Editor’s Note: This is the third part of a series that examines why it’s so hard for heroin and drug addicts to get into treatment in Juneau, and what some in the community are doing about it. To read Part One, click here, Part Two, click here, and for Part Four, the final installment in the series, please see tomorrow’s newspaper.
Juneau’s only residential drug treatment facility, Rainforest Recovery Center, has just 16 beds. But even if one is available, it doesn’t necessarily mean that a drug user seeking treatment can get it.
In order to get into Rainforest, there’s a bunch of paperwork that needs to be completed first. It takes time, money and transportation, and for those in the throes of heroin addiction, it’s one of the biggest barriers to getting through the doors.
Family members, community agencies and recovery coaches like Kara Nelson and Christina Love can all help out, but oftentimes it’s not enough. When a bed isn’t immediately available to them, many drug users simply give in to cravings during the process and go back to using drugs to feel better.
“The ambivalence can be huge,” among drug users deciding whether to seek treatment,” said Love, who has taken countless women under her wing and helped guide them toward recovery. “We lose a lot of them.”
To get into Rainforest’s 28-day in-patient program, a person must first have a substance abuse assessment from either Rainforest or a referral agency, a tuberculosis test (PPD), an updated health and physical, and a filled out application for Rainforest.
“Rainforest Recovery Center is not able to take people just kind of off the street,” Dr. Jenna Hiestand, the medical director for Rainforest, said. “It’s a residential program, and so an application (and packet) has to be submitted.”
There’s sound reasoning why Rainforest requires all of the things in the packet, per the state grant that funds the center, Rainforest’s new interim director Richard Nault said.
The substance abuse assessment tells the center’s staff that the person belongs there and requires that level of in-patient care. The tuberculosis test ensures that the client doesn’t have the disease and won’t spread it to others in the facility. (Tuberculosis is highly contagious and was once the leading cause of death in the U.S.) Likewise, the health and physical is a safety precaution to rule out any communicable diseases. The health and physical also lets the center know if the client has any other medical conditions they need to manage, such as liver disease or heart issues.
But there’s no one-stop shop to get all those things in order, and it’s often a slow-going process. There’s time involved in scheduling appointments at various locations, and then coming up with the money to pay for it.
Nault said the health and physical is actually the hardest piece of the packet to complete because of the time and expense involved.
“Right now we have a stack of applications about this thick,” he said, “and they’re incomplete because the health and physical isn’t there.”
A health and physical is basically an examination by a physician. But it has to be recent, within 30 days prior to admission at Rainforest. That means if someone had a physical six months ago, they would have to get another. And it can cost around $300.
“For the person who’s not yet admitted, who doesn’t the money to pay for the health and physical, doesn’t have any insurance, that’s a heck of a bind, and I’m not sure how to get around it,” Nault said.
On the fast-track
Recovery coaches Nelson and Love recently helped a woman addicted to heroin get into Rainforest within 48 hours, the fastest time they had ever seen.
It was hectic, to say the least, and it almost didn’t happen.
It began on the afternoon of Wednesday, Dec. 9, with a phone call from a friend theirs who needed help getting a friend — a woman in her 20s — into treatment for heroin addiction. The woman had flown from Anchorage to Juneau specifically to go to Rainforest, desperate for help but without knowing that the facility is not set up to accept walk-ins.
That afternoon, the woman opted to detox on her friend’s couch, and by Thursday, it wasn’t going well. She began threatening self-harm.
“Unfortunately, it was at the end of the day,” Nelson said. “But we went ahead and called Rainforest, and they were getting ready to close and told us to call back tomorrow.”
They called Bartlett Regional Hospital’s E.R. next, and told them they were bringing her in because of her mental health state.
“We said we don’t have the capacity to monitor her 24 hours a day, this is above our expertise,” Love said.
The woman’s friend drove her to the E.R., where Nelson met her and stayed with her for hours. While there, Nelson worked on preparing all the paperwork she needed to be admitted to Rainforest.
Nelson said there was a Rainforest application at the hospital, which she helped the woman fill out from the hospital bed.
A Rainforest staffer had told Nelson earlier on the phone that they wouldn’t be available to do a substance abuse assessment for the woman the following Thursday. So Nelson drove around town, trying to find an agency that could do it quicker. All of them said it would have to wait until the next week.
Sometime during the evening, still at the hospital with the woman, Nelson received a phone call back from Nault. He said he could get the woman in for the substance abuse assessment the next morning (Friday, Dec. 11) at Rainforest. He also said the woman could get her TB test at Rainforest, which has never happened before in the past year and a half Nelson’s been doing this. (“That was amazing,” she said.)
“Things were totally different” from the first time she called Rainforest on Wednesday to the phone call with Nault on Thursday, Nelson said.
