HOOKED AND HELPLESS

The lack of treatment in New Mexico for heroin-addicted teens frustrates
doctors, courts and families

Although doctors in northern New Mexico are seeing younger and younger
heroin addicts, the state doesn't have a place to send them for treatment.

"There's a complete lack of effective treatment, absolutely zero," said Dr.
Murray Ryan, an Espanola internist who sees young heroin- addicted patients
every week. "It's not rare or even of any comment to have a 16- or
17-year-old kid not breathing in the ER (from a heroin overdose)."

Ryan said he sees kids in Rio Arriba County who started using alcohol or
marijuana when they were 11 or 12 years old.

"Because the heroin is so casually available, they escalate to heroin in
light speed," Ryan said.

The state Health Department provides some treatment for adult drug addicts
at facilities such as Turquoise Lodge in Albuquerque. But treatment centers
geared for adults can't mix older, hard-core drug addicts with youths, said
Mary Schumacher, director of the department's Behavioral Health Services
Division.

So young drug addicts rely on the state Children, Youth and Families
Department and the state Human Services Department, which administers
Medicaid funds to three health-maintenance organizations under contract to
provide Medicaid care.

But the system isn't working, according to local doctors, some state
officials, and attorneys and social workers involved in the juvenile
justice system. They say the HMOs don't always provide the inpatient care
needed by young drug addicts and send too many kids into outpatient
programs. There also is a lack of youth treatment programs designed to deal
with heroin addiction.

'Mangled Care'

Juan Gutierrez, a clinical social worker with CYFD's Juvenile Justice
Division, said it's a struggle getting treatment for young drug addicts
from the three HMOs contracted under the state's Medicaid managed-care
system Presbyterian Health Plan, Lovelace Health Plan and Cimarron HMO.

New Mexico led the nation in per capita drug-induced deaths in 1995, the
latest year available, with Rio Arriba County recording the highest per
capita death toll in the state from 1993-95.

Since 1995, Rio Arriba County has seen more than 40 heroin overdose deaths
and more than 35 fatal cocaine overdoses.

Deaths from illicit-drug overdoses in New Mexico have more than doubled
from 61 in 1990 to 127 in 1997, according to the state Office of the
Medical Investigator.

The three HMOs subcontract their substance-abuse programs to
behavioral-health organizations, which then sometimes subcontract to other
agencies.

"It's very difficult for a family to access these services," acknowledged
Ken Warner, chief of the CYFD Children's Behavioral Health and Community
Services Bureau. "I'm sure a lot of these families feel like they get the
major runaround."

Many youths who need treatment for drug addiction qualify for Medicaid, but
Medicaid will cover a child's inpatient treatment only if it is "medically
necessary."

"It is true that Medicaid only is supposed to provide care that is
medically necessary. It's not there to solve other social problems that may
exist," said Chuck Milligan, director of the state's Medicaid program.
"That often is a clinical judgment, what is medically necessary."

For Assistant District Attorney Kathleen Ayala, there is no doubt the
heroin-ravaged youths she sees in Children's Court in Santa Fe need medical
treatment.

"Somebody has got to be held accountable for treating heroin- addicted kids
in this state," Ayala said. "It's extremely frustrating. It's heartbreaking
to see a youngster come through (court) going through heroin withdrawal."

Ayala said she recently had a youth in court who couldn't stop shaking or
gagging because of heroin withdrawal. The boy was hallucinating and
couldn't hear well because he had recently overdosed and lost some of his
hearing.

"I really had never envisioned that type of horror being visited on a
child," Ayala said. "We think the kids need the treatment, and (the HMOs)
think they don't."

Dr. Jim Jacobson, medical director of Presbyterian Salud Behavioral
Health/Options, said drug treatment is provided but doctors, judges and
parents often must negotiate with insurance representatives on what
treatment is "medically necessary" and whether the child needs inpatient
treatment or outpatient counseling.

