Pubdate: Wed, 10 Jul 2002
Source: Sun News (SC)
Copyright: 2002 Sun Publishing Co.
Contact:  http://web.thesunnews.com/
Details: http://www.mapinc.org/media/987
Author: Debbie Cenziper

DRUG OVERWHELMS STRAPPED SYSTEM

He made his home in crack houses, sleeping beneath beds to avoid gunfire.

He made money by begging: Homeless. Need to eat.

He bought drugs by selling drugs. He'd keep a few pills as payment for his 
work.

Then, in early May, Derek Collins showed up at the Julian F. Keith Alcohol 
and Drug Abuse Treatment Center near Asheville, N.C., determined to kick an 
addiction to OxyContin.

He came because, at 23, he feared he was going to die.

For months, OxyContin abusers have strained drug treatment centers across 
the Carolinas, forcing counselors into a frantic scramble to find support 
and services.

No one knows for sure how many people in the Carolinas abuse drugs or 
alcohol, but estimates put the number at 310,000 in South Carolina and 
876,000 in North Carolina - roughly 8 percent to 10 percent of each state's 
population. Every year, thousands go untreated because rehab centers, 
particularly those offering inpatient treatment, often lack bed space and 
staff.

Those shortages only grew worse, experts say, when OxyContin abuse struck 
the Carolinas.

"It's the newest, strongest, most seductive drug out there," says Bill 
Rafter, director of the Julian F. Keith center, which some addicts call The 
House of New Beginnings. "It put more strain on a system that already can't 
handle what it's supposed to do."

Now, as law enforcement pushes to rid the region of OxyContin abuse, 
substance-abuse leaders say the Carolinas must focus not only on dealers, 
doctors and the drug, but on the treatment of addiction. They also say 
legislators and the medical community must quickly take steps to fight drug 
abuse, such as creating a prescription monitoring system and offering 
health care professionals training in addiction and the use of narcotics.

In 1998, Americans paid an estimated $277 in state taxes to deal with the 
burden of abuse and addiction on social programs, according to The National 
Center on Addiction and Substance Abuse at Columbia University. That 
compared with just $10 for prevention and treatment.

South Carolina's system for addicts has 34 local agencies charged solely 
with providing support, referrals and services. But officials say too many 
abusers still end up in psychiatric hospitals. The state has only 70 beds 
for patients who need short-term detox services. And while the state runs 
inpatient programs for women, it has none for men.

When OxyContin abuse struck communities from Rock Hill to Myrtle Beach 
beginning in 1999, treatment centers felt the impact.

"When you have a substance like OxyContin, it rises like a tidal wave all 
at once," says John Hart, spokesman for the S.C. Department of Alcohol and 
Other Drug Abuse Services. "If you've got 12 beds for detox and you're 
running 90 percent full all the time, it doesn't take much to overwhelm the 
system."

In North Carolina, repeated studies ordered by the General Assembly have 
found dangerous gaps in substance abuse treatment. About 3,000 patients 
whose primary diagnosis was substance abuse were sent to state psychiatric 
hospitals last year - 22 percent of overall admissions - even though 
hospitals provide little in the way of focused treatment.

Of North Carolina's 100 counties, about 65 have no inpatient treatment 
centers, according to a 1999 study. And those that do frequently run 
waiting lists.

North Carolina has three state-run drug treatment centers, but they also 
run waiting lists. In May, 176 people were waiting for a bed at the center 
in Black Mountain.

Most patients at the center stay 28 days. Waiting lists at the other two 
centers, one just north of Durham, N.C., the other east of Raleigh, N.C., 
are slightly smaller, but that's partly because those centers offer shorter 
stays.

Making matters worse: The Carolinas have only a small network of private 
agencies that provide support, such as halfway houses.

Almost 60 percent of treatment facilities nationally are run by nonprofit 
organizations, compared with 28 percent in each of the Carolinas. The 
number of private, for-profit treatment centers is waning. A number of 
facilities have closed because of operational or financial concerns.

Overall, South Carolina lost 150 beds for substance abuse treatment in the 
past three years; North Carolina lost 230.

Private health insurance often doesn't cover extensive inpatient treatment. 
And policies that do pay typically won't cover repeated stays even though 
research has shown that a majority of abusers need more than one round of 
treatment.

In Myrtle Beach, one of the areas most affected by OxyContin abuse, addicts 
have overwhelmed the nearby Shoreline Behavioral Health Services.

In 2000, the center served just four people whose primary problem was abuse 
of opiate prescription drugs, which include painkillers like OxyContin. In 
2001, the number grew to 24 patients, most struggling with OxyContin abuse.

Some reported they started abusing the painkiller while seeing doctors for 
chronic pain. They told staff they began to crush the drug, mix it with 
water and inject it for an immediate rush. Others, looking to reduce their 
pain, bought more pills from dealers when their prescriptions ran out.

They came to the private, not-for-profit center in severe withdrawal, 
shaking, sweating, vomiting and dehydrated. Off the drug, the pain returned 
sharper and more pronounced.

"I remember thinking that this was the most urgent situation that we've 
been in and feeling rather helpless in how to solve the problem," says 
Tonya Compton, Shoreline deputy director of clinical services. "People 
would tell us, 'I never knew about the potency. I never knew how quickly I 
could become so dependent on it."'

The staff worked triage. The center provides outpatient treatment and 
therapy, so counselors worked the phones trying to reserve beds in medical 
detox units and residential facilities in other Carolinas' cities. Often, 
they encountered waiting lists, or patients couldn't afford the rates. Some 
had no transportation, others no family support.

Some clients returned to Shoreline several times, staffers say, unable to 
wean themselves off OxyContin. The slightest trigger can throw a 
prescription drug abuser into relapse, such as driving by the doctor's 
office that first provided the pills.

Most nights, Compton left exhausted. She'd go home and her fiance would 
say, "Bad day with OxyContin, huh?"
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