As Delaware heroin deaths rise, more treatment options sought

Tina Werkheiser died on a bathroom floor, slumped over in nothing but a purple bra.

Two decades into a stubborn addiction she couldn't shake, Tina's final moment arrived at a house strewn with drugs and alcohol, less than a mile from her grandparent’s home in Claymont. Her toxicology report said she died of a fatal mix of heroin, alcohol and fentanyl, a painkiller used to treat terminally ill cancer patients.

A small puncture wound on Tina's left thigh showed the mark where Narcan, which reverses opiate overdoses, was administered. It became legal for widespread use in Delaware last year, but was given to Tina too late to save her life.

Two years ago, Delaware mobilized to attack heroin addiction. Building on its proactive policing campaign, New Castle County prepared to launch a $500,000 advertising and media blitz aimed at users, the state opened its first detox center in Sussex County, a Good Samaritan law was passed allowing users to report overdoses without being arrested and Narcan was made available to emergency responders and families.

None of that reached Tina and 124 others who died of heroin overdoses in Delaware last year – a 7 percent increase over 2014. Eighty-three deaths were traced solely to heroin, and another 42 were tied to fentanyl, rarely used without heroin. The Delaware Medical Examiner's Office says another 105 died of prescription drug and cocaine overdoses.

Delaware is "awash with heroin," says New Castle County Police Chief Elmer Setting, who is pushing for a new strategy to deal with the crisis.

With the support of County Executive Tom Gordon, state Attorney General Matt Denn and Health and Social Services Secretary Rita Landgraf, Setting on Friday announced a pilot program in New Castle County to offer anyone serious about kicking their addiction access to immediate treatment 24 hours a day, seven days a week.

Setting's approach uses components of a strategy initiated in Gloucester, Massachusetts, where addicts are treated rather than arrested.

"Right now, I have nothing but a referral sheet when someone asks for help,” he says. “We’ve got to stop defending a broken model.”

Although no new funding will be allocated to pay for the program dubbed Hero Help, 10 existing treatment beds in the county will be reassigned to accommodate what Setting believes will be a long line of people wanting to escape heroin cravings. The program is effective immediately.

With the blessing of Denn, New Castle County officers will be able to present treatment as an alternative to petty drug charges and possession of small quantities of narcotics – provided people are willing to enter into voluntary sober living. Those 18 and older – and not wanted on major criminal charges – could get up to 60 days drug-free in a county facility, with counseling and other state resources.

"This is not a get-out-of-jail-free card for dealers," Setting said. "We're still going to make arrests."

The chief says the heroin epidemic sweeping much of America accounts for 90 percent of the crime in New Castle County – from homicide to assault to robberies and petty thefts. Hero Help will reduce deaths and crime, he believes. And with time, the program will prove it deserves more state funding – and begin a new era statewide of treating those struggling with addictions, rather than just arresting them.

"It is not a silver bullet. It's not solving every problem," Setting said. "It simply gives us the ability, when someone is truly in need of help and wants help, it will give us the opportunity to put them into this program."

The new approach is a good step, says Cathy McKay, president of Connections Community Support Programs, which runs treatment facilities throughout the state. But heroin-related deaths are still on the rise. Families are forced to send their loved ones out of state to get help and insurance companies don’t always foot the bill. Some are unsure of what the county plans to do when the 10 beds, or the many residential treatment beds in Delaware, are full.

"At its very best, it's a short-term intervention," McKay says, "and this is not a short-term problem."

Linda Bucci knew her daughter, Tina Werkhieser, would one day die from heroin. For years, she struggled to get her daughter the help she needed – in and out of local detox and treatment facilities, the state’s private psychiatric facility Rockford Center, even while she was locked behind bars. Tina was never able to hold down a full-time job because of mental illness and addiction, Bucci said. And Tina was unable to secure Social Security disability services to get financial support.

"Everybody loved her but herself,” Bucci says. “The system has really let me down.”

Bucci, who supported her daughter and eventually her grandson, says she asked every possible agency for help, to no avail. Her life savings disappeared after being forced to move from home to home because of the behavior of Tina and her friends.

Today, Bucci can’t help but wonder if her daughter could have been saved had there been better addiction treatment services – programs largely unavailable in Delaware now. She wonders what would have happened if Hero Help, or the Gloucester Angel program it's based on, could have rescued Tina. She’s wistful about the life Tina could have led.

