With nearly 44,000 deaths a year, more Americans today die from drug overdoses than from car accidents or any other type of injury.
Many of these deaths could be prevented if patients had better access to substance abuse therapy, experts say. Yet people battling addiction say that treatment often is unavailable or unaffordable.
Only 11% of the 22.7 million Americans who needed drug or alcohol treatment in 2013 actually got it, according to the Substance Abuse and Mental Health Services Administration. While some of those who went without care did so by choice, at least 316,000 tried and failed to get treatment.
"We know addiction treatment saves lives, reduces drug use, reduces criminal activity and improves employment," says Paul Samuels, president and director of the Legal Action Center, which advocates on behalf of people with HIV or addiction. "The data is there, the evidence is in, but our public policy has not caught up with the science."
Meanwhile, the crisis is getting worse, says Thomas Frieden, director of the Centers for Disease Control and Prevention. The death rate from drug overdoses more than doubled from 1999 to 2013, according to the CDC. The bulk of these deaths involve opiates, a class of pain killers that includes morphine and Oxycontin.
In 2012, physicians wrote 259 million prescriptions for pain killers, enough to give a bottle of pills to every adult in the USA, Frieden said. More than 2 million Americans abuse prescription opiates, according to the National Institute on Drug Abuse. About 669,000 use heroin, to which many opiate users turn when they can no longer afford pain killers.
Injection drug use has fueled an outbreak of HIV in rural Indiana, a nationwide surge in hepatitis C infections, and an increase in the number of babies born addicted to drugs. States have responded to the surge in overdose deaths by expanding access to naloxone, a fast-acting rescue drug that can reverse the effects of an opiate overdose. Indiana lawmakers also voted to allow needle exchange programs in communities facing a public health crisis related to injection drug use.
While those approaches are welcome, they don't treat the underlying addiction, said substance abuse specialist Yngvild Olsen, medical director at Reach Health Services in Baltimore. Olsen says she would like to see the USA address addiction at earlier stages, rather than scramble to save lives when people are on the verge of death.
Mike McCrorken says he began smoking marijuana and taking pills at age 12 and graduated to heroin by age 14. His mother and stepfather often injected drugs with him.
"I tried to get help so many times growing up," said McCrorken, of New Haven, Conn."Getting into detox was always difficult because there were never any beds available and they would put you on a waiting list."
The wait for a spot in a detoxification program – which help addicts get through withdrawal – ranged from days to weeks, McCrorken says. He was never able to abstain from drugs that long.
"If I had to wait, without a doubt, I was getting high," he says.
McCrorken finally got into treatment when he was 19, after the death of his stepfather. McCrorken and his mother heard his stepfather collapse behind a locked bathroom door. McCrorken kicked the door down and found his stepfather on the floor, bleeding and unconscious from a heroin overdose.
"Before we called the police," McCrorken said, "we did the drugs left in his pocket."
A growing crisis
People from across the political spectrum are calling for the country to step up its fight against opiate abuse.
The Obama administration in March announced a three-part plan to combat the opiate epidemic, calling for $133 million in new spending, including an expansion of treatment with medications approved by the Food and Drug Administration.
Sen. Edward Markey, D-Mass., has introduced legislation aimed at expanding treatment for patients, as well as educating doctors about safely prescribing opiates.
Sen. Sheldon Whitehouse, D-R.I., and Sen. Robert Portman, R-Ohio, also have introduced a bill to expand addiction treatment, particularly therapies that use medications that reduce cravings and symptoms of withdrawal. These medications — which include methadone, buprenorphine and naltrexone — block or partly block the effects of opiates.
Regular use of methadone or buprenorphine prevents people from getting high if they also take heroin or pain killers, says Kelly Clark, president-elect of the American Society of Addiction Medicine. These treatments are currently used by only a fraction of patients with opiate addictions, she said.
Medicaid programs in at least 17 states, for example, don't pay for long-term methadone treatment, according to the Legal Action Center.
Two landmark laws aimed to expand insurance coverage for substance abuse treatment.
The Affordable Care Act requires that insurance plans include substance abuse and mental health treatment as essential benefits. A 2008 law, which took effect last year, mandates that insurers put substance abuse and mental health care on par with medical treatment.
While the number of people getting substance abuse treatment has risen in recent years, the new laws haven't helped everyone.
A recent report from the National Alliance on Mental Illness found that patients continue to be denied care more often for substance abuse than for other medical issues.
People who need addiction treatment face a number of insurance obstacles, Clark said. Many insurance plans limit the doses of buprenorphine that patients can receive or the length of time that people can take it. Studies show that people with private insurance are three to six times less likely to receive addiction treatment than people with public insurance, such as Medicaid.
Linda Ventura said her insurance company told her that her son, Thomas, would have to "fail first" in outpatient treatment before it would pay for inpatient treatment for his heroin addiction.
"If you relapse, the insurance company says, 'We paid for this before. We're not paying for it again," said Ventura, from Kings Park, N.Y. "But if you come out of remission with cancer, do they say, 'You had four treatments. We're not paying?'"
Ventura has become an advocate for substance abuse treatment since Thomas' death from a heroin overdose in 2012, when he was 21.
Today, she said she's frustrated that her insurance company made it so difficult to access her benefits, even though she paid premiums for 21 years.
"It's as if I have breast cancer, God forbid, and my insurance company says, 'You have a progressive, fatal disease, and we're OK with that. We're going to have you take vitamins and go to talk therapy.'"
Clare Krusing, a spokeswoman for American's Health Insurance Plans, says insurers base coverage decisions on medical evidence and the recommendations of medical societies. People who disagree with an insurance plan's rules or decisions can always file an appeal, Krusing says.
