The Fraying Safety Net: Waging War On Addiction

First Of Two Parts

WHEN TREATMENT SUFFERS, IT SHOWS

HOLLIDAYSBURG, Pa. -- Every year, Pennsylvania police officers and drug
agents make 50,000 new drug arrests. Since 1997, the state has seen a 142
percent increase in admissions for heroin treatment and there's been a 16
percent increase in drunken driving arrests.

Yet Pennsylvania's drug and alcohol programs this year face a reduction of
almost $3 million in state funding, which state officials say won't affect
treatment programs, and they stand to lose millions in federal funding over
the next three years.

It's a trend that goes back years: Addictions and alcohol abuse rise while
funding to treat them remains flat or goes down. Allegheny County, as one
example, has virtually the same funding for drug and alcohol treatment
today as it did in 2000, but it's serving half again as many people.

Should we care?

Before you answer, scroll back to 2003 and click your cursor on Blair
County, about 70 miles east of Pittsburgh. It may shape your thinking.

In the summer and fall of 2003, drug and alcohol treatment programs in
Blair County and across Pennsylvania faced an abrupt loss of funding as
Gov. Ed Rendell and the state Legislature tried to find common ground on
the 2003-04 budget. Even before the impasse, the proposed budget had
included a 50 percent reduction in drug and alcohol treatment money.

Ultimately, most of that funding was restored. But during the six-month
interim, counties and individual agencies scraped by with month-to-month
allocations, trying to keep programs afloat and staffs intact. Few places
illustrated that struggle better than Blair County.

Under the state budget proposed in early 2003, Blair County was looking at
losing nearly half of its $2 million drug and alcohol program budget. In
combination with the state budget impasse, hard decisions had to be made
quickly. Drug and alcohol coordinator Judy Rosser began meeting weekly that
spring with local providers to map out how they could stretch dwindling
dollars to keep people in programs.

"You're talking about people's lives here, the addicts, their families and
even their employers," Rosser said. "It was hard to look at the numbers and
try to squeeze as much as we could in service for clients."

Something had to give. Within months, a nearby drug and alcohol center for
adolescents closed its doors, as did a women's program, leaving Blair
County with about a half dozen providers for its 130,000 people. To further
conserve money, telephone lines for addicts and alcoholics were eliminated.

And this is what happened:

Almost immediately, the Blair County Prison in Hollidaysburg saw increases
in drug and alcohol arrests, as well as drug and alcohol parole violations,
according to a prison record review requested by the Pittsburgh
Post-Gazette. Drug and alcohol offenses also made up a larger share of
crimes: From June through August 2003, 45 percent of all arrests were
drug-or alcohol-related. A year later, after funding had been restored,
that number dropped to 40 percent. Drug and alcohol parole violations were
37 percent of the total for the same three-month period in 2003. In 2004,
they were 26 percent. "We know lots of people went back to jail" during
that 2003 period, Rosser said.

Blair County Coroner Patty Ross recorded 27 drug-or alcohol-caused deaths
in 2003, nearly double the previous year's total. Six of those deaths
occurred in the first five months, before funding started running out.
Then, as programs began winding down, the bodies began surfacing: Four
overdose deaths in four days in June. Four more during one week in August.
Two heroin overdoses the same day in September, one in Altoona, the other
in Roaring Spring. All this happened despite the arrest of a "major heroin
distributor" in June, followed in July by drug raids that netted 24
arrests, both of which should have taken drugs off the street, at least
temporarily. Altoona Deputy Police Chief Mitch Cooper said drug
investigators heard dealers from Philadelphia were bringing in a higher
grade of heroin at the time, which, if true, also could have added to the
death toll. "But there's no scientific or forensic evidence to back that up."

Local health care providers in Blair County noticed a change, too. "We
definitely saw an increase in services" in the latter part of 2003, said
Marian Fifer, executive director of behavioral health sciences at Altoona
Hospital. "And it was our impression that we did see more individuals
seeking admission to our inpatient mental health unit when they were
primarily there for detox reasons."

The connection can be drawn statewide as well: Arrests for cocaine
possession in Pennsylvania jumped to more than 1,000 per month between May
and November 2003, the first time in two years the numbers had reached that
mark. Drug-induced deaths, which had never exceeded 1,200 in a year, jumped
to 1,417 in 2003, according to state Health Department records.

Taken separately, these events might be seen as interesting anomalies.
Together, they at least suggest a link between program reductions and
subsequent increases in both crimes and deaths.

There were implications, too, for Blair County residents who have never
thought of using drugs or abusing alcohol: The tax money not used for
treatment those six months got spent many times over in housing more people
in jail, and in job and productivity losses in the community, to say
nothing of medical expenses and funeral costs.

