Column: Addicts can be kicked out of heroin treatment -- and end up dead

The heroin and pain pill crisis is a full-blown epidemic in our community. But treatment for this addiction crisis is inadequate and the death toll continues to grow. This is the first of a series of columns examining a broken system. You can also watch our WCPO 9 On Your Side special, "Heroin: Fixing a Broken System" at 7 p.m. Thursday.

David Holthaus researched these stories for eight months, with help from WCPO's Heroin Advisory Board, a group of experts, parents and recovering addicts. Holthaus has been a Cincinnati journalist for more than 25 years and is currently managing editor, opinion and engagement for WCPO.com.

If a lung cancer patient sneaked a cigarette while in treatment, would they be kicked out of the hospital?

Of course not.

But that happens routinely at drug treatment programs, where addicts in various stages of recovery are kicked out for a single, often minor, slip-up.

When it happens, they are typically given a few hours to pack their bags, and then literally shown the door. Addicts, some of whom genuinely want to get clean, are suddenly on the streets, often with nothing and nowhere to go.

Their treatment is disrupted without a transition plan in place, a backup or even a second chance.

It’s almost an invitation to return to the escape of heroin again. Suddenly, someone suffering from the disease of addiction is at risk of a potentially fatal relapse. It is a sign of a broken system: Treatment providers kicking out patients for showing symptoms of their illness. 

“One mistake,” said Dr. Mike Kalfas, a Fort Wright physician who treats addicts. “Someone who is sober 29 days out of 30 is still doing well in treatment. But they’ve made one mistake and someone displaying tough love completely unwinds their treatment.”

Aaron Perry

Treatment programs kick out residents for a variety of reasons -- failing a drug test, fighting, or even more minor incidents. The theory is the addict is not yet ready for treatment and might be a bad influence on the others. But the result can be chaos, or worse, for the addict.

Aaron Perry was a few months out of River City Correctional in Camp Washington, where he had completed its locked-down rehab program. He had moved to a sober-living group home called Pax House in Cincinnati’s Mohawk neighborhood. He worked at a meat-cutting plant. Things were looking up as he tried to piece together a sober life after bouts with heroin addiction and jail.

Pax House, like a lot of sober-living homes, was a place where he could live with the support of others wanting to stay sober, under the supervision of a house manager and the advice of a counselor.

His rent there was $90 a week. But when he was a few days late with the money one week, his mom got a call with unwelcome news.

“I have to leave … today,” Aaron told her.

It seems Aaron had gotten crosswise with the house manager, and when Aaron was late with the rent, the manager was unforgiving. He had to go.

“He was getting paid Friday,” his mom said. “The house manager said he disrespected him. I said, ‘Is that a reason to throw him out?’”

The manager, Julius Hightower, disputes the story. He said Aaron was kicked out because he used drugs and overdosed. But no living arrangements were made for him.

So either way, for Aaron, getting kicked out meant he was homeless.

He had long ago used up the goodwill he had at his parents’ house. With nowhere to go, and it being December, Aaron took shelter in a portable toilet in a Downtown parking lot.

That’s where he died on Dec. 13, 2015, from an overdose of heroin and fentanyl at the age of 26, just days after getting kicked out of Pax House.

Aaron Perry was kicked out of Pax House for being late on rent. Three days later, he fatally overdosed.

The get-tough attitude practiced by treatment programs stems from the notion that addiction is not a disease but a choice. Addicts, the theory goes, must simply be conditioned and trained to make better choices, and sobriety will follow.

It’s a notion that has fallen into disfavor among some medical and treatment professionals, who believe that addiction damages brain chemistry, has genetic underpinnings and should be treated as a disease, not as a moral problem.

But that belief has not made its way into practice at many treatment programs.

At Brighton Center in Florence, a regular part of treatment is a weekly gathering called “Community.” The residents, 40 or so, gather in a room in a big circle and air each other’s wrongdoings from the past week. The transgressions are typically minor, such as forgetting to sweep the floor, being late for a meeting, or being inconsiderate to another resident.

The group decides by a vote what the consequences should be, with a choice of three: do nothing; leave the program, or comply with a list of amends the other residents think of. These are usually to write several essays, or letters to family members or other residents, sometimes totaling thousands of words, on topics related to their misdeeds.

But sometimes, in a true-life version of “Survivor,” they are voted out of the center and must leave immediately.

"The danger is a full-blown relapse."

The residents voted out of Brighton Center include Hailie Blair, who, after eight months sober, was voted out because she called her boyfriend and father of her then-unborn child, a violation of her treatment program.

It’s a fundamental part of the Brighton Center program that residents need to answer to their peers, who decide what their consequences will be for any problems.

“If they don’t accept the solution, then they’ve made a choice to pack their bags and leave. They’ve broken their contract,” said Anita Prater, the center’s director.

“If you continue to offer someone help and they’re doing nothing about it, then they’re just wearing out the women here trying to help each other,” she says.
   
But Kalfas and others suggest looking at the bigger picture and considering what the consequences could be when someone’s treatment is terminated, even if it’s for testing positive for drugs.

“If someone has one slip … tighten up the surveillance, put them on some more screening. Look at the whole of their treatment,” he said.

“The danger is a full-blown relapse. If this is someone who hasn’t used heroin in a while, their tolerance has dropped. If they go out and relapse on heroin, they have a high risk of overdosing.”

Kylen Peck didn't overdose, but when was kicked out of treatment in Florida at age 21, a thousand miles from his home in Colerain Township, he had nowhere to go.

Kylen Peck

The staff there had upped his dosage of an anti-depressant, inducing sleepiness. That caused him to miss a few morning group meetings, and he was punished by being forbidden to go on a group outing to the beach. That led to an argument, which escalated enough that police were called.

Kylen was told he could choose jail or three days in the local hospital's psych ward. He chose the psych ward, and upon his release, tried to return to the treatment facility.

"When I went back, I was told I was no longer welcome there anymore," he said.

His mom, Heather Peck said she was "freaking out that my son was going to be on the streets of Miami." 

Through a Facebook connection, she found a sober-living home. But without a car it was hard to find a job, so he fell behind on rent and was kicked out of there.    

He found another place, but when his belongings were stolen, he got into a fight and was kicked out again. His third sober-living home was drug-infested, he said, and by then he was begging to come home.

Fortunately, Kylen survived his bouts of homelessness and has maintained his sobriety.

But it says a lot about the state of the treatment system, when a person recovering from the illness of addiction can be repeatedly discharged onto the streets without care. 

MORE FROM THIS SERIES:
• The shadow system of treatment
• Heroin drug saves lives, but it's hard to get
• 'Body brokers' profit from heroin addiction
• One long road from heroin addiction to recovery