Krusing denied that insurance plans force patients to "fail first" on cheaper remedies before authorizing more expensive options. But as long as treatments are considered equally safe and effective, she says, it makes sense to try the cheaper alternative first.
Insurance hassles are only one of the barriers facing families trying to get help for substance abuse, said Emily Feinstein, director of health law and policy at the National Center on Addiction and Substance Abuse at Columbia University.
There's also a shortage of trained health providers. Many physicians have little to no training about treating substance abuse, Feinstein said. Some feel uncomfortable with patients dealing with addiction. Others would like to treat addiction, but can't afford to specialize in the field full-time because insurance reimbursement rates are so low.
Even when substance abuse treatment is available, the quality of care is often low, Feinstein said. Many addiction programs use unproven therapies. According to a 2012 report from the Columbia addiction center, "only a small fraction of individuals receive interventions or treatments consistent with scientific knowledge about what works."
The bulk of addiction treatment is provided by addiction counselors, Feinstein said. While many counselors are extremely dedicated, they don't have medical training. In some states, they aren't even required to have a high school diploma, Feinstein says.
Bill Williams and Margot Head of New York City ran into insurance barriers when they tried to get help for their son, William, who was addicted to heroin.
In October 2012, their son asked Williams to take him to a local hospital for inpatient detoxification. It was a potential turning point in their son's life, said Williams. It was a moment when his son — teetering between life and death — chose to live. But the family's insurance company refused to pay for the hospital stay, arguing that it wasn't medically necessary, Williams said.
Four days later, their son overdosed on heroin and entered a persistent vegetative state. After six weeks, with no hope that their son would recover, his parents withdrew life support. He had just turned 24.
Searching for solutions
States could make it easier for people to get treatment by requiring insurance plans to offer more comprehensive coverage of addiction treatment, Feinstein said.
But the stigma of addiction leaves many Americans unwilling to fund better treatment, advocates say.
While scientists describe addiction as a brain disease, one-third of Americans say addiction is caused by a lack of will power or self control, according to a 2008 survey by the Columbia addiction center.
Although the USA spends a lot of money on addiction — nearly $468 billion a year — the country hasn't invested in ways that could do the most good, Feinstein said.
Only 2 cents of every dollar spent on addiction and risky substance abuse goes to prevention or treatment; the rest goes to pay for expenses such as hospital care, jails and courts, according to a 2009 report from the Columbia University addiction center.
Yet studies clearly show that prevention and treatment pay off, said Keith Humphreys, a researcher at the Department of Veterans Affairs and a professor of psychiatry at Stanford University Medical Center.
Every dollar invested in treatment saves $4 to $7 in reduced drug-related crime, criminal justice courts and thefts, according to the National Institute on Drug Abuse. While one year of methadone costs $4,700, a year in prison costs $18,400.
Substance abuse treatment "is a really good deal for the taxpayer," Humphreys said. "But it shouldn't have to be. We should do it out of humanity."
One new study finds that hospitals are good places to begin treatment.
Many people suffering from substance abuse disorders make frequent trips to the emergency room, as their addictions harm their health.
Authors of an April study in the Journal of the American Medical Association studied the effects of using these hospital visits to prescribe buprenorphine. Doctors screened all adult patients for substance abuse, then randomly assigned them to one of a handful of interventions, including receiving buprenorphine in the ER or being referred to outside treatment.
Patients treated with buprenorphine were twice as likely to be in treatment one month later, compared to patients who were referred to drug abuse treatment outside the hospital, according to the study, led by the Yale School of Medicine.
And one small town in Massachusetts has decided to change its approach to drug use.
Like police across the country, those in Gloucester, Mass., have long treated addiction as a reason to arrest people. But it hasn't solved the drug problem, said police chief Leonard Campanello.
"We haven't seen any decrease in addiction as a result of penalizing people for addiction," say Camponello, who spent seven years as a plain clothes narcotic officer.
Gloucester police now plan to treat addiction as a disease and help substance abusers get treatment, Campanello says. More than 1.7 million "liked" the decision on Facebook within the first few days after it was posted.
Beginning June 1, people who turn in drugs or needles and ask the police for help will be walked "through the system toward detox and recovery," Campanello says. Two local clinics have agreed to fast-track these patients, so that people trying to quit drugs can get help "on the spot."
In addition, the police department will make the drug naloxone — which can reverse an opiate overdose — available for free, without a prescription, at local pharmacies, Campanello says. Police will subsidize the cost with money seized from drug dealers.
"We are going to join the fight," Campanello says. "We want to see whether we can turn this around."
Heroin addict McCrorken says he also has turned his life around.
His stepfather's death — and his despair over the type of life he'd been leading — left McCrorken suicidal.
"I felt like I was shredded inside," he said.
McCrorken says he was fortunate that an addiction treatment group called Teen Challenge accepted him into its residential rehabilitation program. He hasn't used drugs since. McCrorken, now 26, works for the group handling public relations.
"I get an opportunity every week and every day to share my story with people," McCrorken said. "If had to go through that hell for this purpose, then it was worth it."
Some parents who have lost children to addiction have become passionate advocates for change.
Ventura traveled to the New York state capital last year to lobby for expanded treatment and addiction services. She sometimes showed up to meetings carrying her son's ashes, pointing to them as evidence of the state's failure. "It's hard for a senator to look at you, when you're holding your son's ashes, and say, 'I'm not going to vote for this bill,'" Ventura said. The New York State Assembly last year passed several bills to combat opiate abuse.
Williams and Head also say they're dedicating their lives to helping others get substance abuse treatment. They have traveled to Washington three times in the past year to talk to members of Congress and share their story with anyone who will listen.
"We are determined," Williams said, "that our son's death will not be in vain."
