Part of our ongoing investigation into the Southern California rehab industry.

Thirteen-hundred miles from his rural Arkansas home, Tyler McCollough paces across a motel parking lot, veins bulging at his temple, anxiously gripping himself as the pangs of heroin withdrawal intensify.

Newly homeless and dope sick on the streets of Costa Mesa, the 25-year-old says he’s thinking about stealing from a nearby store – anything to scrounge up the cash he needs to get drugs.

Hours later, relaxing in an In-N-Out booth, he’s calmer. He says a friend gave him a hit of heroin. He also wonders aloud how he came to be living on the streets, so far from the place he used to call home.

Migration stories similar to McCollough’s are repeated with varying frequency across pockets of Southern California.

Searching the web earlier this year for a rehab program, he says he was lured to the region by an offer of a complimentary plane ticket and free treatment. He left a construction job and work on his family’s horse ranch for a recovery program near the ocean in Orange County.

Five months later, when his insurance ran out, McCollough says he was discharged to the streets, where he remained for at least two months. He says he commits crimes to feed his habit.

“I sell drugs. And I steal things and sell them.”

Homelessness has surged in Southern California in recent years, a problem that has confounded officials and motivated local leaders – including Los Angeles Mayor Eric Garcetti and the Orange County Board of Supervisors. Millions of dollars have been spent addressing the issue and identifying its causes.

“They end up getting stuck, homeless, in Los Angeles”

But one aspect of the problem hasn’t been widely examined: What connection, if any, exists between the outsized number of rehab centers in Southern California and the region’s fast-growing homeless population?

There’s evidence to suggest a portion of the growth in some Orange County cities, and to a lesser degree in Los Angeles, can be attributed to the rehab industry’s aggressive recruitment of addicts – and their lucrative insurance payments – from around the country.

Counts of homelessness in Los Angeles, Riverside, San Bernardino or Orange counties haven’t examined potential connections to the rehab industry. But in an area with one of the highest concentrations of recovery programs – the coastal region from Costa Mesa to San Juan Capistrano – government officials, social workers, police and residents say they’re seeing definitive links.

And on Los Angeles’ Skid Row, the head of a new, county-funded “sobering center” says she has noticed something different this year: a handful of homeless addicts who came here from other states for drug treatment programs.

“They end up getting stuck, homeless, in Los Angeles,” said Hilary Aquino, the center’s program director.

At the same time, interstate recruitment of addicts by the treatment industry has caused enough problems that federal lawmakers and officials from California and five other states are exploring how to crack down on widespread abuses. Local officials have proposed making mandatory transportation home part of that solution.

And in a growing number of neighborhoods, residents say they’re dealing with the detrimental effects of a recovery business model that can leave addicts stranded on the streets.

Phil Mutt, 59, a retired Costa Mesa auto mechanic, lives a few houses down from a recovery home and blocks away from a hangout for homeless addicts, including some discharged from rehab programs. Recently, he said, he’s seen people sell drugs on the once-tranquil block he’s called home for more than three decades. In December, someone burglarized his car.

“The city feels a lot less safe than it used to,” Mutt said.

Some Orange County officials and police say the population of homeless addicts has grown over the past two years. They suggest that is partly tied to Proposition 47, a voter-approved California measure that pushed thousands of low-level criminals from state prisons to community-based supervision programs.

Other industry observers suspect local rehabs, building on earlier financial successes, are spending more on national marketing campaigns to attract out-of-state customers, including from states in the Midwest and East Coast where the rate of opioid abuse is high.

Such factors are churning more addicts westward away from their families and systems of support, with little regard for what happens in the aftermath of detox and residential treatment.

Rehab to homeless?

A center of the region’s rehab boom is Costa Mesa, where the recovery industry’s connection to homelessness is most evident. The city, with more than 100 treatment centers, is second only to Malibu in the state’s per-capita concentration of licensed facilities. But Costa Mesa’s rehabs tend to be more affordable for those with limited resources.

Along motel-lined Harbor Boulevard and adjoining streets, small groups of mostly white, 20-something men and women congregate near local businesses. They shoot heroin in fast-food restaurant bathrooms and huddle in alleys and parking lots, buying and selling drugs. Their weathered appearances often belie their ages.

Four years ago, Costa Mesa officials noticed the city’s fast-growing homeless population was becoming younger and more drug-addicted, so they asked social workers to start interviewing street dwellers and collecting data. With that effort, Costa Mesa became perhaps the only Southern California city to examine the rehab industry’s impact on homelessness.

About 5 percent of the 1,105 homeless people surveyed acknowledged being in a local rehab prior to living on the streets. City workers suspect the true number is higher because many homeless people refused to participate. Only two of 12 ex-rehab residents interviewed by Southern California News Group on Costa Mesa streets said they had been approached to take the survey.

