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Heroin and opiate addiction are on the rise in New Jersey.

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When Barbara finally decided to get clean, she was little more than a skeleton.

Nearly a year ago, the New Brunswick mother of two weighed 95 pounds, her body ravaged by a heroin addiction that led her through a life of homelessness and prostitution and left her in a coma after an overdose.

Today, there is light in her eyes when she talks about her life. She has been sober nearly a year. She’s back at a healthy weight and has reconnected with her children, who are 10 and 11. There’s hope for a future, one she said wouldn’t exist without the treatment she sought and received.

"If it weren’t for Integrity House, I’d be dead," she said, while sitting in the substance abuse facility’s Newark offices. "Before I came here, I thought I’d end up in a gutter somewhere. I’m blessed. I see things totally different now."

Barbara is lucky. She has one of a few thousand licensed short- or long-term inpatient substance abuse treatment beds in New Jersey.

Put another way, she won the addicts’ lottery — scoring a chance to get clean in a state-licensed residential facility. In New Jersey, it’s a dream that’s never been further out of reach.

A Star-Ledger analysis of state and local data reveals a troubling relationship between the number of people being treated, the number of people heroin is killing and the number of people unable to find the help they immediately need.

Data obtained this month show the state was on pace to see 760 fatal overdoses in 2013, the most recent period for which statistics are available, up from 449 in 2011 and 591 in 2012. At the same time, the number of people being treated in state-licensed treatment facilities has leveled off at 33,500 between 2012 and 2013 — after steadily increasing since 2006. And in a 2013 report, the federal Substance Abuse and Mental Health Services Administration estimated that out of 179,000 people in New Jersey who abused or were dependent on illicit drugs, only a quarter received treatment.

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While there is no uniform data on the number of people on waiting lists, interviews with treatment experts and the anecdotal evidence suggest there is "a woeful lack of treatment beds in New Jersey," said Evan Weiss, Integrity House’s director of admissions.

At Integrity House, the current waiting list for a bed is more than 300 names long, Weiss said.

Weiss and other treatment experts say the failure of state and local officials to meet this new demand has put New Jersey in a position where it can only adequately treat a fraction of those in need. Too often, the experts say, people craving help are being told to tread water for days or weeks until a bed opens as they face an addiction waiting to pull them back under at a moment’s notice.

"We see it all the time," said Louise Habbicht, who works at Parent-to-Parent, a Marlton-based group that helps connect drug users to treatment options. "A lot of time there are three-week waits for a bed. A person can die in that time. Sometimes you only have that window of opportunity, and it’s small."

Hitting Bottom

Michael didn’t set out to become a prescription opiate and heroin addict. No one does.

A Monmouth County native, Michael, 28, said he began using drugs and alcohol recreationally in high school. He went to college, but said he was soon kicked out as his drug use, mainly prescription forms of the narcotic pain reliever oxycodone, began to take over his life.

He began stealing when prescription drugs, which can cost $20 to $40 a pill on the street, became too expensive. He then turned to heroin, which, at prices as low as $5 a bag, seemed like the logical progression.

"Everything really fell apart from there," he said.

Heroin led to more illegal activity, arrests, probation and eventually a 28-month stint in state prison. While he was sober during his prison stay, he said he didn’t receive treatment or support. He thought he could remain clean when he was released in September, but soon after fell into old patterns and once again found himself behind bars.

"When I woke up in jail again, that was it for me. I vowed to myself that I wasn’t going to do this anymore," he said. "I remembered I had so much going for me when I first got out and was clean. I asked for help."

He ended up at Integrity House, where he has been since early June, and now has more than four months of clean time. He said the treatment programming has changed him.

"When I got out of prison the first time, I was abstinent, but I wasn’t really sober. I was still very sick inside," he said. "I’ve always been an addict, even before I used drugs. I know that now. I’m addressing my defects. Obviously things aren’t perfect because I’m still in treatment. But when I wake up in the morning I’m happy and excited for the day. I didn’t have that before."

Robert Budsock, CEO of Integrity House, said Michael’s progression of drug use is all too common.

"We’re seeing it more and more. They are quickly moving from prescription drugs to heroin. It’s like lightning," he said. "Heroin now is easier to get. The big risk is at least with prescription drugs you know it’s FDA approved. You don’t have that with heroin, and that’s why it’s so easy to overdose."

The Treatment Gap

Patricia Kazanowski, a counselor and recovering heroin addict at Integrity House, says more residential treatment centers are needed in the Garden State.

New Jersey last conducted an assessment of its substance abuse treatment needs in 2010, when the recent spike in heroin and opiate abuse was only beginning to escalate.

State officials estimated that more than 31,000 people who were in need of substance abuse treatment in the state could not access it, about 37 percent of the total demand.

"We know there is a lack of treatment in New Jersey," said Roseanne Scotti, New Jersey director of the Drug Policy Alliance. "But right now, we don’t actually know how much of a need there is. There’s been a lack of drug treatment here for years, but ultimately it requires money to fix. After going through this year’s (state) budget process, I’m not sure where it’s going to come from."

Outpatient substance abuse treatment, which typically consists of a mix of individual and group counseling, has been on the rise in New Jersey. But it often falls short of the needs of many heroin and opiate addicts seeking recovery, which can include a medical detox, housing and medication, officials said.

