Warm Handoffs Could Help Save Opioid Users' Lives
On the day she was released from prison, Katy Anke and her parents learned there was an open bed at a private treatment facility near Pittsburgh. She could check herself in at 10 a.m. the following day. After weeks of trying to find a place that would take her, it sounded perfect.
Katy had graduated from North Allegheny High School, earned a technical degree and was living on her own. But she started to take Oxycontin as a way to fight off depression. Soon she was living in an apartment with no power and she was hooked on pain killers.
After serving a two-and-a-half-month sentence for drug paraphernalia charges, Katy wanted to get her hair done before she reported to the in-patient program. So her father, Jack Anke, took Katy to her apartment in Oakland. The plan was for her to pack her clothes, head to a hair appointment and then drive to her parents’ house to spend the night.
“There were times when you could trust her and times when you knew you couldn’t," Jack said. "This time we felt pretty good about it."
But then the calls started. First, Katy said the hair dresser was running late; then she called to say the appointment was going long. Finally, Katy called around 9:30 p.m. to say she had to get one more thing from her apartment.
“Well, basically we never heard from her again and we had a knock on the door from the police department (at 2:30 a.m.),” Jack said, with a quiver in his voice. Dianne, his wife, continued, “And our guess is— well I’m sure of it— she died at the dealer’s house. She died of an overdose in, I believe, their bathroom.”
As awful as the story is, Katy’s death is not unique. A recent study by the Allegheny County Department of Human Services and the Department of Health found that of the 1,355 opioid-related deaths in Allegheny County between 2008 and 2014, 14 percent of those individuals had been released from a prison or a publicly-funded in-patient treatment facility in the past month. And that doesn’t count those who were in private rehab facilities.
The Naive Brain Needs A Warm Handoff
“Doing the usual, routine piece is not going to work,” said Peter Luongo, Executive Director of the Institute for Research, Education and Training in Addiction. “In fact, this report says to me that we’re getting the outcomes we’re structured to get.”
As a user becomes addicted to opioids, his or her brain starts to build a tolerance. But when addicts stop shooting up for even a few weeks, their brain resets. Public health officials call it a “naive brain” and counselors warn addicts and their loved ones about it all the time.
“The concern of course is that if someone… gets out of jail and they go right back to using the same amount that they were using previously, now it has a much stronger effect on them,” said Karen Hacker, Allegheny County Health Department Director.
Couple that with the seemingly ever-growing strength of heroin mixed with fentanyl, and you have an overdose death. That has advocates calling for “warm handoffs.”
A warm handoff is when a person comes out of jail and they are met by someone from a rehab center and taken directly to an in-patient facility for treatment. Then, when they are leaving treatment, they are either taken to a halfway house, or put in direct touch with a counselor and a doctor that can help with addiction therapy.
Warm handoffs rarely happen, even if family members are trying to find help—treatment facilities often have a six to eight week wait. That has led many to say the region needs more treatment beds.
Who can help?
“I’m not so much seeing that there aren’t enough treatment beds, but the problem seems to be matching people, getting them to where they need to be,” said Karen Plavan, Director of the non-profit Oasis Recovery Center in Pittsburgh.
There is a long list of hurdles for addicts who want help. Some facilities will not take Medicaid, some commercial insurance holders cannot to afford their deductible, most facilities don’t simultaneously treat mental illnesses and addiction and many facilities prefer to not take people who have been in jail because they can make more money if they admit a person who is actively using drugs compared to someone who is not.
Plavan said she can work her long list of contacts and almost always get a user into treatment in just a few hours. But not everyone has access to that type of assistance.
Advocates like Luongo are hoping the Allegheny County report will spur some changes.
“You know, warm handoffs are not hard to do," said Luongo, who is a strong advocate of medication-assisted therapy. "Creating a continuity of care, using peer specialist, shifting to a recovery orientation instead of an episodic, acute care system. Those are all within reach."