This is where heroin almost killed her

Cheap fix: heroin's resurgence

This is where heroin almost killed her

Was jail the only place she could find help?

Published on October 3, 2015

MAYS LANDING, N.J.

Ashley Gibbons had been holding it together, or so she told herself. Sure, she had sold off her electronics, stolen money from her mother and slept with guys who gave her money. But it wasn’t as if she was an actual prostitute: “I didn’t go and find random people. I knew them,” she said.

She had tried heroin for the first time at 21, four years ago, and for a long while, it remained an occasional thing. But she needed more and more to get high and, though she held onto her job, pretty soon everything else was falling apart.

About this series: From the countryside of New England to the cities of the Midwest, the most deadly epidemic of heroin use in half a century is tearing at the fabric of American life. In this series of articles, The Washington Post examines why heroin has made such a powerful comeback, how well-intentioned government policies have fueled demand for the drug and why enormous hurdles stand in the way of bringing the epidemic under control.

Read part one: David McCarthy briefly got clean on his own after detox programs and rehab failed. But the lure of inexpensive, plentiful heroin eventually proved too much.

Read part two: Pellets, planes and the new frontier, how Mexican heroin cartels are targeting small-town America.

Ashley’s mother, Alicia Gibbons, tried to get her daughter into rehab. She called at least 20 places, and they either didn’t have a bed available or didn’t take her insurance.

One place said it had room — but then said Ashley wasn’t using enough heroin to qualify. At another facility, managers accepted Ashley, but when she got off the bus, they denied her admission because she had used heroin in the previous few days and this program was only for people who were clean.

There were so many rejections that, at one point, Alicia said she handed her daughter “a razor and told her to cut her arm so they would put her in the mental hospital because they would detox her” there.

Ashley hit bottom one day last year. After spending two months in jail, she bought four bags of heroin and shot up two of them. She returned, still high, to the three-story townhouse she shares with her mother, her mother’s boyfriend, her four siblings and her 5-year-old daughter.

Ashley drew a bath in the upstairs bathroom, the one with an inflatable puffer fish dangling from the ceiling and prints of humpback whales and fish on the walls. She climbed in and injected two more bags of heroin. Then she nodded off, her head slipping under the water.

Downstairs in the living room, where a mirrored sign reads “Hope,” Alicia wondered why she hadn’t heard her daughter leave the bathroom. Concerned, she bounded upstairs. Jiggled the handle of the bathroom door. Locked. She banged on the door, called Ashley’s name. Silence. Banged again, screamed her daughter’s name. Nothing.

Alicia raced downstairs and got her boyfriend, Jose Vega, who ran up and broke through the bathroom lock. Ashley “was blue-gray, no pulse,” her mother said. Alicia and Vega pulled her onto the tile floor. Vega furiously started CPR, although he’d never learned it.

“It just kicked in,” he said.

Ashley’s sister called 911 while Alicia ran to her bedroom and pulled out her naloxone kit, a leopard-print cosmetic case containing three needles and a vial of the drug that reverses the effects of a heroin overdose. Alicia had taken a course on the drug while Ashley was in jail. Now, she trembled as she pushed the needle into the vial — and broke the needle.

The sister yelled at the 911 operator, Vega kept trying CPR, and Alicia attached another needle. This time, the drug flowed into the syringe. The mother plunged the sharp into her daughter’s arm. Twice more, she filled the syringe and injected her daughter. Finally, Ashley started to convulse.

“All of a sudden, I came to and I puked up all this water,” Ashley said. “I was so high, though. It sounds horrible, but that was like the best and the worst high I ever had in my entire life. I’ll never feel that again unless I overdose and die and come back again.”

Ashley Gibbons and her boyfriend, Chris Hopper, hang out at her family’s home in Mays Landing, N.J. Gibbons, who first tried heroin four years ago, is battling addiction, and her mother has been pushing to get her the treatment she needs.

That time, Ashley got into a rehab facility for two weeks of treatment  and then into a halfway house, where the state paid most of her bill through a program for people younger than 25. But Ashley turned 25 while she was there and was told she had to leave, in part, she says, because she hadn’t been following the rules. She now owes the facility $3,000.

“I don’t have it,” she said. “I make $8.75 at ShopRite, and that’s $150 a week. I’m an addict, not a rich bitch.”

Through it all, Alicia has kept pushing to get Ashley the treatment she needs. At one point, the mother got so desperate for help that she called the cops in hopes of getting her daughter arrested.