"The whole nature of managed care changes the way they accessed care
before," Jacobson said. "They do have to go through certain hoops because
that's how we manage the overall system and costs."

Presbyterian Salud is owned by Value Options, the company that provides
behavioral-health services for both Presbyterian Health Plan and Cimarron HMO.

Spencer Ward, the executive director of Lovelace's provider called MCC
Behavioral Care, couldn't be reached for comment.

Milligan said there is oversight by the state Medical Assistance Division
of the behavioral-health organizations to ensure they are providing
treatment for young drug users. Doctors or parents who have trouble
accessing care for Medicaid-eligible youths can call the division hot line
at (888)99-SALUD for assistance.

"We're monitoring access to care," Milligan said. "Every time we've heard a
concern, we've resolved it."

Warner with CYFD isn't as optimistic about Medicaid's success in treating
young drug addicts.

"The Medicaid system providers aren't delivering," he said bluntly. "There
is clearly a need for more directed substance-abuse treatment."

CYFD tries to provide inpatient drug treatment services for some children
who don't qualify for Medicaid, Warner said. But the state department spent
less than $500,000 last year on residential treatment, mostly for youths
with mental-health problems.

Most youth treatment facilities in the state are geared toward mental-
health problems or drugs such as marijuana or alcohol. None of the more
than 20 people interviewed for this story could name a treatment facility
in New Mexico designed to treat heroin addiction among youths.

Treatment facilities can send young heroin addicts through their programs,
but there is little follow-up to see if the youths return to drugs after
coming home, Ryan said.

"They try to jam a square peg into a round hole," Dr. Ryan said of the
treatment programs. "It's in the arena of $1,000 toilet seats with no
accountability for results."

Community approach Inpatient treatment is important at first to help a
child detoxify from drugs, but more emphasis needs to be placed on
community-based treatment options, Ryan said.

"The one-size-fits-all philosophy would have to go out the window," Ryan said.

Many children with drug problems come from families where substance abuse
is prevalent, Ryan said. Counseling services need to include family members
and work toward changing a negative environment in the home.

St. Francis Academy in Espanola is one of just a few facilities in Rio
Arriba County trying to provide that service. The counseling center
received almost $77,000 this fiscal year from CYFD for patient assessment,
counseling and home-based services. La Clinica del Pueblo in Tierra
Amarilla received $8,700 to provide similar services.

St. Francis Academy has about 250 clients, mostly children and youths.
About 25 percent of the children and 60 percent of the teens have drug
problems, said director Jim Kavanaugh.

"These aren't the kids who are really eager to receive help. The challenge
often is engaging them and keeping them involved," he said. "Very often the
parents are drug-users themselves."

Counselors make home visits and attempt to get parents into substance-
abuse counseling as well, Kavanaugh said. Teens also meet in peer
counseling sessions to help each other through their problems.

But heroin-addicted kids who need inpatient treatment have nowhere to go in
Rio Arriba County. They are sent to programs as far away as Alamogordo,
Albuquerque and Arizona.

Jacobson said the three HMOs' behavioral-health organizations are working
with state officials in an effort to find or develop treatment programs
that can handle kids who use multiple drugs, including heroin.

"It's such an emerging issue in New Mexico," he said. "The system just
isn't there yet to provide that care."

U.S. Sen. Pete Domenici, R-N.M., has held several field hearings in
Espanola in an effort to address the burgeoning heroin problem and increase
coordination between local, state and federal agencies.

A field assessment team staffed by drug-abuse experts and members of the
U.S. Attorney General's Office is scheduled to arrive in Espanola today to
begin helping local and state officials devise a comprehensive plan to
battle the heroin problem.

Although heroin addiction is notoriously difficult to treat, Ryan said the
community can't give up on kids who have become addicted before their lives
have really begun.

"One of the beliefs is it's untreatable, which I don't accept," Ryan said.

"If there is some family member who cares about the kid, if there is a
mentor, those are the kids that make it. It's not hopeless."