The men and women arrived before dawn, lining up in the bone-chilling cold for the opportunity to prove they are addicted to drugs and need treatment.
When the doors finally swung open at 6:35 a.m., the small crowd shuffled from the snow-covered walkway and into the faint light of the Avivo recovery center near downtown Minneapolis.
Avivo evaluates people on a first-come, first-served basis each weekday morning. The first 10 to walk through the door got cups of fresh coffee and sit-down sessions with professional clinicians. The others were turned back to the darkened streets — untreated and discouraged.
“It’s ridiculous that we should have to stand out in the freezing cold just for the chance to admit that we’re ready to change our lives,” said Angela Naviosh, who is addicted to heroin and arrived at the clinic at 5:30 a.m.
This daily ritual plays out at treatment clinics across the state and reflects the barriers that thousands of Minnesotans on public health insurance programs face in their efforts to kick drugs and get treatment.
But it could soon be put to rest. State and county agencies are eliminating long-standing obstacles to treatment, starting with Minnesota’s complicated process for determining whether people struggling with addiction qualify for publicly funded care. By July, evaluations will be streamlined across the state and many people seeking help will be approved for treatment within hours instead of weeks.
“This will save lives,” said Patina Park, executive director of the Minnesota Indian Women’s Resource Center in Minneapolis. “There is a very short window of opportunity when an addict’s mind is clear enough to want out of a very bad situation. If you wait even one day, that window can close and the consequences can be fatal.”
The shift is part of a broad package of changes to Minnesota’s treatment system that legislators approved last year and are finally taking effect. They come as authorities across the Upper Midwest struggle against an opioid epidemic that claimed the lives of 637 Minnesotans in 2016 and now kills more residents each year than auto accidents, according to the state Department of Health.
A major goal is to expedite front-end assessments for the tens of thousands of Minnesotans who depend on public insurance for medical care and seek treatment each year for chemical dependency.
For decades, Minnesotans seeking publicly funded treatment for drug addiction have had to navigate a labyrinthine process, starting with a lengthy evaluation, known as a “Rule 25” assessment, that determines whether a person has a substance abuse disorder and needs medical care. These interviews typically last one to two hours, but they can take even longer for patients struggling with trauma and mental illness, said Rich Latterner, treatment manager at the White Earth Opiate Treatment Program in Minneapolis.
“A woman once told me, ‘If treatment is as hard as that Rule 25, then I’m not sure I can handle treatment,’ ” he said. “The assessments are needed, but they can be heart-wrenching.”
These assessments, while overlooked in the broader fight against opioid abuse, play a huge role in reducing drug addiction — they’re used to gauge the severity of a person’s addiction and can determine whether a person qualifies for 21 days of outpatient therapy or a year in residential treatment.
In Hennepin County alone, officials processed about 15,000 assessments last year.
But the lengthy evaluations are just the beginning of the process. Once the assessment is submitted, it can take counties up to 10 days to authorize public funds for the treatment. Once the funding comes through, it often takes several more weeks to be accepted into a treatment program.
Sobriety advocates say they know several people who died while waiting.
“One of the reasons this opioid epidemic is still here is because of all the paperwork,” said James Cross, founder of Natives Against Heroin, a 12,000-member group based in Minneapolis. “When someone wants help, we need to get them to a safe spot — now.”
Typically, evaluations must be scheduled days or weeks in advance, which is unrealistic for drug users who may be homeless and struggling with mental illnesses, providers say. In the Twin Cities, only a few centers accept walk-in clients for assessments, and the time slots are short.
“People need to have access to the care they need when they need it,” said Chuck Johnson, acting commissioner of the Minnesota Department of Human Services, which spearheaded the larger effort. “Unfortunately, the current system isn’t very good at that.”
For the first time, starting in July, providers in Minnesota will be reimbursed under Medicaid for these assessments, as well as care coordination and “peer recovery” services. The change is expected to dramatically expand access to these services, cutting down on wait times. In addition, providers will be able to assess clients without having to wait for county approval, eliminating another bureaucratic delay.
Over time, officials said, evaluations for drug treatment will be handled much like any other medical procedure — ending the long waits and early-morning lines.
For many addicts, simply getting to an assessment interview can be a struggle.
Amy Gunderson, 53, of St. Paul, said she finally decided to seek help after her boyfriend assaulted her last week while they were both high on methamphetamines. “I could have been killed,” she said.
On Friday, Gunderson woke at 4 a.m., packed herself a bag of peanut butter and jelly sandwiches, and then caught a series of buses to the clinic on Chicago Avenue. Among the first in line, Gunderson wrapped her scarf tightly around her face to keep warm as other drug users began to emerge from the predawn darkness.
“This means everything to me,” said Gunderson as she entered the clinic for her assessment. “If I don’t get into treatment, then I’ll never get my life back together.”
Anthony Feather, 32, of Minneapolis, said he was so determined to get an assessment for his heroin addiction that he stayed up all night wandering the streets and riding light-rail trains to avoid falling asleep and missing his chance. “If I don’t get this Rule 25 [assessment], then I’ll have nowhere to stay,” Feather said, his hands trembling in the cold. “For some of us out here, this is life-and-death important.”