When Bucci heard about the county's new approach, her hand went to her heart: "They have to do something. They have to do something.”

She paused and dabbed her tears with a tissue. “I always said to Tina, ‘Please don’t let your son grow up without a mother like you grew up without a father,’” she says. “It breaks my heart.”

Despite the best efforts of law enforcement and treatment experts, nothing has slowed Delaware's heroin problem.

“We haven’t gotten to the point where we are stopping the deaths and reversing the trend,” says Dave Humes, an advocate and board member of atTAcK addiction, a grassroots organization fighting opiate use.

Humes is hopeful that the different approach announced Friday may change that trend, but he's skeptical because the program essentially amounts to a rearranging of resources – rather than an infusion of new funds, new treatment facilities.

“We need to get some of these [federal] dollars” secured through grants, Humes says. “That way, we can get new beds rather than shift beds from one population to the other.”

Gloucester avoided one funding problem by using volunteers from the community, dubbed "angels," to sit with addicts at the Police Department while calling rehabilitation facilities locally, regionally and, if necessary, nationally to secure an open treatment bed. The volunteers cost the department nothing and help engage the wider community in its fight against the heroin epidemic.

New Castle County is not using angels because it is worried about having to vet volunteers and avoid liability should a volunteer be harmed by the person seeking help, Setting says.

Gloucester Police Chief Lenny Campanello says his town of 29,000 eliminated the need for additional funding by using drug seizure money taken during heroin busts to fund its treatment placement program.

In Delaware, money acquired through drug seizures is placed in a statewide pool that any department can access through written requests. Under the Gloucester approach, funds such as the $7,740 seized this week in a heroin drug ring operating out of Dover, police could use at least some of the money to battle the biggest crime problem facing the state.

Denn, who signs off on which departments get drug seizure money from the Special Law Enforcement Assistance Fund, said he would support using some funds to aid Hero Help or other such programs. A committee of chiefs from around the state makes recommendations on where the money should go. Money from the fund has already paid for Narcan carried by law enforcement, he notes.

Use of the overdose-reversing drug is only one of the efforts the state has taken over the past two years. After The News Journal published two deep series of stories on heroin and sponsored a forum on the issue with Christiana Care Health System pointing out treatment shortcomings in southern Delaware, the state opened an additional detoxification facility in Harrington.

The Department of Health and Social Services has since expanded state funding to add beds, open detoxification centers and provide more sober living homes. A medication-assisted treatment facility in Millsboro run by Connections Community Support Programs now treats about 600 people a day for addiction.

New Castle County launched a $500,000 public media campaign that filled billboards, posters and an interactive online video game called “The Heroin Trap” with anti-addiction messages. Nearly all the game's messages say the same thing – getting out of heroin is practically impossible. And no matter what answers players provide, the only way out is to quit. Otherwise, you die.

Scare tactics do little to deter drug use

To reach adolescents, county officials say, the message must be blunt. But experts say ad campaigns using scare tactics are largely unsuccessful. Most teens just tune out.

In Massachusetts, the state mandated a screening program to engage students twice in their academic career about their behavior and decision-making. Gloucester implemented the program a few years prior to the legislation and has seen success.

"I don't think scare tactics work with kids," said Cindy Juncker, the head nurse for Gloucester Public Schools. "You need to make it their idea."

Grassroots efforts from parents grieving over the loss of their children, such as atTAcK addiction, have arguably had the most effect statewide, helping change laws to allow those high on heroin to report an overdose of a friend without consequence. atTAcK addiction also played a big role in getting naloxone, often referred to as Narcan, into the hands of law enforcement, EMTs and school nurses across the state to fight the immediate effects of overdose.

“There is not a silver bullet here in terms of dealing with this epidemic,” says Michael Botticelli, director of the White House Office of National Drug Control Policy. “Addiction is tremendously underdiagnosed, and it’s often the intersection with the criminal justice system that motivates [people with addiction] to get care.”

The key, Botticelli says, is ensuring treatment and assistance for those suffering from addiction.

Nationally, 160,000 people have died from drug overdoses in the past 15 years, and an additional 7.9 million Americans ages 12 and older are in need of treatment for addiction and not getting it.

Denn wrote guidelines to support Hero Help, ensuring that police offer the program only to people genuinely seeking an escape to addiction. Violent criminals, gang members, drug dealers, weapon offenders or anyone with a long criminal record is not eligible for the program, Denn says.

Neither are those with current or pending domestic violence charges or violence against law enforcement.