There are some privately run inpatient treatment centers in New Jersey and scores more in other states, but they can cost tens of thousands of dollars making it a nonstarter for many addicts, who are often poor, homeless and uninsured. Treatment providers say insurance reimbursements also make it financially challenging to offer inpatient services. The number of people receiving detox treatment in hospitals, for example, has dropped by nearly 80 percent since 2006.

"There’s not a great (financial) incentive to operate an inpatient facility right now," Budsock said. "The rate of reimbursement is barely enough to keep the lights on. We have to look to supplement what we receive through private fundraising."

Nicole Brossoie, a spokeswoman for the state Department of Human Service’s Division of Mental Health and Addiction, said Gov. Chris Christie’s administration has allocated more than $600 million toward substance abuse prevention and treatment and cited the expansion of Drug Court and the Medicine Assisted Treatment Initiative, designed to help treat people with opioid addictions in their own neighborhoods, as examples of progress in recent years.

"In addition, Medicaid expansion has made insurance for treatment available to many more people," Brossoie said in a statement. "With continued support from the Administration, (the Department of Human Services) continues to develop and expand various treatment options and increase access to these services."

Addiction specialists say they expect opiate and heroin use to continue to rise

But addiction specialists say the road to adequate treatment for substance abusers far too often remains a convoluted process filled with dead ends and long waits.

"It’s horrendous," said Frank Greenagel, a professor and clinical social worker specializing in addiction at Rutgers University.

Greenagel called navigating the insurance process for treatment "a nightmare," but added that options are even more limited for those who don’t have insurance. More than 60 percent of people who received substance abuse treatment in New Jersey in 2013 did not.

Budsock and Weiss said intravenous drug users, like many heroin addicts, often need a medical detoxification and some form of residential treatment to begin to rebuild their lives. The number of intravenous drug users in treatment has more than doubled in the last decade to more than 21,000, and now accounts for more than one in four people in New Jersey substance abuse facilities annually, according to state data.

"A lot of addicts need a program like this; they don’t have anything when they come in," said Patricia Kazanowski, a recovering heroin addict who now serves as a counselor at Integrity House. "I’ve probably been in almost every treatment facility in New Jersey. There aren’t a lot of programs like this around. They do need more."

Weiss said detox and residential treatment facilities are often forced to play an elaborate chess game with patients, swapping them in and out of different levels of treatment at a moment’s notice when beds open up.

"We experience bottlenecking at times, where people are waiting three to four days to get into a bed at a facility," Weiss said. "In that time period anything can happen."

Scotti said it has forced third-party groups like Parent-to-Parent to step in and connect substance abusers seeking help with available treatment facilities both in the state and out.

"It’s a completely nonsensical system," Scotti said. "If we’re really serious about this problem and we want to do something about it, then we would be doing something about this system."

A Deadly Problem

Star-Ledger file photo

The number of deaths related to heroin in New Jersey has been on a steady rise for the last several years. There were 591 heroin-related deaths in the state’s 21 counties in 2012, up from 449 in 2011 and 287 in 2010, according to state records. And the 380 that occurred in the first six months of 2013, the most recent data available, put the state on pace to eclipse each previous year.

Though it is difficult to track the number of prescription-drug-related overdoses because users often have a cocktail of drugs in their systems, state data show hundreds tested positive for other opiates at the time of their death from 2011 to 2013.

the epicenter

Ocean County has been at the epicenter of the opiate crisis’ recent resurgence. The largely suburban county recorded 112 drug overdoses in 2013, more than double the 53 from 2012, which county Prosecutor Joseph D. Coronato has called a grave situation.

Coronato said there is no silver bullet that will fix the burgeoning crisis, but he believes a multifaceted approach to the issue involving education, legislation and enforcement can begin to rein it in.

Already, forums hosted by the prosecutor’s office have drawn thousands of residents in recent months. Prosecutors also have charged nine alleged drug dealers in connection with overdose deaths in Ocean County during the last year in an effort to deter dealers and stiffen penalties on those leading the opiate trade in the county.

But it is the use of naloxone, a nasal spray that almost instantly reverses the effects of an opiate overdose, that has paid immediate dividends. Coronato said naloxone, also known by the trade name Narcan, has revived 65 overdose victims in the county alone this year and has recently been distributed to law enforcement officials statewide.

"We’re not ready to pound our chests," Coronato said, noting that the county’s 39 overdose deaths are down from the 79 recorded by this time last year. "But at least it’s a positive trend."

Coronato conceded there currently isn’t a consistent mechanism to connect addicts saved by naloxone to treatment facilities, something he hopes to remedy but understands is a challenge.

"You’ve helped them for that moment, but that’s it. We need to be able to capture those people," he said. "You need to get these people the help they need. These people almost stepped into the light. You need to capture those people there, when they’re vulnerable."

And unfortunately, according to Greenagel, the need for substance abuse treatment shows no sign of slowing down.

"The number of arrests hasn’t changed. Overdoses haven’t changed. If anything, it’s going to get worse," Greenagel said. "We have a whole group of young people who are coming of age and haven’t yet experienced a real problem with their pill use. … It’s going to get worse before it gets better."