Other counties struggled, too.

Philadelphia and Allegheny, the two largest counties, simply fronted the
money to programs and rode out the crisis. But in more rural counties --
basically, the rest of Pennsylvania -- the funding delay resulted in
reduced services or, in some cases, closed programs.

Cambria County, for example, lost its only outpatient provider north of
Johnstown. According to the state Health Department, at least one program
closed because of the state budget crisis in Beaver, Butler, Dauphin, Erie,
Lackawanna, Lehigh, Schuylkill, Venango, Westmoreland and York counties.

Gaudenzia Inc., the state's largest provider with about 65 drug and alcohol
treatment programs, primarily in central and southeastern Pennsylvania,
closed three programs for addicted teens, totaling 45 beds.

In short, counties faced the same rising demand/dwindling resources battle
they'd fought for years, only at fast-forward speed.

A 2001 Columbia University study found that 13.1 percent of all state
spending nationwide -- totaling $81.3 billion -- dealt with substance abuse
and addiction. Of that money, less than 4 cents of every dollar went to
prevention and treatment. In Pennsylvania, it was less than 3 cents.
Meanwhile, the study also found that costs of dealing with substance abuse
ate up 14 percent of Pennsylvania's budget, at an annual expense of $283
per resident.

"It's a chronic disease. That means a lifetime disease," said Gene Boyle,
director of Pennsylvania's Bureau of Drug and Alcohol Programs. "People
need to realize that treatment works."

Saying 'no' to methadone

If the residents of Blair County needed a reminder of the alarming drug
problem that summer of 2003, it came in their local newspaper one June
morning. The report in the Altoona Mirror said that 18-year-old Tarah
Mitchem, described by police as "a major distributor" of heroin, was
arrested at her home, a half block from Altoona's Roosevelt Junior High
School. Police confiscated $2,000 in heroin, $12,000 in cash, a sawed-off
shotgun and handguns. Mitchem later pleaded guilty to felony drug
possession with intent to deliver and is now serving a 2 1/2- to 5-year
sentence at the state prison in Muncy, Lycoming County.

Yet two months and five overdose deaths later, Gene Boyle faced a restive
crowd that filled the Pinecroft Fire Hall north of Altoona to hear about a
proposed new methadone clinic.

"For whatever reason, people up there were looking at it as 'Not In My Back
Yard,' " Boyle recalled. "It really didn't matter that we brought tons of
research, that we were able to describe the benefits of someone being on a
medication -- and methadone is a medication. They didn't want anything to
do with a methadone clinic."

The clinic never got off the ground, and today Blair County still has no
methadone program.

Dwindling resources

Working in her small, windowless office on the fourth floor of the Blair
County courthouse in Hollidaysburg, Rosser can measure her frustration in
whole numbers.

In 1998, her office served 950 people with drug or alcohol problems. Today,
it's 1,500. Yet going into the new budget year, she faced a $200,000 cut,
about 10 percent of her budget. She has attached butcher paper to her
office walls, where she scrawls numbers as she figures and refigures what
she can do.

"Right now, I'm going week by week in managing my numbers," she said.

Her program's contract with the state requires that she offer a full
continuum of care. So, when money runs low, the pressure is to move people
in the residential program into a halfway house, and those in the halfway
house into outpatient care. Yet the outpatient program, which used to serve
20-25 people at a time, has been reduced to eight slots.

"If you eliminate these treatment programs, alcoholics and addicts don't
just disappear," said Michelle Denk, executive director of the Pennsylvania
Association of County Drug and Alcohol Administrators.

"They're going to show up in our emergency rooms, they're going to show up
in our county prisons, they're going to show up in increasing domestic
violence and child welfare cases."

These days, they also show up on waiting lists. Unless they have private
insurance, Blair County residents with serious drug problems must vie for
one of the two residential slots available -- the number had been four
until March. Fifteen people are on that waiting list.

If an addict in Blair County needs methadone, he or she has to travel to a
neighboring county. The two closest centers are in Curwensville, Clearfield
County, and Johnstown, Cambria County. In the past year, four Blair County
residents have died in car accidents while driving to or from one of the
two methadone clinics, according to coroner Ross.

Kris Canfield, program manager at Curwensville, says about 75 percent of
her 175 patients are from Blair County and "the majority" of names on the
250-name waiting list are also from Blair. The Johnstown program has no
waiting list, primarily because it does not accept Medical Assistance
clients -- the state reimbursement for Medicaid is about two-thirds of the
$95 per week rate everyone else pays.

