Editor’s Note: This is the second part of a series that examines why it’s so hard for heroin and drug addicts to get into treatment in Juneau, and what some in the community are doing about it. To read Part One, click here, and to read Part Three, click here, and to read Part Four, click here.
Kara Nelson, the executive director of Juneau’s Haven House, and Christina Love, an advocate for AWARE, were at work last Wednesday afternoon when their phones rang.
A friend of theirs had called with an emergency situation: A woman in her 20s, who had shot up heroin every day for the past six months after being released from Hiland Mountain Correctional Center in Eagle River, had just arrived at the Juneau airport from Anchorage. She was a stranger to Juneau, and her friend said to come to the capital city to receive substance abuse treatment.
So she did. But she arrived to Juneau without money or paperwork to get treatment. Nothing had been arranged, and her friend, who had called Nelson and Love, was on probation and wasn’t in a position to help. The woman had nowhere to go, and no one to help her.
“They honestly thought that they could get off the plane, and she could go straight into treatment,” Love said. “They didn’t know until somebody told them … that’s not the case.”
Nelson and Love dropped what they were doing and did all they could for the next two days to get the woman into treatment quickly. With their help, she was admitted to Rainforest Recovery Center, Juneau’s only residential drug treatment facility, just two days after arriving.
“It literally has taken less than 48 hours, which is unheard of,” Nelson said.
Help no matter what
Nelson and Love receive phone calls similar to the one above a couple times a month. Those calling for help are usually women who have heard about them through word of mouth.
The pleas vary, but Nelson’s and Love’s response is always the same.
“Our policy is that everybody walks away with something, that we help them no matter what,” Love said.
Nelson and Love, both of whom are addicts in long-term recovery and who have become pillars in Juneau’s recovery community, became certified recovery coaches about a year and half ago.
Recovery coaches are people with an established foundation in recovery who can help other active and recovering substance users in their journey to recovery. The idea behind the peer-to-peer partnership is that the “coaches” have walked down the same path before and can help others do the same.
“If you’re going to climb Mount Everest, then you want a Sherpa, and we see ourselves as the Sherpas,” Love said. “We’ve been up this hill many times.”
Recovery coaches are supposed to have first-hand experience and expertise, and Nelson and Love have that in spades.
Both have been addicted to drugs, including heroin. Both have overdosed. Both have detoxed. Both have been diagnosed with mental health disorders. Both have been kicked out of treatment. Both have been arrested.
“Between Christina and I and some of the other ladies who are really great mentors, we’ve pretty much been through everything,” Nelson said. “You’re not going to one-up us on much.”
As recovery coaches — they’re two of just a handful in Juneau right now, though they envision many more — they do everything in their power to help substance users on their path to recovery.
“We’ll get calls at all hours of the night, and then we go and meet people where they’re at,” Love said. “Depending on what stage they’re at — maybe they can’t stop using and they need treatment, so we walk them through that process. Or, maybe they’re on medically assisted treatment. So depending on where they’re at in their recovery walk, then we meet them and get an idea of where they’re at, and then empower them, and we give them the options.”
Most of the time, though, the people who call Nelson and Love want the same thing: help with detoxing and getting into treatment.
In the past, Nelson and Love have opened up their homes to people had a place to detox. But they both have children at home, and they’re not always available to watch someone 24/7.
“We’ve had things like, I had a girl drink my hand sanitizer, or things that even somebody as versed as I am can’t anticipate,” Love said during a recent joint interview with Nelson at AWARE. “So it’s urgent to get systems in place.”
“Right now, we need to have a place to detox,” Nelson said. “Right now, we need a ‘right now.’”
“People need to have a place to go, other than our couch,” Love added.
The two places you would think an addict would be able to go to detox — Rainforest and Bartlett Regional Hospital’s emergency room — usually won’t accept them.
“It’s insane how many people we’ve sent to the E.R. or to Rainforest that get turned away,” Love said.
Rainforest right now is only set up to help people who are already clients and enrolled in the 28-day in-patient program.
And emergency room doctors can’t help them unless there’s another medical matter at hand that a doctor believes is life-threatening.
That’s because BRH does not consider opiate detox medically dangerous, even though it’s excruciating for addicts. In contrast, withdrawal from alcohol and barbiturates like Benzodiazepine is considered medically dangerous.
“Most detoxes, 90 percent, are not going to require physician oversight, and they’re not going to require a 24-hour nursing supervision,” Dr. Jenna Hiestand, the medical director of behavioral health in charge of overseeing the clinical care of BRH’s mental health and detox patients. “So the things that are concerning are people that have alcohol withdrawal seizures, people that have delirium tremors — very severe, life-threatening withdrawal that does require them to be in a hospital setting.”
“Opiate withdrawal is miserable — you want to die — but it’s actually not medically that dangerous,” said Dr. Carl Heine, a Bartlett E.R. physician, in a recent interview. “People don’t die from opiate withdrawal, but you wish you were going to die.”
Those going through heroin withdrawal experience diarrhea, nausea and vomiting. There’s also general pain and achiness, anxiety and jitteriness, and increased heart rate and blood pressure.
“Have you ever seen the move Trainspotting?” Heine asked, referring to the ‘90s cult classic that famously features a scene wherein Ewan McGregor is coming off of heroin and hallucinating that his friend’s dead baby is crawling on the ceiling. Heine said that was probably the most accurate depiction of what it’s like.”
Unless there’s a mental health issue involved (such as someone who is suicidal) that can land them in one of the 12 beds in BRH’s mental health unit, the hospital’s E.R. doctors dole out medications to ease the opiate withdrawal symptoms (usually Clonidine to lower blood pressure, and Ibuprofen for the nausea and vomiting) and send them on their way.
The suicide card
Without a place to go, a lot of addicts who are desperate for help play the “suicide card” in order to get a bed in BRH’s mental health unit. It’s a common belief that it gets them into Rainforest faster.
Technically, it can help accelerate the process because it gets an agency involved — Juneau Alliance for Mental Health Inc., (JAMHI), will step in and do an assessment —and an agency’s referral is necessary to get into one of Rainforest’s 16 beds.
But that’s just as fast, or as slow, as going to JAMHI directly for the referral, or any number of agencies in town from Gastineau Human Services to AWARE.
The only people who are allowed to skip ahead of other people in line for a bed at Rainforest are women who are pregnant and IV drug users, per the state grant that funds Rainforest and dictates what Rainforest can or can’t do.
Richard Nault, Rainforest’s interim director, said there’s good reason for the “all intakes are considered equal” rule.
Rainforest accepts applications based on when they are submitted, and if they tell someone, say in Ketchikan, that they can have a bed on a certain date, it’s not fair if it’s not available on that date because they accepted someone else instead.
“If we got a client referred from the hospital and all the beds are tied up, that emergency would not bump someone who’s ready to come in,” he said. “That’s obviously not really cool.”
And if Rainforest were to bend the rules it would get in trouble for breaking the conditions of its grant.
“That’s one of the no-no’s,” Nault said.
So how did Stacie Arnold, the 24-year-old Juneau resident who played the suicide card and got into Rainforest the next day, get in? Probably good timing. It likely just so happened Rainforest had a bed available. (For more on Arnold, see part one of this series.)
Nault said he couldn’t discuss specific cases or clients, but that in general, the waiting list at Rainforest varies greatly. Sometimes, there’s bed available immediately. Sometimes, it’s weeks or more.
But it takes more than just good luck or timing to get into a bed at Rainforest.