City leaders have suggested that former rehab clients living on the street have contributed to increased crime. Since 2010, the number of licensed treatment centers in the city has more than doubled, not including hundreds of sober living homes.

In a roughly parallel period, the six years ending in 2016, Costa Mesa’s property crime increased by 41 percent – driven by a 62 percent rise in burglaries and a nearly two-fold jump in auto thefts, according to FBI data. News reports from that period are peppered with stories of young out-of-towners from places such as Seattle or Arizona breaking into homes and stealing vehicles.

On Skid Row in Los Angeles, the Exodus Recovery center offers temporary shelter to homeless drug users while they sober up. Officials there have seen a small-but-noticeable influx of former rehab clients from other states.

“We’ve seen individuals from Seattle and Texas and Nevada,” Aquino said.

It’s a pattern she has not observed before, despite working for more than a decade in the addiction treatment field. While the numbers are small – only a few of the center’s visitors came to California for rehab – Aquino said she hasn’t attempted to quantify a connection.

Los Angeles County’s annual homeless count also hasn’t examined if such a link exists. The factors boosting the population are numerous and complex, and changes in the methodology used in annual tallies make detailed analysis difficult. While not conclusive, some demographic patterns appear to parallel what officials in Costa Mesa and some other cities say they are seeing.

This year, the report shows L.A. county’s homeless population grew 23 percent compared to 2016. And the number of unsheltered youth climbed 81 percent to 4,536 – most of whom are young adults, a group prominent in rehab centers. In the same period, the number of county homeless whose last residence was out of state increased by 21 percent.

Down the coast in southern Orange County, sheriff’s officials said homelessness has increased in recent years, in tandem with an influx of new drug treatment centers.

Sheriff’s Sgt. Richard Himmel said he sees three to four people become newly homeless in Dana Point each month after they’re discharged or kicked out of local sober living homes. San Clemente sheriff’s officials report a similar trend.

“They’re from out of state – out east or down south – and for the most part, they become part of our permanent homeless population,” Himmel said.

“And they are committing a large number of petty crimes to support their habits,” he added.

But data on any link between rehabs and homelessness isn’t easily available, in part because rehab operators have gone to court – and won big money – from cities that try to regulate the industry.

Sheriff’s officials said they intentionally avoid compiling statistics or attempting to analyze the number of homeless people who have come from local rehabs. Himmel said Dana Point’s city attorney advised the department not to track sober living homes or their clients. Another official, sheriff’s Lt. Mike Peters, San Clemente’s contract police chief, said his department is “careful what numbers we keep” to avoid being sued for monitoring recovering addicts.

Federal high courts have extended anti-discrimination protections for the disabled to those being treated for addiction, limiting what cities can do to regulate recovery programs and sober living houses.

The lack of data has left officials guessing about if and how the rehab industry has changed or expanded the local homeless population.

The number of people identified as both homeless and recent rehab patients is relatively low, perhaps 100. That would be a small fraction of the total number of homeless people in Orange County, which last year was pegged at 4,792. But it could account for a more considerable share of the newly homeless, which the county says is 340 people.

Notably, some other rehab-dense American cities are seeing links between concentrations of drug-treatment facilities and homelessness.

In Palm Beach County – home to Delray Beach, the focal point of Florida’s rehab boom – government counts found a 73 percent increase over the past two years in the number of homeless youth between the ages of 18 and 24, a demographic that’s a prime target for interstate rehab industry recruiting.

Prosecutors there have a name for the patient-brokering schemes that send addicts through a revolving door of treatment, relapsing and homelessness: the Florida shuffle.

“The (rehab patients) are not going back home to the Northeast,” said Palm Beach County State Attorney Dave Aronberg, who leads the county’s Sober Home Task Force. “The incentives are too great to remain here: the free rent, the free transportation, the lifestyle. They’ve set up these individuals for failure.”

Back on Harbor Boulevard in Costa Mesa, Blake Lowe, 24, recently of Seattle, drags his rolling suitcase down the sidewalk. He says he’s on his way to his eighth rehab in five months.

The commercial fisherman says he attended a drug treatment program in Corona during the summer for his heroin addiction but failed out after two weeks. Since then, he says he has been scoring drugs on Southern California streets, alternating between brief stints in treatment and living in motels in Riverside, Los Angeles and Orange counties.

“I got trapped in it for a little bit,” Lowe says. “I could probably be progressing more back home.”

In May, the Costa Mesa City Council attempted to break what officials saw as the recruitment-to-homelessness drug treatment cycle. They adopted a law requiring sober living homes to make transportation available to discharged clients so they could return to the places they left behind.

Officials said early signs indicate the new rule may be reducing the number of homeless. But City Councilman Jim Righeimer said the ordinance has been difficult to enforce because of federal laws protecting recovering addicts.

Trapped in a cycle

Money is driving addicts from the East Coast and Midwest to California and other states with high concentrations of rehabs. Some local officials say systemic failures in California’s treatment industry, coupled with a relaxation of penalties for some drug violations, encourages out-of-state addicts to stick around.

