If Frederick County health officials are certain of anything, it’s the need for a 24-hour detox center — a facility that could provide immediate assistance to residents withdrawing from opioids and other addictive substances.
But nearly a year into planning it, significant barriers remain to establishing such a center by the end of 2019, the current goal for the work group overseeing the project.
“If you’re looking for progress, this is probably going to be a real short conversation,” said Cynthia Terl, a member of the work group and director of community outreach for Wells House@Gale Recovery, a residential addiction treatment program in Frederick. “Our goal is to have a free-standing, medically supervised detox by the end of this three-year local health improvement process. So we’ve got two more years, and it’s probably going to take all two years.”
For Terl and other addiction experts — including health care providers such as Frederick Memorial Hospital — the need for a crisis detoxification center has become increasingly obvious over the past few years. Frederick County has some of the highest rates of opioid-related overdoses in Western Maryland, and available evidence suggests such overdoses are significantly underreported, said Andrea Walker, the director of Behavioral Health Services for the Frederick County Health Department.
But while substance abuse continues to rise, treatment options remain limited. Patients seeking medical assistance for addiction often wait weeks or months for treatment at a residential care center in Maryland. Frederick County has no facilities that house patients during critical detoxification — the five to seven days when patients are at the greatest risk of relapse or medical complications.
“Alcohol and opiates are alike in the fact that sometimes people are not able to go through the physical detox process alone,” Terl said. “They just can’t. They’re not strong enough to do that.”
“You could argue that detoxing does make some people suicidal,” Walker said at a recent meeting for the facility’s working group. “It’s an incredibly stressful process on the body.”
Facing the barriers
The number of residents seeking treatment for substance abuse has placed a particular strain on FMH, where families often expect services that the hospital can’t deliver, said Jason Barth, director of its behavioral health unit.
When patients come to the emergency room for treatment after an overdose, hospital staff can stabilize them and offer to connect them with a peer support recovery specialist for follow-up care. But FMH does not offer rehabilitation services, nor can it house patients for five to seven days while monitoring their physical needs and connecting them with follow-up services.
“The hospital is doing the job it’s intended to do,” Barth said. “This is a problem that needs greater community support.”
That’s where the detox center comes in. Members of the local work group recently toured Baltimore Crisis Response Inc. (BCRI), a crisis service center that offers — among other programs — a residential detoxification unit with 13 beds.
According to Edgar Wiggins, BCRI’s executive director, patients who come into the detox unit generally stay for seven days. That’s enough to guide them through the critical withdrawal period and hand them off to designated care coordinators, who refer patients to the next level of treatment — be it intensive residential treatment or an outpatient group such as Alcoholics Anonymous.
“One of the most important things is that continuum of care,” Wiggins said. “Addiction and substance abuse are chronic conditions that are stress-impacted and relapse-prone, and when patients end up in the hospital, they typically don’t provide any follow-up.”
That continuum, though, comes at a cost. A detox center in Frederick County would need to meet the requirements set out by the state of Maryland for a level 3.7 withdrawal management program, just a few steps down from hospital treatment. BCRI’s detox unit is overseen by an addiction psychiatrist and staffed by nurses 24 hours a day, services that would also be required at a Frederick County site.
Beyond medical providers, a working center would need full-time administrative and billing staff, janitors and a working kitchen — all the auxiliary needs for a residential facility, Walker said.
Wiggins estimated that the yearly operating budget for withdrawal services alone was $1.4 million at BCRI. Realistically, establishing a new facility in Frederick County could cost even more. The group is still working to determine possible locations for the detox center, which could require constructing a new building or significantly modifying a structure. Qualified medical staff would need to be recruited and hired. And under new state regulations, the facility would need to be accredited by the Joint Commission or CARF International, two health care certification programs with stringent regulatory requirements.
Since July 1, Maryland has nearly doubled the reimbursement rates for residential detox treatment, increasing Medicaid coverage from $211 to $400.50 per patient per day. There’s still no assurance, though, that a detox center in Frederick County would immediately turn a profit, Walker said.
The work group has already determined that the facility would need at least 16 beds to be financially sustainable — though 20 would be optimal — and there’s still no clear funding source for purchasing a building. As a result, it’s likely that the center would require financial investment from the county and state.
“In order to ensure the best chance of success for the program, startup funding, I think, is necessary,” Walker said. “Many of these programs, in the first year, are operating at a loss, and startup funding can help alleviate that.”
A clear need
Advocates for the detox center expect at least some resistance to the idea of using public funding to treat substance abuse. But for Terl — who’s spent years connecting patients with services that aren’t available in Frederick County — the problem has become too big to ignore.
“The frustration is if you have somebody who is reaching out for help, we need to help them right then and there,” Terl said. “Because further down the road, they move past that point. We’re often finding that there is nowhere to send these people.”
A designated detox center could also connect more patients with medication assisted treatment — including buprenorphine and Vivitrol — and help them manage intense physical symptoms. For many local providers, the facility would be a welcome centralization of services that are now scattered or unavailable across most of Frederick County.
“I think a lot of agencies have done a wonderful job, but the reality is that we are simply overwhelmed,” said Dr. John Molesworth, president of the Frederick County Medical Society. “You really want to have that inpatient detox and provide the whole spectrum of treatment, including crisis stabilization. And a more comprehensive facility would take care of that.”