The county's Mobile Enforcement Team, created by Setting three years ago, targets high-crime areas where most calls for service are largely related to heroin. Drug dealers ensure that their job security is good.

“[Heroin] is a huge law enforcement problem,” Denn says. “In terms of violent crimes, an awful lot of it is heroin-related: drug deals gone bad, a number of home invasions.… It’s a definite driver of both property and violent crime.”

People asking for help must complete the designated treatment program to obtain the county's support for dropping minor charges, Setting says. He stressed that drug users won’t be able to use the program as a shield from serious crimes.

Gloucester’s program offers similar exemptions, and Chief Campanello says those seeking help have not used the program as a way to just avoid jail. While Gloucester has been using the program only one year, it has seen a decrease in crime and an increase in trust of police officers.

Success will be measured in many different ways, Campanello says, including aiding neighborhoods heretofore viewed by law enforcement as a problem, forging partnerships with treatment facilities and moving dollars spent fighting crime to dollars spent on addiction treatment. Today the largest drug treatment referral system in the United States remains the criminal justice system.

“The end game for us is to step out of this equation,” Campanello says. “No one should have to go to the police department for access to substantial care. … Hopefully, police [someday] won’t need to facilitate care anymore.”

On a cold night in February, members of the county's Mobile Enforcement Team cruise through Alban Park west of Wilmington, looking for prostitutes and drugs. Officers are not a welcome sight to those looking to make quick cash on a drug deal, and some retreat to their homes at the sight of the cruiser.

Less than an hour into their shift, MET officers pull over two cars that whip out of a shopping center parking lot. Both commit traffic violations, giving the officers reason to stop the vehicles. Police had watched one vehicle sit idle in the parking lot for about 45 minutes, then abruptly leave to follow another car.

“He claims he’s been clean for awhile – who knows,” says Master Cpl. Brian Cote after speaking with one driver. “People tell us a lot of stories.”

Cote finds “empties,” small bags used to hold heroin. While there are no drugs inside the driver's wallet, a hypodermic needle found inside his car makes it clear to police he’s still using heroin. Those with addiction have a 90-percent relapse rate, according to state data.

In the other vehicle, a dealer admits he organized the rendezvous to sell them heroin. Police find five bundles of heroin, typically 10 bags in each bundle, a crack pipe and some crack inside the second car.

Officers blow into their hands to keep warm as police pick through both vehicles in search of evidence. The two men, already in police custody, plead with officers to overlook the drugs. They try to cut deals.

Back at department headquarters, Sgt. Brian Burke tests the drugs. After years on the job, Burke knew the substance but didn't know what it was cut with.

MET officers recovered 65 baggies of heroin from the vehicle stopped for a traffic violation, a small amount of drugs in the large scheme of things.

On another sunny morning in late February, the team focused on a treatment clinic along Lancaster Avenue where people get their daily dose of suboxone, a medicine used to stave off withdrawal symptoms without providing a high similar to opiates or heroin.

Cote paused for a moment, maneuvering his police car to take another loop around the clinic. A few people standing outside are known by police to target those fighting addiction – selling heroin to those standing in line to get suboxone.

“Those people selling to addicts, they have no soul,” he said. “People are out here trying to get help, and they’re here because of them. They are bad people.”

America consumes 80 percent of the world's opiates, but it has been slow to move away from a system focused on incarceration rather than addiction treatment.

Landgraf says Delaware's antiquated treatment system needs to change. Lack of coverage by insurance providers and lack of government funding makes it nearly impossible to individualize treatment for those with addiction.

Because beds in the Hero Help program will quickly fill and addicts will again have nowhere to go, Landgraf says those entering voluntary treatment through the program may first undergo a medical screening lasting 23 hours in a temporary bed. The beds are called “loungers” because they're not permanent, used only to house people during screening.

There are 16 "lounger" beds in New Castle County and another 16 downstate.

The more specific Delaware can get in individualizing treatment, the better off state residents will be when seeking help, Landgraf says.

“We know it goes beyond treatment,” she adds. “Many times, this disease robs you of everything.”

Hero Help can't fill all those gaps. Some people will be turned away because of capacity issues, and others will die of overdose.

But Setting hopes the change will reach more people like Tina Werkheiser and hundreds of others struggling with addictions to heroin and painkilling drugs.

“Heroin is a death sentence in so many cases,” Setting says. “I’d rather do this than say I didn’t do anything.”

Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.