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Editorial: Home detox is a radical idea, but it could be another path to saving lives

It’s a measure of the scale of the opioid crisis that a plausible recommendation is for addicted people in withdrawal to detoxify, not under direct medical supervision, but at home, with the help of family members. If it seems like a chancy idea, there may be a reason for that – except for this: Without it, people will die.

The problem is in the number of detox beds available in Western New York hospitals and the competition for them, not just from those addicted to opioids, but other substances as well, including alcohol and benzodiazapine.

Avi Israel, an addiction recovery advocate whose son, Michael, killed himself in 2011 while suffering from opioid addiction, is pushing for the at-home program. It would cover the cost of hiring doctors authorized to write prescriptions for buprenorphine, a drug that curbs opiate cravings, and pay for home visits by nurses.
Family members would be crucial to the effort, which would require them to be trained and provided access to buprenorphine, also known as Suboxone.

As Israel says, a carefully constructed home-detoxification program, whatever its deficiencies, is better than getting no treatment and ending up dead. Indeed, with opioid deaths averaging more than one a day in Erie County, it is urgent that help be provided to those who are seeking it. Overdose deaths for the first half of 2017 reached 191 confirmed or suspected cases. Sadly, and to no one’s surprise, that’s a faster rate than last year.

The money could be available, since the Erie County Legislature recently set aside $500,000 for treatment providers and other community agencies to improve access to drug rehabilitation treatment.

Israel’s idea is one among three proposals to speed the delivery of care to those addicted to opioids. Erie County Health Commissioner Dr. Gale R. Burstein is working with partners on a program to provide a prescription to immediately begin medication-assisted treatment. It would connect addicts with a treatment program before they are discharged from emergency rooms. Funding is being sought through a private foundation, Burstein said.

And Erie County correctional health officials last week received funding from county legislators to hire three workers who will link interested inmates with outpatient addiction therapy after they leave the Holding Center. In the past, inmates could go through medically supervised detoxification while in the Holding Center, but were provided no assistance once they left the facility.

Inevitably, many were drawn back into familiar, if destructive, behaviors. Not all who take advantage of the program will succeed, but it will change the lives of those who do and lower the public costs associated with repeat incarcerations and medical treatments.

The opioid crisis is a national problem, and far worse in other areas than it is in Western New York. Most of today’s addicts are people who had been suffering severe pain and filled the prescriptions their doctors offered them.

Those opioid-based pain-killers, it turned out, were as addictive as their street-corner cousin, heroin, to which many users turn when they can no longer secure lawful prescriptions. That heroin today is frequently laced with fentanyl, a synthetic and lethal drug.

The crisis is overwhelming the health care system. There aren’t enough beds to handle all those who are detoxing. Intelligent creativity is called for. That’s what Israel’s proposal is. It will need to be monitored closely for its best chance of long-term success, but under the circumstances, it is worth pursuing.

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