Delaware's heroin crisis: Federal state of emergency could help treatment
Brittany HornPenny Rogers knows grief.
It's been less than a month since her 23-year-old son, Vincente Tambourelli, was found dead on the bathroom floor in his Florida home. He moved to Boynton Bay about two years ago to be closer to his father — and to put space between him and his Delaware friends hooked on heroin after finishing a drug treatment program run by the state Department of Correction.
Everything seemed to be trending upward for the young man, including a good job at a local restaurant and a long streak of sobriety.
Then a fatal dose of heroin took his life.
"He was always about giving a thousand chances," the 51-year-old mother said at her home Wednesday. "Nobody should be written off."
On July 14, Tambourelli became one of an estimated 142 people to fatally overdose daily across America. Though his death won't be logged in Delaware's 133 overdose deaths so far this year — six in a recent five-day span — the wake of Tambourelli's death rippled through the First State.
The unending surge of opiate- and heroin-related overdose deaths — and the urging of a federal commission focused on drug addiction — has prompted President Donald Trump to say he will declare a national emergency.
A declaration would allow the commission, according to a report penned by state and federal leaders, to take immediate action and will likely bring emergency funds deployed to states hit hardest by the epidemic. Officials also believe a declaration would eliminate barriers to treatment by providing insurance waivers to patients in need of residential care.
These waivers are key for facilities that offer residential treatment, as a federal exclusion within the Medicaid program limits providers using this insurance from having more than 16 beds if they want to be reimbursed for these services, said Dr. Karyl Ratay, director of the state Division of Public Health.
"This has been a real barrier to treatment facilities being able to expand to address some of the needs," she said.
Though it's immediately unclear what a declaration would bring with it, officials are hopeful that more funding will be a part of the response, especially because of how hard Delaware has been hit by the epidemic.
"I think it is a positive if it means (Trump is) recognizing the severity of the problem," said state Attorney General Matt Denn, who has pushed for legislation to better combat Delaware's heroin epidemic. "From my perspective, anything that increases the funds that are available in Delaware, for treatment specifically, are a plus."
A declaration would only further what leaders in Delaware and moms like Rogers say the state has been fighting for years: a crisis that has taken hundreds of lives and continues to impact more each day.
"We're in one," Rogers said of the emergency. "We've been in one."
The state Department of Health and Social Services has $3 million in new funds this year to fight the heroin epidemic, specifically around improving Delaware's treatment programs and services. This follows last year's budget that came with no new dollars to combat the heroin epidemic.
The General Assembly awarded the department $1 million this year that will go toward increased access to treatment. An exact plan for those dollars is expected this fall, according to the state.
The other $2 million comes from the 21st Century Cures Act, which will be deployed to develop "a more coordinated, comprehensive, engaging and person-centered treatment system in Delaware," according to the state. The department will see an additional $2 million next year as part of the grant, as long as it gets reauthorized to continue its efforts.
Ideally, the dollars will help fill the current gaps in the state's treatment system and help employ more case workers and peer counselors to get people the help they need, said Health Secretary Kara Odom Walker.
"This is $5 million," she said. "So you want to use it in a way that's filling in real gaps. We know that the same old thing hasn't been working ... so we need to pull people together in a coordinated way and use it strategically."
These efforts may happen sooner should more funding become available as a result of Trump's pending declaration.
"I don't think we have a good handle on how to best serve people who are experiencing issues with substance abuse"' Walker added. "Anything to elevate these efforts will help us."
A large part of her focus will be on educating and empowering primary care doctors and family physicians — a world Walker knows well.
As a family doctor by trade, Walker believes that treatment for addiction should start with a physician or provider that people are most comfortable with and see regularly. To stem the increasing number of people addicted to opiates and heroin, Walker said more Delaware doctors need to prescribe medication-assisted treatment.
Medications like methadone and suboxone, which stave off symptoms of withdrawal, remain the standard of care for those with addiction, despite the stigma of substituting one drug for another through medication-assisted treatment. In order to prescribe these medications, doctors must be partnered with a mental health provider or counselor to offer the accompanying therapy when taking this medication, Walker said.
"These are medicines that prevent death," she said, "that prevent people from being unable to hold jobs or be a good parent. Suboxone is a wonderful tool in this battle against the opioid crisis. We have to get more people in the state prescribing."
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Yet the stigma of methadone clinics and the accompanying line of people waiting for their medicine in the mornings has been difficult to shake, Walker said. Many doctors don't want to draw that clientele to their practices, even as more and more people die from the disease of addiction, she said.
In 2015, 27 million people reported current use of illegal drugs or abuse of prescription drugs, according to the national report provided to Trump. Yet only 10 percent of those people self-reporting their illness receive treatment for their addiction.
"Primary care, in my opinion, has to be at the center of dealing with the crisis, this emergency that we're really in," Walker said. "Mental health affects health, affects every bit of the health spectrum. This is chronic disease management."
The crisis has prompted others in the state, including Denn, to take new tactics in curbing the heroin and opiate epidemic from a legal standpoint. Though heroin- and opiate-related crimes account for much of the state's caseload, Denn said the human toll is impossible to ignore and requires everyone to take ownership of the epidemic.
The attorney general helped push three pieces of legislation this year — one of which will remove preauthorization requirements for treatment and require insurance companies to fund inpatient residential treatment when deemed medically necessary for those with Delaware plans.