“I just wanted her away,” Alicia said. “It takes getting into trouble to get mandated to go away. I kept pressing charges against her. Charges, charges, charges.”

Rates of heroin addiction and fatal overdose are skyrocketing in the United States, and a political consensus has emerged to emphasize treatment over criminal prosecution. But there’s little agreement on how to pay for more treatment, leaving addicts facing obstacles so daunting even a healthy person would struggle to overcome them.

Treatment centers are often prohibitively expensive, overcrowded, underfunded and subject to byzantine government rules. Health insurance coverage is stingy to nonexistent. And the social stigma of heroin addiction is still so potent that many users and their families are reluctant to seek help in the first place.

That leaves one sure route into rehab: “Treatment in the overwhelming majority of cases begins behind bars,” said Jim McGreevey, the former New Jersey governor, who runs an experimental treatment program in Jersey City.

The need for more treatment is acute, said Obama administration drug czar Michael Botticelli, who estimates that up to 80 percent of heroin addicts are never treated.

“We’re approaching the same mortality rate as at the height of the AIDS epidemic,” he said. When addicts first get treated in jail, “it means we have missed so many opportunities.”

Video: Treating America’s deadly heroin epidemic

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Phoenix Rescue Mission offers a free 12-step program to recovering addicts. Two women in the program share their stories. (Whitney Shefte)

In many states, governors have tackled the epidemic more forcefully with rhetoric than resources. In Maine, where the number of people seeking treatment for heroin addiction has tripled since 2010, Gov. Paul LePage (R) has called on law enforcement “to disrupt the drug supply and hunt down the traffickers” while he has sought to cut Medicaid enrollment and coverage, saying state health-care programs are too generous.

Vermont Gov. Peter Shumlin (D) devoted his entire State of the State address  last year to what he called “a full-blown heroin crisis.” The state attacked its waiting lists, leading to a 40 percent increase in the number of addicts getting treatment. But overdose deaths have continued to climb. Vermont also adopted a “good Samaritan” law granting immunity from prosecution to anyone who calls for help if they witness an overdose.

In New Jersey, Gov. Chris Christie (R) has made treatment a cornerstone of his presidential campaign, declaring in one TV ad that “we need to be pro-life for the 16-year-old drug addict who’s laying on the floor of the county jail.” But while Christie has signed bills aimed at improving access to prevention and treatment, “there’s no money to increase the number of beds,” said state Sen. Joe Vitale (D), one of the legislature’s most persistent treatment advocates.

Meanwhile, private insurance companies often deny coverage for substance-abuse treatment, according to a recent survey by the National Alliance on Mental Illness. In New Jersey last year, just 10 percent of substance-abuse admissions were covered by private health insurance — down from 22 percent the previous year.

President Obama’s Affordable Care Act was supposed to address this problem: It requires insurers to treat addiction like any other medical condition. But the law only went into effect for many insurance plans in January. Botticelli acknowledged that “there’s room for greater enforcement,” adding that the administration is investigating complaints of declined coverage, higher co-pays and reimbursement limits.

The insurance companies’ approach to substance abuse is “hugely shortsighted,” Botticelli said. “There are huge economic costs to untreated addiction.”

Hospital admissions for opioid drug use

A 2013 national survey by the Substance Abuse and Mental Health Services Administration reported hospital admissions for opioid drug abuse, including heroin, are especially high in New England, Texas and the Southwest.

Per 100,000 people age 18 and over, March 29, 2013

56 to 339

504 to 712

340 to 503

713 or more

NH

WA

VT

ME

MT

ND

OR

MN

MA

ID

WI

NY

SD

RI

WY

MI

CT

PA

IA

NJ

NE

NV

OH

IN

IL

DE

UT

CO

WV

VA

MD

KS

CA

MO

KY

NC

TN

OK

AZ

AR

NM

SC

AL

GA

MS

LA

TX

AK

FL

HI

Data not available for the District of Columbia.

Opioid treatment facilities

Although heroin overdose deaths have quadrupled over the past decade, the number of treatment facilities nationwide has increased only slightly in recent years.*

In thousands

1.3

1.2

1.18

1.1

1.0

1.0

2003

2005

2007

2009

2011

2013

*Only those certified by SAMHSA.

