CROWNSVILLE, Md. (AP) - Jessie Holt was four months sober from heroin, but then the coronavirus pandemic hit. Recovery meetings shutdown. It became harder to find construction work. He was isolated from his support system while in quarantine.
“Not being able to go anywhere, do anything, it just gets you inside your mind and complacent. You just feel like you want to get high,” Holt said.
On a summer evening in August, Holt relapsed in Brooklyn Park and contacted Pascal Crisis Stabilization Center in Crownsville for short term help. They picked him up, but he passed out after reaching the short term care center. It took eight doses of Narcan and CPR to revive him.
“It’s really unheard of. You either come back after five or six doses, or you die,” said Holt, a well-known Pascal patient. “Because of my status with the people here … they were doing anything they could in their power to keep me.”
Holt eventually got additional treatment, but not every person who overdoses gets the help they need. Short-term treatment at the Pascal center can help people like Holt who may fall through the cracks, but health officials say longer-term care is key to recovery.
And while overdoses are up in Anne Arundel County this year, the usual pathways to long-term care have been obstructed by the pandemic.
Courthouses were closed for weeks, severing the referral progress for incarcerated patients awaiting treatment. Some walk-in patients fearful of contracting COVID-19 or uninterested in isolating upon arrival leave rehab early. Others are denied entry when a resident tests positive for COVID-19, sending the facility into a two-week lockdown.
Now, they’re facing steep financial shortfalls because of it, putting the programs at risk for closure. Without Medicaid reimbursements or federal and state funding, treatment centers straining under large deficits like Gaudenzia and Hope House say they will have to close some of their centers soon.
“It’s an existential crisis for us,” said Peter D’Souza, executive director of Hope House Treatment Center, a nonprofit addiction treatment center in Crownsville and Laurel. “If we have to close, we have to close. That’s not the issue. The issue for me is - who is there afterward to deal with all the other deaths that are happening due to the opioid crisis?”
Mental health and addiction advocates expressed concern almost at the start of the pandemic that isolation, lost jobs and treatment disruption could exacerbate the county’s opioid epidemic and push people in recovery to relapse.
Now it’s happening. Since January, 657 overdoses have been recorded in Anne Arundel County, a 15% increase compared to last year through October. Of those 657 overdoses, 113 people have died, an 8% increase in fatal overdoses from the comparable period a year earlier.
Statewide, Maryland recorded 1,187 opioid-related deaths from January to June, including heroin, prescription opioids, fentanyl and morphine. The most recent quarterly data is up by 9% compared to the same period last year and nearly on par with deaths seen in the same period in 2018, when Maryland recorded one of the country’s highest rates of death due to drug overdose, according to the CDC.
It’s a trend seen across the country, as preliminary U.S. Centers of Disease Control and Prevention data suggest drug overdose deaths are on track to surpass a record of 71,000 overdose deaths in 2019.
Anne Arundel County’s largest mental health and drug rehabilitation centers are nestled in a campus of neighboring brick buildings off General Highway in what used to be the Crownsville Hospital Center, a state psychiatric facility.
A person suffering from withdrawal or overdose can go to crisis centers such as Pascal as Holt did before moving to a residential rehab program like Hope House and Gaudenzia. Other times, men and women in jail for drug offenses can get a reduced sentence by agreement to enter Gaudenzia’s treatment program.
Patients arrive at Pascal after falling through the cracks, unable to get a scheduled medical appointment or lapsing on their medication and experiencing a significant psychiatric crisis, such as being floridly psychotic or having intense hallucinations, said Katherine Bonincontri, president and executive director at Pascal.
Paired with a demand for outpatient treatment services, Pascal has seen a 63% increase in new telehealth appointments than the same six-month period last year.
Over the past eight months, Pascal provided over 13,000 behavioral health sessions and served 654 new behavioral health clients and 351 new medication management clients.
But the patients aren’t making it through to long term treatment.
Dale Klatzker, Gaudenzia CEO, is bracing for a $3.4 million loss in revenue driven by the fall of in treatment referrals for incarcerated patients while the courts were closed.
Gaudenzia is the largest treatment provider of a state-subsidized program for inmates struggling with addiction. As part of the “8-507” program, residents who complete the treatment can receive reduced jail sentences.
Gaudenzia runs six treatment facilities with 200 beds between Anne Arundel County and Baltimore. It served around 120 patients per day through the program in 2019. That rate dropped by 75% to about 30 people per day in September. Since court proceedings have resumed, patient volumes have increased slightly.
Patients at rehab centers can receive medically-supervised detoxification, medication-assisted treatment and in-house recovery programs. To continue these services and keep staff employed, Klatzker asked the Maryland Department of Health to release money budgeted for the program to fill the gap.
D’Souza sent a letter to the state health department detailing the medical rehab facility’s 75% drop in revenue.
Aliya Jones, deputy secretary of behavioral health at the Maryland Department of Health, responded to Gaudenzia that the agency is working on evaluating the issue. In the meantime, facilities are encouraged to apply for a federal “Provider Relief Fund.” The $175 billion fund created by the CARES Act allocates money for healthcare expenses or lost revenue due to COVID-19.
The health department announced Wednesday the state will award $50 million in grants for local treatment and recovery programs to combat substance use disorder.
A Gaudenzia spokesperson said the company has applied for the relief, but the grant would be much lower than what the company has lost and continues to lose.
It’s not just state funding. Around 95% of Hope House’s patients are on Medicaid, and with the 80-bed facility operating at less than half capacity, those revenues also have dropped.
Hope House goes into a two-week quarantine every time a resident tests positive for COVID-19. Incoming patients can’t enter the building or start treatment until all staff and residents test negative. It’s a dire situation that’s happened six times between the two centers in Crownsville and Laurel.
People seeking treatment during the lockdown are referred to other facilities or told to come back later. Unable to get immediate help, people are more likely to overdose and go back to places like the Pascal center, or worse, die.
If not for its savings, Hope House would be closed.
“It’s like going to a hospital and saying, ‘Sorry we can’t take you,’” said D’Souza, Hope House CEO said. “What can I do? Our hands get tied up once we get in a positive case, and it breaks my heart.”
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The Associated Press contributed to this report.
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