Denn said he is hopeful that more treatment providers will want to come to the state and open up facilities with the knowledge that insurance companies will pay for the services they offer.
"From my perspective, the best thing the federal government could do would be to provide more financial resources to the state for treatment," he said. "At the end of the day, treatment costs money ... and Delaware, as are other states, are in tough financial times."
There is still much to be done, including educating doctors on the importance of good prescribing practices, Denn added. Four out of every five new heroin users begin with nonmedical use of prescription opioids, according to the federal commission's report.
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"I don't know how you can see the overdose numbers and the fatality numbers and not consider it an emergency," Denn said. "It is the public health crisis of our generation."
Rogers' eyes well with tears when she recalls the lovable, goofy son that oozed empathy and forgiveness, always returning messages and telling stories to his 8-year-old niece. No conversation with Tambourelli ended without "I love you," she said, even when the topic turned to his addiction.
Rogers still struggles with the inability to understand what drove her son to use a drug that ultimately killed him.
"Imagine if you could take Superman and put him in a bottle and swallow it," Rogers recalled Vincente explaining to her. "And I just remember thinking, 'What the hell does that mean?'"
"But when you see more and more people using it, I remember thinking ... everybody must think it's like bottled Superman because what else would draw you to something like that? If it wasn't so God-like that you're willing to trade your kid, your home ... and sell your soul, then that's what it has to be like. It has to be like God in a pill."
Law enforcement is facing its own battle, as heroin and opiate addiction remains the driving factor behind a majority of crime statewide. Many agencies have been forced to re-evaluate how they respond to those suffering from addiction because of the sheer volume of daily arrests and overdoses.
TREATMENT:Dover police start Angel program to combat heroin
MORE:As Delaware heroin deaths rise, more treatment options sought
Identifying it as a disease is often the first step to change — and the very reason agencies around the state are starting to offer treatment rather than incarceration.
The Middletown Police Department is joining Dover Police and New Castle County police in offering versions of the Angel Program, a treatment-focused approach from law enforcement that originated in Gloucester, Massachusetts.
"This is now the drug of choice, and it's killing people at an alarming rate," said newly appointed Middletown Chief Michael Iglio. "Enforcement alone doesn't solve all of your problems."
The program, which is now available at the department, allows those struggling with addiction to ask police officers for help and get connected immediately with treatment through Connections Community Support Programs, the provider the department partnered with for this initiative. Officers also can offer the program to those facing low-level crimes, provided they're willing to enter into recovery.
Connections is in talks with several other police departments, including Newark, Harrington, Georgetown, Ocean View and Millsboro, about launching the program, said Alex Cropper, the site manager at Connections clinics in Dover and Millsboro.
The Angel Program and variations of it have shown success in Dover and New Castle County. But statistics don't paint a fair picture, according to advocates and experts.
Heroin and opiate addiction carries with it a high relapse rate, estimated as high as 80 percent for those addicted. Many who enter into treatment may wind up using again.
"Relapse is a part of what we call the stages of change," Cropper said. "You don't get into addiction overnight, so therefore you're not going to beat addiction overnight."
Middletown City Councilman Jason Faulkner recalled pulling together then-police Chief Daniel Yeager and a representative from Connections last year at National Night Out. The immediate response, he said, was that something new must be tried — and soon.
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About a year later, the program has finally launched to a community in desperate need.
"This is just a tiny piece," Faulkner said. "If there were over 300 Delawareans who died of overdose last year, what bigger problem do we have? We're having budget battles in the state of Delaware over all this stuff, but this barely gets into the conversation. We have to put money in treatment and change the way we're educating kids."
Faulkner's own son is in recovery in Pennsylvania after a rocky battle with heroin, he said. Since watching his 24-year-old battle the disease, his feelings toward the way society should handle addiction have greatly changed.
His family long ago undertook efforts to be "beacons of hope" for others in what often feels like a grim cycle of addiction.
"I can't live without hope," Faulkner said. "I have to wake up every day and think my son is going to get clean and stay clean."
The optimistic effort isn't always easy, but communities like atTAcK Addiction, a grassroots nonprofit started by parents who lost children to accidental overdoses, offer a bit of shelter in what many describe as a never-ending storm. That's where Faulkner and his family connected with those trying to make a difference — and found those living by the same mantra.
"We're so focused on the person struggling for so long ... that we forget that we need a little hope too," said Faulkner's daughter, Megan. "That the family needs hope. ... For a while, we felt really lonely."
Even today, Tambourelli's mother distinctly remembers the first time she shared her family's secret: that her son, Vincente, was addicted to painkilling drugs — and later, heroin.
In the days and weeks after his death, Rogers was reminded again how loved her son was and how supported she is by the addiction community and beyond.
"I never knew my heart could be so full of love and so full of sadness all at the same time," she said, recalling the flood of people who gathered around her dining room table laughing, crying and remembering Vincente.
Years ago, Rogers wouldn't believe that anyone in Delaware cared about those with addiction. Her circle, as she called it, was small — but it grew as she met more people who were fighting the same battle.
Now, she's determined to see the epidemic end. The lives of Vincente and hundreds of others must be remembered and honored through real change, she said.
Too many people are dying, Rogers said quietly, her eyes welling with tears — and the community of those affected and supporting each other is far from small.
"I realized that the circle's big," she said.
Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.
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