“The next day, everyone was accommodating, everything was streamlined, and they had the assessment ready for us,” she said.
The only thing they had left to worry about was the health and physical.
On Friday afternoon, Nelson drove the woman to Juneau Urgent Care in the Mendenhall Valley to get it done. The physical was a flat $150, but because the woman was a new patient there was also a $200 charge.
Because Nelson said she wasn’t expecting that extra $200 new patient fee, Juneau Urgent Care allowed her to do a payment plan. She had to pay the $150 up front, and was allowed to pay the $200 by the end of the month.
Nelson said a family member of hers — an “Angel donor,” she said, who wished to remain anonymous — donated the $150 to cover the physical.
By 4 p.m. on Friday, Dec. 11, the woman was admitted as a patient at Rainforest, a momentous occasion that brought Nelson to tears.
It was a good thing it happened quickly, Nelson said. The woman was beginning to doubt she could get in and started to want “other means to feel better,” as Nelson put it. But the woman stuck it out.
“There’s very few times where people are begging, ‘I want to get clean, and I don’t want to do this anymore, help me.’ And that was her,” Nelson said of the woman.
It should be noted that the cost of treatment wasn’t a factor in getting the woman into Rainforest. Per grant rules, Rainforest is prohibited from turning patients away based on their ability to pay.
It costs about $30,000 on average to stay the 28 days in the center, but the center has a sliding scale fee and most of its clients are covered through the newly expanded Medicaid.
That’s not to say that the cost isn’t a factor for those seeking treatment, or won’t later become an issue when it comes time to pay up. But the policies in place at the center ensure that money is not a barrier to getting in the door.
Changes within Rainforest
Since coming on board to Rainforest in mid-October, Nault said he’s tried to make some improvements in speeding up the process of getting patients through the door. It’s a direct result of the efforts of Nelson, Love and others in the community rallying for change.
Doing the TB test in-house, like for the woman in the above scenario, is a big one.
“One of the things that we’ve been doing to help get people in is if they’ve got the health and physical, and if they’re not symptomatic for tuberculosis, we’ll take them in and administer the TB test the minute that they’re admitted,” he said on how it works. “But the health and physical (is needed beforehand and) helps to screen that there’s no active symptoms of TB.”
Nault also noted that Rainforest has a new in-take person to process new clients, which should speed up that process.
On a grander scale, he said the most important thing he can do right now is be “visibly responsive” to the community, which is demanding easier access to drug treatment in light of a crippling and deadly heroin crisis that has claimed seven lives in Juneau this year. He’s met with various agencies, as well as community members such as Nelson and Love about how to make it easier for drug addicts to seek treatment. Last Sunday, he also was a panelist at a public forum hosted by the “Juneau, Stop Heroin, Start Talking” group.
Another big-picture change, he said, is really striving to ensure that everyone who comes to Rainforest seeking help doesn’t leave empty handed, even if there’s not a bed available. He said they will start asking people if they would like to get a head-start on out-patient services, or see what they can do to get them linked up to another agency that can help them — anything to give them “a ray of hope,” he said.
“I think we’re really trying to work toward no one going away with nothing, and everybody getting something,” he said.
Brainstorming
In light of some of the difficulties that addicts seeing treatment in Juneau face, several community members have been brainstorming ideas on how to make the process easier and faster.
Nelson said she is already trying to elicit donations for a fund to help people pay for health and physicals.
Michele Stuart Morgan, the local woman who formed “Juneau – Stop Heroin, Start Talking” a few months ago to help break the silence and stigma surrounding heroin addiction, said that’s something her task force wants to look at, too. Her group just became a non-profit last week under the umbrella of Juneau’s National Council on Alcoholism and Drug Dependence. Morgan also met with Nault last week after hearing him speak during the panel she hosted for the community.
One thing that’s clear, Nelson said, is that people want to help. After last Sunday’s panel discussion, a woman who heard of Nelson and Love’s recent efforts to get the woman into treatment introduced herself. She told Nelson that she went to Juneau Urgent Care herself to pay the remaining $200 on the balance. It had already been paid — someone beat her to it.
“I have no idea who did that,” Nelson said.
She said she hopes to have a system in place soon for others willing to donate.
Nelson will also be the first to tell you how happy she is with the recent changes and improvements at Rainforest. But the fact remains, she said, that it’s still not enough.
The problem of not having enough detox, treatment and recovery services for addicts isn’t limited to Rainforest, she said.
“We don’t think we have the only answer, or we have all the answers, but what we know is everybody needs to be in the room,” she said. “Every person. Because this is not a D.O.C. issue, this is not a JPD issue. This is not a Rainforest issue. In reality, the responsibility to change things lies on our community.”
Kara Nelson, left, and Christina Love, both addicts in long-term recovery, are trained recovery coaches, helping guide drug addicts into recovery.