Source: Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration

The Washington Post

Hospital admissions for opioid drug use

A 2013 national survey by the Substance Abuse and Mental Health Services Administration reported hospital admissions for opioid drug abuse, including heroin, are especially high in New England, Texas and the Southwest.

Per 100,000 people age 18 and over | March 29, 2013

56 to 339

340 to 503

504 to 712

713 or more

NH

WA

VT

ME

MT

ND

OR

MN

MA

ID

WI

NY

SD

RI

WY

MI

CT

PA

IA

NJ

NE

NV

OH

IN

IL

DE

UT

CO

WV

CA

VA

MD

KS

MO

KY

NC

TN

OK

AZ

Data not available for the District of Columbia.

AR

NM

SC

AL

GA

MS

LA

TX

AK

FL

HI

Opioid treatment facilities

Although heroin overdose deaths have quadrupled over the past decade, the number of treatment facilities nationwide has increased only slightly in recent years.*

1,282

1,239

1,189

1,108

1,067

1,069

2003

2005

2007

2009

2011

2013

*Only those certified by SAMHSA.

Source: Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration

The Washington Post

Opioid treatment facilities

Hospital admissions for opioid drug use

Although heroin overdose deaths have quadrupled over the past decade, the number of treatment facilities nationwide has increased only slightly in recent years.*

A 2013 national survey by the Substance Abuse and Mental Health Services Administration reported hospital admissions for opioid drug abuse, including heroin, are especially high in New England, Texas and the Southwest.

1,282

Per 100,000 people age 18 and over | March 29, 2013

1,239

1,189

1,108

1,067

1,069

56 to 339

340 to 503

504 to 712

713 or more

NH

WA

VT

ME

MT

ND

OR

MN

MA

ID

WI

NY

SD

RI

WY

MI

CT

PA

IA

NJ

NE

NV

OH

IN

IL

DE

UT

CO

WV

VA

MD

CA

KS

MO

KY

NC

TN

OK

AZ

Data not available for the District of Columbia.

AR

NM

SC

AL

GA

MS

LA

2003

2005

2007

2009

2011

2013

TX

AK

FL

HI

*Only those certified by SAMHSA.

Source: Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration

The Washington Post

Heroin users who are arrested at least get free — if medically unsound — detox simply by being locked up. If they’re lucky, they can move on to intensive rehabilitation and maybe a period in “sober housing,” halfway houses designed to keep them abstinent long enough that, with continued therapy, it might stick.

But a blizzard of bureaucratic rules makes it hard to land a spot in these facilities. Many heroin addicts sell to their friends, for example, and federal law prohibits anyone convicted of drug distribution from receiving welfare benefits. That lifetime ban means no rent vouchers, no food stamps  and, often, no ability to pay for treatment.

Increasingly, states are opting out of this ban. New Jersey has not, although Christie signed a law lifting it for inmates who agree to undergo drug treatment in prison.

“What was meant to be a deterrent has become a crushing, debilitating post-incarceration sentence,” McGreevey said. “The only way we can alter the behavior of using and selling drugs is to, for a limited period, ensure that [addicts] are able to eat, have sober housing — and get treatment.”

Heroin users receiving treatment

A 2014 national survey by SAMHSA reported that the number of heroin users receiving addiction treatment has more than doubled, with a surge among those 26 and older.

Age 26

and older

In thousands, 2014

473

400

224

18 to 25

200

133

50

12 to 17

8

12

0

2003

2014

Note: Respondents received heroin treatment during most recent substance use treatment.

Sources of help

Self-help groups, such as Narcotics Anonymous, are the most popular form of treatment for heroin users.

Millions of people age 12 and older, 2014

Self-help group

2.2

Outpatient

rehabilitation

1.7

Outpatient mental

health center

1.1

Inpatient rehabilitation

1.0

Hospital inpatient

0.9

Private doctor’s office

0.8

Emergency room

0.5

Prison or jail

0.4

Note: Respondents could report that they received treatment in more than one location.

Source: Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration

The Washington Post

Heroin users receiving treatment

A 2014 national survey by SAMHSA reported that the number of heroin users receiving addiction treatment has more than doubled, with a surge among those 26 and older.

 

Age 26

and older

In thousands, 2014

473

400

224

18 to 25

200

133

50

12 to 17

8

12

0

2003

2014

Note: Respondents received heroin treatment during most recent substance use treatment.

Sources of help

Self-help groups, such as Narcotics Anonymous, are the most popular form of treatment for heroin users.

