Kristin Roope knew she’d be dead soon, and most nights she wished for it.
The need for pain pills or heroin was overpowering, as if nothing else in life mattered. More, her body demanded, whatever the cost.
She’d lost her home, her Ford Mustang, her young daughter.
“I figured she was better off if I’d die. Then it wasn’t ‘mommy chose drugs over me.’ It was ‘mommy can’t be here, she’s dead,’” said Roope, who lived in a tent off Midlothian Turnpike where she spent every day begging for drug money.
Sometimes, the price of her addiction would bring her just enough clarity to see she needed help.
Roope remembers being dirty, hungry and barefoot in the lobby of the Richmond Behavioral Health Authority five years ago, only to be told she would be added to a waiting list.
People are also reading…
“The people were extremely nice and wanted to help, but there was nothing they could do,” Roope said.
Virginia’s programs for helping opiate abusers have been overwhelmed for years, a problem that state leaders are pledging to address. Desperate people such as Roope often have to wait two months or more to be enrolled in detox or at a clinic where they can receive suboxone or methadone, the two drugs most commonly used to treat opiate addicts.
“We need to treat it … and most people who need it aren’t getting it,” said Jim May of the Richmond Behavioral Health Authority, who has seen firsthand that putting opiate addicts on a waiting list can be dangerous.
“They’ll change their mind, go out and shoot up drugs, and won’t come back,” he said.
And not coming back typically leads to an increase in property crimes to pay for drugs, incarceration, health problems or death.
Drug overdoses, mostly from painkillers and heroin, now are the leading cause of injury-related death across Virginia and the country. Since 2007, painkillers and heroin have killed more than 4,400 people in Virginia.
***
State officials are pushing an $11 million plan through the General Assembly — it would double with federal matching funds — to address the opiate addiction epidemic at a time when substance-abuse funding has risen by less than $1 million — less than half of 1 percent of the state’s substance-abuse budget — in the past seven years.
The trends come as private health providers cut back on substance-abuse treatment coverage and the strength of the prescription pain pills — which drove higher rates of addiction — increased, said Del. John O’Bannon III, R-Henrico, who is a practicing physician.
“We had better coverage for substance abuse in the ’90s than we do today, because we’ve seen insurance companies treat this as low-hanging fruit; a frailty, a personal problem or moral failing instead of the illness it is,” O’Bannon said.
Tepid state funding growth coupled with rising medical costs have resulted in an 18 percent drop in the number of people the state treats for all forms of substance-abuse issues each year, according to officials with the Department of Behavioral Health and Developmental Services.
That comes as a 40 percent spike in the number of people seeking treatment for opiate abuse has further strained an already overwhelmed system. The state added $534,000 for substance-abuse treatment in targeted parts of the state in 2007. But that funding skipped over Richmond, which has had more heroin overdose deaths since 2007 — 156 through the end of last September — than anywhere else in the state.
Officials with the state Department of Behavioral Health and Developmental Services say they do not know how many people across Virginia are on waiting lists for substance-abuse services. But a 2013 report found 1,104 were waiting in the first three months of that year, a number the report notes is a conservative estimate since it does not cover the full year. Of those people, about two in five remained on a waiting list for more than three months.
About one-quarter of the state’s community services boards, the local agencies that deliver many of the services, have been able to eliminate waiting lists for opiate abusers since then, and the rest try to offer other services while patients are waiting as a way to keep them connected to the system.
Margaret Lewitus, 23, said she overdosed on heroin twice after turning to an overburdened state-funded facility in Northern Virginia.
Lewitus called twice a day for a month — as instructed — to find help. She eventually gave up after placing one last call from a phone she borrowed at the Vienna metro station.
“(I was) emotionally and physically just deteriorating,” said Lewitus, who was 15 when she tried heroin for the first time — through a connection she made at an Alcoholics Anonymous meeting.
Lewitus first overdosed in a McDonald’s bathroom, then at the home of a friend who dropped her off in front of the emergency department of a nearby hospital.
“I didn’t end up getting help for two more years,” she said. “I tried detoxing on my own a bunch of times and just couldn’t make it — or I guess — just didn’t make it. I really wanted help.”
