State calls for ideas on reforming detox services

  • Article by: CHRIS SERRES , Star Tribune
  • Updated: December 28, 2013 - 7:12 PM

Lack of services means alcohol and drug abusers cycle in and out of ERs and other costly treatment.

Alarmed by a worsening shortage of detox services across Minnesota, state officials are considering dramatic changes to the state’s outdated system for treating chronic alcoholics and drug users.

Each month, hundreds of heavily intoxicated people cycle in and out of expensive hospital emergency rooms and jails, while others receive no treatment at all because of the state’s dwindling number of detoxification facilities. Fourteen detox centers have closed across Minnesota in the past decade, leaving wide swaths of the state with limited or no treatment options for people suffering from potentially life-threatening symptoms.

Now, the state is exploring ways to expand treatment for addicts after more than a decade of cuts by county governments.

Last week, the Department of Human Services (DHS) sent a formal request to drug and alcohol treatment providers, seeking input on ways to expand detox and other treatment services.

“You know it’s time to make changes when you have to send a sheriff 80 to 90 miles to the nearest detox” facility, said Gary Olson, executive director of the Center for Alcohol and Drug Treatment in Duluth, which receives patients from places as distant as Brainerd, two hours away.

Among the possibilities under consideration is the creation of lower-cost treatment sites for people who just need a place to sleep and sober up, and longer-term housing for homeless people whose dependence on drugs or alcohol helps keep them caught in a revolving door between the street and the ER.

‘Nowhere else to go’

At the detox center at 1800 Chicago Av. in south Minneapolis, director Sharlee Benson pulls a bulky folder from a shelf. Nearly four inches thick, the folder is the treatment history of a homeless alcoholic named “Duane,” who has checked in and out of the detox ward 1,296 times over the past two decades.

Benson pulls out another thick folder. This one is for “Joe,” a chronic alcoholic who has been admitted more than 650 times.

Duane and Joe are such familiar faces that the nurses know how they like their morning coffee and eggs. The center declined to disclose their full names because of privacy concerns.

“This is proof that the system is not working,” Benson said, holding up one of the patient files. “These patients have turned detox into a form of housing because they have nowhere else to go.”

There are now 22 licensed detox facilities in Minnesota, down from 54 two decades ago, according to state data. The number of admissions to detox services has dropped 21 percent, from 38,837 in 2001 to 30,604 in 2012, while Minnesota’s population increased 9 percent over the same period.

Though they represent a minority of patients, chronic inebriates such as Duane and Joe pose a special challenge: Most have been in and out of jail and multiple treatment programs, making it difficult for them to find permanent housing or stable work. They need detox services but are filling scarce beds that could be used by people who are more amenable to treatment.

Those who don’t find beds in detox facilities often are sent to hospital emergency rooms, which cost up to 10 times more per patient. The ER at Hennepin County Medical Center in Minneapolis is treating 700 to 800 people a month who are chronic inebriates, according to county estimates.

Taxpayers often end up footing the bill because the patients have no insurance or the services are covered by Medicaid, which is funded by state and federal governments.

“This is an enormous cost to taxpayers and the outcomes are poorer,” said Robert Muscala, director of a chemical health clinic in Edina, who said he sends about 90 percent of his heavily intoxicated patients to area emergency rooms — because the beds are usually full at local detox centers.

Behind the curve

There is now widespread agreement among doctors and groups that treat addiction that Minnesota is behind the curve in creating alternatives to expensive, inpatient medical care for chronic alcoholics and drug users.

  • Detox By the Numbers

    30,604: Admissions to Minnesota detox centers in 2012

    14: Detox centers shut down statewide in past decade

    21%: Decline in detox admissions since 2001

    22%: Minnesota adult population who acknowledge binge drinking in past year

    17%: U.S. adult population who acknowledge binge drinking in past year

    Source: Minnesota Department of Human Services and Centers for Disease Control and Prevention

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