Millions of people age 12 and older, 2014

0.5

1.0

1.5

2.0

2.5

0

Self-help group

2.2

Outpatient rehabilitation

1.7

Outpatient mental health center

1.1

Inpatient rehabilitation

1.0

Hospital inpatient

0.9

Private doctor’s office

0.8

Emergency room

0.5

Prison or jail

0.4

Note: Respondents could report that they received treatment in more than one location.

Source: Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration

The Washington Post

Heroin users receiving treatment

Sources of help

A 2014 national survey by SAMHSA reported that the number of heroin users receiving addiction treatment has more than doubled, with a surge among those

26 and older.

 

 

Self-help groups, such as Narcotics Anonymous, are the most popular form of treatment for heroin users.

Millions of people age 12 and older, 2014

Age 26

and older

0.5

1.0

1.5

2.0

2.5

0

In thousands, 2014

473

Self-help group

2.2

Outpatient

rehabilitation

400

1.7

Outpatient mental

health center

1.1

224

Inpatient rehabilitation

1.0

200

18 to 25

133

Hospital inpatient

0.9

50

12 to 17

8

0.8

Private doctor’s office

12

0

Note: Respondents could report that they received treatment in more than one location.

2003

2014

0.5

Emergency room

Note: Respondents received heroin treatment during most recent substance use treatment.

0.4

Prison or jail

Source: Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration

The Washington Post

In a storefront in a run-down section of Jersey City, McGreevey attacks addiction with every tool at his disposal. His program offers released prisoners career training, job-placement counseling and continuing therapy. It provides housing in a facility where everyone must be employed or in school. And its 56 volunteer lawyers persuade judges to convert addicts’ fines into jail time, so they can leave detention with a clean slate.

“Basically, you have to come here from jail, but without this place, you’d be right back in jail,” said Sean McClintock, 47.

Two years ago, McClintock, the burly son of a fire chief, was caught shoplifting to raise money for heroin. He tried to get into a detox facility in New Jersey but was told that he’d have to get on a waiting list. A helpful nurse gave him some advice on the sly: Take the train under the Hudson River and try one of New York City’s more generously funded hospitals. That same night, McClintock walked into the emergency room at Manhattan’s Bellevue Hospital and was put in a seven-day detox program, even though he had no insurance.

McClintock went to jail on the shoplifting charge and connected with McGreevey’s program. It now provides him with housing and a job, as well as regular drug testing and counseling.

After spending most of his adult life behind bars, McClintock has been out and clean for nearly two years, he said — “the longest I’ve been out of jail since I was 19.”

About a quarter of McGreevey’s clients relapse, a relatively low rate given that most addicts return to drugs and crime at least once after treatment. But McGreevey’s state contract provides care for only 284 people; New Jersey recorded 781 heroin overdose deaths last year.

Sean McClintock, above left, is a recovering heroin addict who has spent most of his adult life behind bars. McClintock, 47, says he has been clean since he connected two years ago with an experimental treatment program run by former New Jersey governor Jim McGreevey, above right, that provides him with housing and a job, as well as regular drug testing and counseling.

In South Jersey, Michael and Darla DeLeon’s cellphones ring around the clock with panicked parents trying to get their children into treatment. The couple — he’s a recovering heroin addict who spent a decade behind bars — travel the country teaching parents about heroin and obstacles to treatment.

“I can’t tell you how many people we lost on waiting lists,” Darla said.

Here, as in many places with soaring overdose numbers, the most immediate action taken to combat heroin-related deaths has been to make it easier to obtain naloxone, also known by its brand name, Narcan. A few states, such as Ohio and Kentucky, have even made naloxone available without a prescription.

But the DeLeons and some other treatment advocates are wary of relying too heavily on naloxone. It saves lives in moments of crisis  but does little to steer addicts away from the drug.

“I had a girl Narcaned nine times, and she died with a needle in her arm,” Darla said.

Some states have resisted expanding access to naloxone.  In Maine, LePage argued that being brought back to life could create “a false sense of security that abusers are somehow safe from overdose.”

“Reviving a person from an overdose is good, but that’s the beginning of something, not the end of something,” said Robert L. DuPont, who served as White House drug czar in the 1970s and was the first director of the National Institute on Drug Abuse.

DuPont advocates making treatment and long-term monitoring mandatory for people saved by naloxone. In South Jersey, Ocean County Prosecutor Joseph D. Coronato is working to make that happen.