***
About 80 percent of opioid abusers across the country are not receiving treatment, Johns Hopkins University researchers reported last year.
Virginia officials still are grappling with how best to defray the human cost of addiction and its consequences, which had a $613 million impact on the commonwealth 10 years ago, according to an estimate prepared for legislators and the governor. And that dollar figure says nothing of the broken relationships and human suffering that go hand-in-hand with opiate addiction.
A 2008 study from the state’s Joint Legislative Audit and Review Commission identified a need to improve the access and effectiveness of treatment for addicts, who may not seek care because of stigma or denial that a problem exists.
Many patients even will pay cash for treatment if they can to avoid a paper trail of their condition, said Karen Kimsey, a deputy director at Virginia’s Department of Medical Assistance Services, which administers Medicaid, the joint state-federal safety net program for pregnant women, children, the elderly and people with disabilities.
“We have a disease that tells us we don’t have a disease,” said Ron Schneider, clinical director of the sobering-up center for people going through withdrawal at The Healing Place in South Richmond, where up to 88 percent of patients in any given month are addicted to opiates. “The opiate and heroin epidemic is definitely thriving in the Richmond area.”
Although state officials have spent years working to determine what government can do to provide help, there’s no guarantee that people who need the help will seek it, Kimsey said. Officials have convened task forces to develop dozens of recommendations for fixing the problem and created a documentary, released last year, highlighting the dangers of heroin abuse.
But the first meaningful increase in state funds for treatment in the past decade, now making its way through the General Assembly, is slated to take effect across some regions of the state on Jan. 1.
Advocates of the plan, which would be implemented statewide the following year, say it should expand substance-abuse services to all Medicaid members and increase reimbursement rates to encourage more health care providers to offer services for substance abuse.
“Starting Jan. 1, 2017, the goal is that you won’t have to wait,” said Dr. Katherine Neuhausen, incoming chief medical officer at the Department of Medical Assistance Services. “A Medicaid member, at least, can walk into any facility and get treatment.”
Metro Richmond, Southwest Virginia and the Winchester area would be the first to benefit, followed by Hampton Roads, Northern Virginia and the Roanoke area. Statewide implementation is slated to begin Jan. 1, 2018.
Some experts are concerned that expanding the availability of buprenorphine may have unintended consequences.
“They’re asking primary care doctors to do it who don’t know addiction,” said Dr. Marty Buxton, medical director at the Family Counseling Center of Richmond for recovering addicts as well as at Tucker Pavilion, the behavioral health center at Chippenham Hospital.
“They’re giving them a three-month supply in one shot. It’s like putting a 6-year-old in a candy store and saying only have one candy bar a day.”
Another aspect of the state’s plan, meant to offset that risk, increases Medicaid payments for counselors to work alongside doctors who prescribe buprenorphine. The state also is recruiting people with experience around addiction or mental health crises to act as peer support for those in recovery.
***
Roope’s first taste of opiates came from a doctor. She was 20 and started feeling sharp pains in her back.
She took the painkillers doctors prescribed her for a year and, by then, she was hooked. Roope started buying pills on the street, often paying $80 a day just to avoid the debilitating withdrawal symptoms.
One of her ex-husband’s friends suggested heroin — it would feed the same craving at a fraction of the price.
Roope had sworn to herself that heroin was the one drug she’d never touch, after she attended the funeral of a high school friend who overdosed. But the physical ache for an opiate, along with her dwindling funds, trumped a silent promise made years earlier.
It’s a path that has become far more common in recent years, another unintended consequence with brutal results. The explosion of painkiller prescriptions in the 1990s and 2000s created a new set of addicts, and efforts to curb their use in recent years has opened up the market for heroin.
The death toll continues to rise. Four out of five overdose deaths in Virginia are linked to prescription painkillers or heroin. More people died of heroin overdoses in the first three quarters of last year — 244, according to the latest available data — than in all of 2014.
So for many, the state’s changes may not come soon enough.
“I have a couple patients that may (die),” Neuhausen said.
She said she expects the state changes to cause a ripple effect of additional services for addiction. Local health providers already have expressed interest in expanding services, thanks to the proposed boosts in reimbursement rates.
Among these is Rubicon, a residential treatment facility established in 1970 that was acquired last year by the Richmond Behavioral Health Authority. Without the enhanced and expanded Medicaid rates, Rubicon’s capacity would be about 80 residential treatment beds, Neuhausen said.
“With this benefit, they believe on Jan. 1 they can open 180 residential treatment beds … because they’ll be able to get reimbursement for any Medicaid member,” she said. “That’s why this is such a game-changer.”
Increasing Medicaid rates could expand capacity for all Virginians, said O’Bannon, the physician/lawmaker who was a member of the governor’s task force on prescription drug and heroin abuse.
But state officials cautioned that up to 400,000 low-income Virginians without health insurance, who would be covered if lawmakers opted to extend the Medicaid program, will be left behind.
“That’s a problem that needs to be solved in Washington,” O’Bannon said. “Virginia has made a decision not to expand Medicaid.”
Estimates from the federal Substance Abuse and Mental Health Services Administration are that about 18 percent — or up to 73,000 — of the people the state estimates would be covered under expansion experienced substance-abuse problems in the past year.
State officials contend that this number is low, considering that more than 216,500 Medicaid members were treated for substance-abuse problems in 2015.
The bottom line, O’Bannon said, is that it will take time and resources to address a problem that has festered for decades.
He traces the genesis of the problem to a shift in the 1990s to physicians prescribing painkillers once reserved for cancer or other severe conditions for milder chronic problems, all while pharmaceutical companies offered assurances that their drugs were not addictive.
“I fault the drug companies for being complicit in pumping out these stronger painkillers and advertising them to make a profit,” he said.
Virginia began providing reimbursement for Medicaid substance-abuse services, which is voluntary, only in 2007. But the rates offered — such as $16 for a 15-minute unit of case management — were so low that doctors would lose money on treatment services if they agreed to take Medicaid.
“The rates that were established for outpatient services, day treatment services and even the inpatient services were set so low that almost nobody wanted to play ball with those rates,” said May, the Richmond Behavioral Health Authority official.
The result is a tangle of red tape in which more than half of mothers whose addiction led to their children being placed in foster care had to wait more than a year to enter court-mandated substance-abuse treatment.
Almost the only Medicaid recipients eligible for residential substance-abuse treatment are pregnant women, and those women often do not receive covered care because Medicaid expires 60 days after they give birth.
Tracking the epidemic alone has caused headaches for state policymakers who say the effects are felt across the state at agencies ranging from schools to social services departments to jails.
Even identifying people treated for substance abuse can be difficult, since most addicts have mental health issues or other diseases that also require treatment.
“The reality is a community pays for this. They just have choices of how they pay for it,” said Daniel Herr, assistant commissioner for behavioral health services. “They’ll either pay in lost lives, emergency room visits, detox ... or they’ll pay in providing the services that are needed.”
***
Roope tried different programs for getting clean over the years, but like many opiate addicts she kept going back for more.
After more than a decade of addiction, Roope, 36, is now nearing four years clean.
After being placed on a waiting list by the state, Roope got a room in April 2012 at the McShin Foundation, which helps addicts but gets no state funding. Such outfits as McShin and The Healing Place, which often end up trying to help people who had no luck in the public system, also are feeling the crush of the epidemic.
At McShin, where help finally was available on the day Roope was willing to ask for it, she stopped wanting to die. Roope now works there and helps others get their lives back.
She once again has a home, a car and — most important — her energetic 11-year-old daughter.
Roope and her boyfriend live with their three children and three dogs in a house in a rural part of Henrico County. The refrigerator is decorated with pictures from their last trip to the beach and drawings of birds and fish made by the kids.
Roope knows that even today, one bad decision could wreck the life she has spent years rebuilding. That image of her barefoot, homeless and hopeless is part of what keeps her sober.
“I couldn’t imagine living that life today, but I couldn’t imagine living this life back then,” Roope said. “All I can do today is not go back.”