For a period this spring, it appeared that Curwensville might stop taking
medical assistance, too, because the state reimbursement didn't cover the
program's costs for those patients.

Had that happened, Rosser said, "we would have thrown probably about 75-100
people back into the community because they were not going to be able to
afford it any more. That could have caused a lot of problems this summer."

But there's still the more than 200 waiting to get in. When Rosser looks at
that list, she considers each name a missed opportunity. A serious addict
may not wait a day for treatment, much less a month or a year, before he's
using again, she said.

And, like an untreated cancer, addiction spreads, both outward and
downward. Rosser noted that since 2000, heroin has surpassed alcohol as the
primary drug of choice among those under 25 seeking treatment in Blair County.

A curious property crime drop

Altoona Police Chief Janice Freehling reached into a filing cabinet
recently and pulled out a copy of her 2003 annual crime report. It
contained good news: The crime rate had gone down 15.5 percent that year,
with an 11 percent decrease in violent crimes -- homicide, rape, robbery
and aggravated assault -- and a nearly 25 percent decrease in property
crimes, such as burglary, theft and vehicle theft.

The news was good for the whole of Blair County, too. State police records
show that burglaries, thefts and car thefts -- crimes often linked to drug
users trying to support their habit -- went down markedly in 2003 from the
previous year, the car thefts by more than half.

Why would this happen at a time the county was struggling to keep its
treatment programs operating?

Rosser, who oversees the county's drug and alcohol programs, thinks she
knows -- the methadone program in Curwensville opened its doors in March
2003, on the heels of the Johnstown methadone program a few months earlier.
That meant that in early 2003 dozens of heroin addicts suddenly had an
alternative to stealing from others to support their habit.

"You take one heroin user off the street and you have a reduction in crime,
because they are spending anywhere from $100 to $200 a day and they usually
are not getting that legally."

State police crime statistics appear to back Rosser. From 2002 through the
first three months of 2003, police in Blair County made an average of 9.5
burglary arrests each month. Once the Curwensville program opened, the
monthly average dropped to 6.5 burglary arrests for the remainder of 2003.

While the methadone program took some heroin users off the street, however,
many others were still waiting to get in -- and still using. For them and
those who used other drugs, treatment options were still drying up, which
could account for the increased drug arrests and deaths even as burglaries
and car thefts decreased.

Freehling, who admits to mixed feelings about methadone programs ("I think
they send the wrong message"), has nevertheless become a believer in the
value of treatment. "A lot of our dealers are from outside this area, but
what has happened over the years is people have become addicted, so we have
more local people doing small-time deals." That makes treatment "a very
important part" of fighting drug crime, she said.

"We can enforce, and enforce and enforce all we want, pick up people and
put them in jail. But if they don't get treatment, we're going to be back
arresting them again."

A Heroin Explosion

Outgoing District Attorney David Gorman says Blair County has aggressively
policed and prosecuted drug crimes in recent years, and state narcotics
agent Randy Feathers noted they still execute major drug busts every 2-4
months. Their drug arrests are high, they believe, because they've doggedly
pursued dealers and users.

But one grim statistic suggests the drug problem has maintained a foothold
since 2003: In the past two years, the rate of drug and alcohol deaths in
Blair County has doubled to more than two per month.

Those who died typically were in their mid-30s, but they included a
15-year-old Altoona youth who overdosed on Vicodin, hydrocodone and Xanax
- -- two narcotic painkillers and an anti-anxiety drug -- last Christmas Eve.
In the 18 months beginning in July 2003, 41 people died from drugs or
alcohol, and two others -- one a 17-year-old -- committed suicide by
overdosing on drugs.

Last month, members of the Blair County Drug Task Force arrested 51
suspected dealers, including one juvenile. That happened four days after
drug agents arrested seven heroin dealers who police say came from New York
to set up a distribution network in Blair County. Police recovered $25,000
worth of heroin in that raid.

Drugs, particularly heroin, have become so pervasive that, in separate
interviews, treatment coordinator Rosser, drug agent Feathers and Altoona
chief Freehling each stated their belief that few Blair County families
have been untouched by drugs. Just about everyone either knows someone who
uses, or knows someone who has been victimized by someone who uses.

Struggling To Kick The Habit

For Christine Ferrone's daughter, now in her 20s, it started with OxyContin
experimentation at a few parties. When she started feeling ill without the
Oxy a few weeks later, she found a cheaper and more accessible alternative
- -- heroin.

Within weeks, she had descended into a routine where her waking hours were
spent trying to score at least two bags of heroin at $40 each, about four
times the going price in Pittsburgh. She went through a series of
low-paying jobs, but her habit drew her to shoplift and steal. At one
point, she sold her $1,000 high school graduation necklace for $40. She got
thrown out of her house twice.