An investigation this year by the Southern California News Group found that treatment patients can be worth hundreds of thousands of dollars in medical payments from insurance companies. That bounty has spawned a secondary industry of so-called “junkie hunters” who receive kickbacks for selling addicts from around the country to the highest-bidding rehab facility, regardless of its quality of treatment. California’s lax oversight has allowed many rehabs to be operated by people with insufficient training, state investigators found.

Rehab programs often consist of initial stays in a licensed treatment center, followed by a period in sober living homes, which are largely unregulated environments that can be rife with drugs. When the insurance money runs out, some homes kick patients to the streets without follow-up support.

That sort of treatment exacerbates the cycle of recovery, relapse and slipping into homelessness, some experts argue.

Al Johnson, chief assistant state attorney for Palm Beach County, Florida, said because insurance companies generally cover only short-term residential treatment, recovery center operators have a financial interest in patients relapsing.

“It’s people, post-treatment, who still have an addiction, who are most likely to be on the streets,” Johnson said. “People have been here for years in this cycle.”

Upwards of 60 percent of people who get treatment for drug abuse relapse, according to the National Institute on Drug Abuse, a federal research center. The institute states that “long-term follow-up” is crucial to successful addiction treatment.

Some former rehab residents say unethical practices contribute to relapses. They describe being lured out of treatment, back to the streets and into other different rehabs with promises of drugs supplied by addicts who are being paid by patient-brokers.

Others exploit the market of rehab graduates and dropouts in different ways.

Sergius Harty, 25, who came to California from Chicago by way of Texas, said he simply sells them drugs.

“Having relapse-ready rehab clients, the business is booming,” said Harty, who has been homeless off-and-on in Southern California for two years. “They’re cycling in and out. I target them. I don’t even have any shame about it anymore.”

Police officials maintain recent prison reform laws in California are another factor in out-of-state addicts remaining here after coming for treatment.

They routinely cite Proposition 47, a 2014 voter-approved measure that reclassified some felony drug crimes as misdemeanors to lower state prison populations.

Many elected officials support the changes, which are intended to emphasize community rehabilitation programs over incarceration. They note no significant research studies have established links between increased crime or homelessness and criminal justice system reforms.

But Himmel, the Dana Point sheriff’s department sergeant, insists there’s a connection.

“Back home in another state, if they relapse, those (drug) crimes are felonies and they might go to jail if they get caught,” Himmel said. “Here, not only is the weather great, but you only get a ticket if they catch you with meth or heroin.”

Harty, who said he first used heroin at 15, after his father lost their home during the Great Recession, echoes Himmel’s view.

On a recent evening, he disappeared into a ditch behind a Costa Mesa restaurant to inject heroin into his hand. Shortly afterward, he said he was stopped and frisked by the police. Officers confiscated a small stash of dope and let him go, he said.

“In Texas, I did six months for (possessing) a gram of meth,” Harty said.

“Out here, I might get a ticket for it.”

Some in the rehab industry pitch out-of-state treatment as a way for addicts to escape familiar temptations, but other operators question the efficacy of the practice.

“I want people to be in an environment where they have family support, community support, where they return to the community employed,” said Nancy Clark, who has run her own drug treatment program in Costa Mesa for 27 years.

But the migration of addicts to Southern California isn’t likely to slow soon, industry observers say. That’s partly because of the state’s efforts to expand health insurance availability. Addicts from other states are allowed to acquire health insurance coverage for drug treatment through a state-sponsored marketplace the day they arrive. And some recovery programs have paid the premiums – sometimes illegally – because they’ll make thousands in profits through billings, authorities say.

Nonprofit organizations working with the homeless are beginning to offer trips home for those stranded in Southern California after treatment.

At the Courtyard in Santa Ana, Orange County’s first year-round homeless shelter, workers said they’ve bought one-way bus tickets for dozens of out-of-state homeless over the past year, close to a third of them former clients of local treatment programs. And Family Assistance Ministries, a San Clemente nonprofit, said they’ve provided about a half-dozen former rehab patients with transportation back to other states.

Others, like Ricky Burnell, aren’t interested in returning home.

The 26-year-old says a free train ticket lured him from Chicago to an Orange County rehab in 2010 to kick his heroin and methamphetamine addiction. Ejected 60 days after he arrived, the Kurt Cobain look-alike says he’s remained in the area for seven years, piling up two burglary felony convictions and several jail stints. He’s often on the streets of Costa Mesa with other former rehab patients, trying to scrape up money to eat and get his next fix.

Along the way, he got a new tattoo: “CML” on his right jawbone.

“It stands for ‘Costa Mesa Local,’” Burnell says with a grin.

“It’s where I’m from now.”

Staff writers Tony Saavedra, Scott Schwebke and Teri Sforza contributed to this article.

More: