Alaska Region Deals With Opioid Use, Lack of Detox Options

Nov. 19--PALMER -- Despite what one Alaska state trooper described as "a huge rise in heroin" in recent years, Alaska's fastest-growing region has no place where addicts can undergo detox when they make the hard choice to get clean.

That's according to panelists at a substance abuse forum hosted by the Mat-Su Health Foundation and attended by about 130 people at Mat-Su College's Glenn Massay Theater Monday night.

Detox is the process of clearing the chemical dependence on drugs or alcohol from an addict's system. Most experts advise doing it under medical supervision. Symptoms of heroin withdrawal can include nausea, vomiting, diarrhea or seizures -- none generally considered life-threatening in the way alcohol detox can be. Many addicts end up detoxing in jail after getting arrested on drug- or alcohol-related crimes.

The only option for Valley residents seeking inpatient detox now is the 14-bed Ernie Turner Center operated by Cook Inlet Tribal Council in Anchorage.

"Sixty people call every day for a detox bed," said Rebecca Ling, the council's director for recovery services. They are told to call back daily to keep them engaged, Ling said. "It sounds a little strange for us to tell someone to call back tomorrow, because who goes on a waitlist when you need detox?"

Losing the window

Waiting isn't an option for some addicts -- or their families -- trying to take advantage of that brief window in which they're ready to get clean.

In a video about the Valley's heroin problem created in cooperation with the MyHouse Mat-Su homeless youth center and screened Monday night, Wasilla's Heather Christiansen said she's tried without success to get her heroin-addicted son into a program after he calls her for help.

"By the time things come together, it's too late," Christiansen says in the video. "I lost him again."

Nugen's Ranch, a longstanding residential treatment program about 30 miles from Wasilla on Point MacKenzie, once offered detox beds but funding cuts eliminated them, clinical supervisor Cathy Bishop said Monday. The Salvation Army's Clitheroe Center in Anchorage also used to offer detox, but that program also ended a few years ago.

Nugen's Ranch now does post-detox residential treatment, which usually incorporates counseling and sometimes medical therapies -- and it's the only such facility in the Valley. It has 22 state-funded treatment beds and they're all full, with a two- to four-month waitlist.

When Nugen's has been approached about doing detox again, Bishop says, "No way."

Due to the facility's location, addicts who haven't gone through detox face a 45-minute delay in medical treatment should problems arise.

But there are bigger issues: staffing difficulties, high costs (the Ernie Turner Center in Anchorage spends $500 per day) and little reward.

"Unfortunately, a lot of people that use detox services tend to repeat over and over and over and over," she said, adding that Nugen's saw one client 33 times.

Though there is no inpatient detox available in Mat-Su, the Sunshine Clinic in Talkeetna offers an outpatient suboxone-based opioid detox program with 40 slots available.

Mat-Su Regional Medical Center, the only hospital in the Valley, will admit patients suffering from alcohol withdrawal but not heroin or other drugs, emergency department director Anne Zink said Monday night.

That's because addicts can die from alcohol withdrawal, Zink said, while withdrawing from heroin is medically less serious in general.

"I think this kind of difference is hard for people to understand," she said, adding that family members will beg for help for addicts who they fear will die from overdose or other heroin-related risks. "There's not a lot of resources to refer those people to."

'Barrier regs'

The shortage of detox beds in Southcentral was exacerbated by a state-level nursing change, several panelists said.

Only registered nurses -- rather than licensed practical nurses -- are allowed to supervise detox patients under state-level regulations enacted a few years ago, according to Bradley Grigg, manager of the Alaska Division of Behavioral Health's treatment and recovery section. That makes hiring difficult and also leads to higher costs that create barriers to new detox providers, Grigg said.

RNs can make $14 to $16 an hour more at hospitals than they would at detox facilities, Ling said. That's for work under far less grueling conditions than contending with vomiting, emotionally unstable and sometimes violent addicts and alcoholics.

At Ernie Turner, fewer nurses to handle admissions led to nearly half the detox patients being treated for all addictions including alcohol, Ling said: 360 a year, down from 680 before the regulations changed.

The tribal council is working with the state nursing board to remove what she calls the "barrier regs keeping us from detox."

Heroin in the Valley

There are few solid statistics on heroin use in the Valley. A Mat-Su Health Foundation survey showed that, between 2002 and 2011, 4 percent of residents reported using heroin, but 21 percent reported binge drinking.

A 2013 survey of high school students here, however, showed 2 percent of traditional students said they'd used heroin at least once and 8 percent of alternative-school students did.

There's definitely more heroin out there, state trooper Joel Miner told the panel. Miner works the night shift with his drug-sniffing dog, Chevron.

"Any night of the week right now, within about seven to 10 traffic stops, I can find heroin," he said. "It's getting about that bad."

About three-quarters of heroin addicts first get hooked on Oxycontin, said Alaska's chief medical officer, Jay Butler. Many addicts switched to heroin when the painkiller was reformulated to make injection harder.

Butler said he struggles with the fact that doctors using painkillers in ways "a bit inappropriate" over the past two decades contributed to the heroin problem facing Alaska.

"I feel a certain burden of that as a medical provider," he said.

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