps. It’s part of making amends. You kind of go back and try to right everything you did that was wrong.”

Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.