"You might like it at first because it's something new," said the daughter,
who asked that her name not be used because she doesn't want her past to
derail her new career path.

But once addiction set in, she said, "it was not fun, because you're waking
up sick every day, and you need it just to function. I'd spend my last
dollar on dope before I'd spend it on food."

Instead of partying with former classmates, she said, she'd go to drug
dens. "We had people who were 50, and we had people who were 15. When
you're using, you don't hang out with friends. You hang out with people who
are using."

Most frightening is the young woman's description of how accessible heroin
is -- "If someone's under 18, it's probably easier to buy heroin than to
buy cigarettes" -- and how it and other drugs have proliferated. Among her
high school graduating classmates, she says more than half "are still using
[some kind of drug], or they're in recovery, or their mothers or fathers
are using or are in recovery." She came to that conclusion by looking
through her yearbook and counting the faces she'd seen at parties, or
rehab, or had heard were in jail.

For Christine, a nurse who sometimes works with pregnant addicts, the
nightmare remains vivid despite her daughter's nearly three years of being
clean. When they first learned of their daughter's addiction, they put her
in a rehabilitation program. She checked herself out three days later.

She tried, and quit, two other programs before deciding on her own to
enroll in the Johnstown methadone program. "I just got tired of waking up
sick," she said.

She still makes the 40-minute drive two days a week, and is allowed to take
the methadone on her own the rest of the week. She has been able to reduce
her dosage and hopes eventually to stop taking methadone altogether. Her
parents pay for the treatment, and have told her to continue for as long as
she needs.

"You learn not to think ahead," Ferrone said. "There were so many times we
thought we were getting better, and then the bottom fell out."

Sometimes, full recovery never comes.

At age 47, Robert P. "Buckwheat" McCann of Tyrone was the fifth-oldest
Blair County resident to die from a drug overdose in 2003. But, like most
addicts, he started using drugs young -- at age 14, while living in
Philadelphia. He was on methadone "for years" before moving to Tyrone two
years earlier, said his sister, Peggy McCann.

He didn't have a car, so getting to one of the outlying methadone clinics
was out of the question. But by then, it probably didn't matter, she said.
"He said it's never a 'kick it' thing. You always have the craving to get
it. He liked doing it."

Other surviving relatives of those who overdosed either did not want to
talk to the Post-Gazette or could not be found. A few of those who
overdosed had obituaries in the local paper two years ago, with a passing
mention that they'd "died at home" or "died after a brief illness."

Treatment money woes

Over the next three years, the federal government will be phasing out a
matching fund arrangement with Pennsylvania and a handful of other states
after taking issue with whether the states were really contributing their
fair share.

Last year about $7 million of the money, called Intergovernmental Transfer
Funds, was spent on drug and alcohol treatment. Although counties may
decide to make up for the lost funding in coming years, the federal money
nevertheless will be gone completely in three years.

The $2.9 million cut in the state's $41 million drug and alcohol budget
this year was earmarked for upgrading the department's computer system.
State health officials emphasize that no treatment programs will be cut.

Had it remained, the money would have been used to start modernizing the
state's Client Information System, which tracks admissions, demographics,
lengths of stay and other data. The current system, in place since 1991,
uses outdated DOS software.

"Providers actually have to find old computers that run on DOS," said
Patricia L. Valentine, Allegheny County's deputy director of the Office of
Behavioral Health.

Boyle, director of Pennsylvania's Bureau of Drug and Alcohol Programs, said
that until now, the state allocation had seen increases every fiscal year
since 1998-99. The $56 million in federal block grant money, however, has
remained the same the past three years.

In reality, Boyle acknowledged, flat funding means losing ground.

"Absolutely, there's no question that there are more people who need
treatment services for longer periods of time, but we are doing different
things to impact on that" such as looking at ways to reach substance
abusers earlier, so they'll need fewer services.

"But when you have level funding, it doesn't help. We certainly will fight
to put more money into the system."

Locally, Allegheny County's total drug and alcohol funding could only
charitably be called stable -- not until last year did the combined federal
and state allocation return to the 2000-2001 level of just over $20
million. During that same period, the number of people served has increased
from 6,222 to 9,858, a 58 percent increase.

"If we had double the amount of money tomorrow, we could spend it
legitimately," Valentine said. She knows that's not going to happen.

Instead, as she met with local agencies providing drug and alcohol services
this spring, Valentine had to convey a message with a familiar refrain: "I
tell them, 'There's not going to be new money. You'll be lucky if it's
flat, and we should expect some reduction. Look over your programs and have
a contingency plan.' "