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At-home detox urged to save lives of addicts in withdrawal

Weeks before Michael Brady died in March from an opiate overdose, he went to a local hospital emergency department seeking help for withdrawal symptoms.

But the staff told the 25-year-old Lancaster man his condition was not severe enough to be admitted. It was the third time time he had been taken to the emergency department but then sent home.

"The first time I brought Mike in, he was dehydrated. He couldn't walk, he was moaning, he was sweating profusely. He really needed to stay in a hospital. He actually fell over at one point and then they wanted to send him home, you know?" said Deborah Palmer of her late son.

With opiate withdrawal not viewed as enough of a medical reason on its own to justify a hospital admission, some now say home might be the best place to begin going through detoxification.

Addiction recovery advocate Avi Israel says the stories he has heard from other parents warrant the unorthodox approach of home treatment.

"If this had been around when my son was going through withdrawal, after he had been denied a bed at a detox, I would have tried it," said Israel, whose son 20-year-old son Michael took his own life while suffering from opioid addiction in 2011.

Michael Brady died in March from an opiate overdose.

Israel, whose Save the Michaels House of Hope already trains family members and others as recovery coaches, says he plans to submit a $100,000 grant application to the Erie County Legislature in coming days to consider funding his proposal.

His proposal comes as the number of overdose deaths so far in the first half of this year has reached 191 confirmed or suspected fatalities. For all of last year, there were 296 confirmed deaths and three additional suspected deaths, according to the Erie County Medical Examiner's Office.

In driving home his point, Israel said he was unable to find an available bed over the weekend in Erie County for a 27-year-old man who wanted to begin recovery by entering a detoxification facility.

"He has a 3-year-old boy whose mother died about a year ago from an overdose. He has a girlfriend who is pregnant and he wants to get treatment and be a father to his kids but was not able to find a facility that would take him," said Israel, who by midmorning Monday managed to place the individual in a  Rochester facility.

The placement happened after Israel said he appealed for help to Dr. Charles W. Morgan, medical director for the state's Office of Alcoholism and Substance Abuse Services.

"I made about 15 phone calls Monday morning and this tells me we don't have enough detox beds," Israel said.

An Amherst mother said she was so desperate last month after her son was sent home from an emergency department that she purchased Suboxone from a drug dealer to ease her son's withdrawal symptoms. She asked not to be identified because she does not want to get in trouble with the law for buying the narcotic from a drug dealer.

"I didn't want him going back out on the streets and buying heroin. I was afraid he would die," the mother said.

Trying to stem a crisis

Legislators have set aside $500,000 in grant money for treatment providers and other community agencies to improve access to drug rehabilitation treatment.

Two other recent proposals would also speed up delivery of care to addicts.

Erie County Health Commissioner Dr. Gale R. Burstein, along with officials in the treatment community, are working on implementing a program that would provide a prescription to immediately begin medication-assisted treatment and link addicts with a treatment program before they are discharged from emergency rooms. Funding for the program 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.

If his grant application is approved, Israel said it would cover the cost of hiring doctors authorized to write prescriptions for buprenorphine and pay for home visits by nurses who would look in on individuals going through withdrawal.

But it is the family members who would play the biggest role.

"We want the family to have skin in the game. If they are part of the process, the desire to recover would be much greater for the person who is addicted. Your family is right there with you, going through it. They just didn't dump you at a hospital," Israel said.

But it can't be cold turkey, he said.

For it to work, parents and loved ones of addicts would need training, access to a prescription for buprenorphine – the medication that curbs opiate cravings and is also known as Suboxone – and supervision from doctors and nurses.

Addicts often end up in emergency rooms after relatives or first responders revive them with Narcan, the opiate antidote, but they are often discharged unless they have a pressing medical condition, drugs in their system that might create a deadly cocktail, or if a woman addict is pregnant.

Israel says providing the chance to go through a carefully monitored detoxification at home  is better than getting no treatment and possibly ending up dead from another overdose.

Increased risk

Reaction to Israel's proposal from physicians specializing in addiction treatment is mixed.

"It is an interesting concept that should be funded. However, it would be important to also collect data to evaluate its effectiveness in the real world," said Dr. Richard D. Blondell, a professor and vice chair for addiction medicine at the University at Buffalo.

Dr. Torin J. Finver, an addiction specialist, says it may be asking too much of families, given the fierce nature of addiction.

Finver commends Israel for his efforts but does not believe it would work given the behavior of addicts.

"We have years of data showing that short-term detoxification from opiates increases the risk of overdose and death and upwards of 90 percent are back using within two weeks if they are sent back to their regular environment," Finver said.

Finver, the medical director at Horizon Health Services' Terrace House, a treatment facility on Elm Street in downtown Buffalo, said it is important to medically stabilize those going through withdrawal and develop an appropriate plan for the next level of care.

"That means either a referral to further inpatient stabilization, a rehab, followed by a sober living residence, a halfway house, and all opiate addicts should be considered for medication for either short-term or long-term management of the continued cravings and blocking of the ability to mood alter with opioids," he said.

Going through withdrawal at home, according to Finver, would present impossible challenges for loved ones.

"Nobody is going to be able to monitor them to the point where they can't run off to get high again," he said, adding that the addict also has to want to change. "No matter what medication we use, the internal drive and motivation has to be there to embrace a lifestyle that does not alter one's mood with substances or other behaviors."

Israel, however, says denials and delays for admissions to detoxification units and treatment programs demand a new approach if lives are to be saved.

"If we stop that craving with medication and engage them right off the bat, the numbers of addicts who stay in addiction treatment are much higher," Israel said of the need for families to play a greater role.

And Israel says that while the number of fatal overdoses recorded by the Medical Examiner continues to increase, they do not represent a complete accounting of the death toll.

"They don't reflect suicides brought on by despair from the addiction, they don't reflect deaths caused by driving while impaired on opiates, or job site accidents brought on by opiate addiction," he said.

Parental support

Palmer says her son died March 27 in the bathroom of his grandmother's Amherst home.

"Mike was found on his knees like in a praying position. The needle was near him on the floor and one of those little waxy bags they put heroin in was empty on the sink," she said, adding that the drugs in his system turned out to be fentanyl and other potent synthetic opioids.

She says it was wrong that he was turned away from the emergency department. She would have gratefully accepted a prescription for buprenorphine to assist her son in withdrawing at home until he could have been placed in a treatment program.

"I was told his withdrawal was not bad enough. I was told they keep the beds for the alcohol and benzodiazapine, which is a more deadly withdrawal. I said, 'Are you people nuts?' He'll go back out and use heroin again,' " Palmer said.

The Amherst mother who bought drugs for her son said he is still awaiting placement in a residential drug treatment facility. She supports Israel's proposal.

Having a home detoxification program that includes medication to reduce cravings would be a step in the right direction, the Amherst mother said.

Hospitals should be required to admit individuals who are seeking treatment when going through opiate withdrawal, she said.

"When I found him in his bedroom, I gave him two doses or Narcan and he wasn't coming back. I had to administer CPR," she said. "When he was taken to the hospital, he was having a huge withdrawal.

"They would not give him anything," she said. "He wanted to go to detox. They would not take him. He was saying he would kill himself rather than go through the pain."

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