Ocean County has one of the state’s highest rates of heroin addiction. Addicts saved by naloxone used to be in and out of the ER  in a few hours, stabilized and ready to get high again. But under an innovative agreement financed with drug forfeiture funds, local hospitals provide emergency intervention, clearing an addict’s path to immediate detox and rehab.

Because of health-care privacy laws, the county does not have data on how many overdose victims have been moved to rehab. But the county’s rate of fatal overdoses appears to have slowed somewhat, from 101 in 2014 to 68 in the first nine months of this year.

Sometimes, against all odds, the system works. Patrick Curatola had never met anyone who used heroin. He’d never been arrested. He’d never even taken the bus. He grew up in the suburbs. Good family. Money no problem.

As a teen, he smoked weed with friends. In his early 20s, he dabbled in tranquilizers such as Valium and Xanax. A few years later, his brother gave him “blues,” or Roxicodone, a narcotic pain reliever that he took after work.

“That feeling of melting into my bed at night felt real good,” said Curatola, now 33.

He started taking more and more pills. When his girlfriend objected, he found his way to a Narcotics Anonymous group and then an outpatient program, which accepted him even though he didn’t have insurance. After five months in the program, Curatola said, he was clean for the first time in years.

It didn’t last. A few weeks after the program ended, he wanted to get high and went to his brother, who by then had graduated to heroin.

“I’d never seen heroin in my life,” Curatola said. “I was scared to death I was going to die.” But the high others described was so alluring and the drug so much cheaper than anything he’d used — “$15, I was good for the night” — that he started sniffing.

Three months later, he overcame his fear of injections and shot up.

“The euphoria I felt within five seconds was unlike anything I ever felt,” he said. He never sniffed again.

Within weeks, Curatola was buying heroin on the street and stealing from his parents — cash, their TV, their jewelry. A few months later, he was pulled over in a traffic stop; police found heroin and arrested him. The first thing he did after leaving the police station was buy more heroin.

After his fourth arrest, in 2011, Curatola went through withdrawal in a jail cell in Bergen County, N.J. The prosecutor offered to move his case to drug court, which would get him treatment in exchange for a strict regimen of drug testing and counseling. Five days after he agreed to the deal, he was sent to a six-month, state-funded outpatient program.

Then it ended. And Curatola “felt like every once in a while I deserved a bag of heroin.”

Last year, he was arrested again. After four months in jail, he was sent to Integrity House, a state-funded rehab facility, where he was treated for addiction, anxiety and depression. Then he moved to a sober halfway house, where he got help finding a job as a waiter.

Now Curatola is in an outpatient program, financed with his Medicaid and state welfare benefits, which are paid directly to Integrity House. He has stayed on track, even after his brother died of a heroin overdose.

At the New Jersey mausoleum where his grandparents are interred, Patrick Curatola, 33, grieves for his father, who died last fall while they were estranged, and his brother, who died in July of a heroin overdose. Curatola, a recovering heroin addict, is in an outpatient program financed with his Medicaid and state welfare benefits.

Curatola’s story is the anomaly, McGreevey said: “Far more common is the anguished call I get from the parent of an 18-year-old son over whom the parent has no legal authority and they’re trying to secure a bed somewhere . . . and there’s nothing for them.”

But Curatola has been clean for nearly a year now, and he’s starting to talk about the future.

“I still have a lot to prove,” he said. His parents cut him off after too many lies; his father died last fall, before they could reconcile.

“I’m still dealing with the guilt of not being there the one time he needed me,” Curatola said. “That’s my inspiration now, to do right by my dad and make him proud.”

Alice Crites contributed to this report.

About this series: From the countryside of New England to the cities of the Midwest, the most deadly epidemic of heroin use in half a century is tearing at the fabric of American life. In this series of articles, The Washington Post examines why heroin has made such a powerful comeback, how well-intentioned government policies have fueled demand for the drug and why enormous hurdles stand in the way of bringing the epidemic under control.

Read part one: David McCarthy briefly got clean on his own after detox programs and rehab failed. But the lure of inexpensive, plentiful heroin eventually proved too much.

Read part two: Pellets, planes and the new frontier, how Mexican heroin cartels are targeting small-town America.

 

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David McCarthy briefly got clean on his own after detox programs and rehab failed. But the lure of inexpensive, plentiful heroin eventually proved too much.

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Credits