He’s Ready For a Detox Facility. Why Is It So Hard to Find One?

Kmsbarton’s Loved One is working on his recovery. Now he’s ready to commit to a treatment program, but is encountering barriers at every turn. As frustrating as these obstructions are, they can often be overcome. Here’s our advice. 

In Rhode Island there aren’t nearly enough detox facilities available. They were all filled last time my son wanted to go. Can you imagine? Actually there was one place that had beds, but it refused him admission based on a prior time he was there (because of an “overfriendly goodbye” between him and a staff member. Actually he just created a bond during rehab, but affection with staff is prohibited, understandably). So that’s a huge problem when the Loved One decides to go get help! Another thing I found out, to my surprise and disappointment, is that if your loved one is on Suboxone, they are limited in which detox/rehab centers will take them. Anyone ever hear of this? Any insight on this would be helpful. Can you ever go out of state without private insurance? My Loved One has Neighborhood Health and Medicaid. Thank you.

COVID is making substance use disorder treatment beds, chronically in short supply, even more difficult to secure. I recently looked into a detox bed for someone in Portland, Maine, and was told the detox center was closed due to a nursing shortage. There are also census limits like never before. In some places (like homeless shelters), they are allowed to admit only 50% of their pre-pandemic numbers. 

Hospital emergency rooms are feeling the pinch. I learned of someone turned away from the ER recently because his complaint of bugs under the skin didn’t rise to the level of urgent. Scabies isn’t urgent, granted—but isn’t a methamphetamine addiction? No one thought to put him in front of a doctor.  

It shouldn’t be this way.

It is so frustrating when the family learns CRAFT and it works, your Loved One says yes to treatment, and the doors to treatment are closed. The Loved One, out of desperation, presents at the emergency room only to be turned away. Perhaps you watch helplessly as your Loved One’s motivation for going into treatment wanes and that emotional window of opportunity closes. In our health care system, there have always been easily missed opportunities to respond to life-threatening conditions. That this shortage has worsened is completely devastating. 

As those on this platform know only too well, getting that door of treatment open at the time your Loved One says, “Okay, I’ll go,” is often tough. Now, as you’re describing, it’s become even more difficult. It’s hard enough to overcome their often great resistance to accepting help with addiction. One federal study found that 50% of those who admit to a problem are resistant to accepting help—and of course, supporting a Loved One into treatment is a primary goal of CRAFT. Indeed, much of CRAFT is focused on just this, creating and noticing that little bit of willingness and presenting treatment options (or any wellness opportunity, for that matter), at that crucial moment. 

They turned him away for WHAT? 

And, yes, it’s hard to imagine someone with out-of-control diabetes being refused or thrown out of care for showing affection towards a staff person. Your experience warrants a complaint to the state. I don’t see how admission to a medical detoxification program is anything less than urgent, life-saving care. It should not be denied because of a hug, or even more than a hug, on a past occasion. Fraternizing with other residents is a problem in social residential settings, but you are talking about a medically necessary and life-saving detoxification unit. 

Some rules may work in your favor. 

There are exceptions to Rhode Island Medicaid that might allow your Loved One to be treated out of state. If the out-of-state hospital is certified to the same level as an in-state hospital, you should be able to go out of state. I’m sure this won’t be easy, but it looks possible.  

I know less about Rhode Island, but in Massachusetts, there are rules now that prevent treatment and recovery homes from receiving funding from the state if they exclude folks on Suboxone (or any medication). The exclusions are still allowed in some criminal justice-funded programs and privately-funded homes, but otherwise that battle has been mostly won in Massachusetts. 

When you’re punished for positive actions.

According to some administrators, having residents on MAT (Medication-Assisted Treatment) creates a problem in the therapy and treatment for those not on MAT. This misperception is supported by approaches like 12-step recovery programs in which proponents of AA (and not AA, the institution) consider people on MAT to be non-abstinent. This, despite traditions in programs like AA that state they have no opinion on outside matters like psychiatric medications and treatment care.  

I recently spoke to a recovery home that does not admit people on MAT. The person we were discussing was abstinent from his opioids. So why, the director asked, would we endanger him by mixing him with people on active opioids? (Suboxone is a combination of an opioid blocker and an active opioid). And why would we put anyone already abstinent on an active opioid?  

I don’t believe there is a good answer to the first question. Individuals on MAT are not high from the drugs they take, and their medication should be locked up and dispensed by staff. The second question, however, is a good one. The answer right now is driven by serious public health concerns over the risk of death from overdose.  

MAT isn’t the whole answer, but it’s used because it works. 

The U.S. lost 100,000 people to all drug overdoses in 2020, one third more than the previous year. Most of that increase was due to more fentanyl in the drug supply and the combination of opioids and benzodiazepines, which together create life-threatening respiratory depression. Taking Suboxone as prescribed reduces overdose deaths by 50%, plain and simple.  

And with the system now also stressed by COVID, there are even more serious gaps in treatment, especially inpatient or residential care. It is also easier to put someone on Suboxone than to provide anything more comprehensive, such as a combination of MAT, therapy, let alone a residential program. I have yet to hear of anyone, perhaps ever, being turned down for MAT, except when the person had a history of diverting their medication. 

The cruel irony of all this isn’t lost on us. Your Loved One starts MAT, and then isn’t allowed into more intensive treatments.  

The bottom line is that families need to search harder and wider for treatment of their Loved Ones. I am sorry to hear about your frustrations, Kmsbarton, and I share them. Thank you for writing in. Your questions will help other families sorting out treatment for a Loved One.