Walking out on detox puts heroin users at risk

Opiate addicts who check themselves into a detox unit are at a fragile first step in the recovery process: in medical treatment, but still in the grips of withdrawal. It's a danger point where many addicts succumb and return to using, addiction specialists said.

Addicts walking out of treatment against the advice of doctors and counselors is a routine and dangerous occurrence, specialists at Long Island detox centers said.

With prescription medications in their systems and an unpredictable drug tolerance level, "it's right after detox that people are really at the highest risk of overdose," said Dr. Constantine Ioannou, vice chairman of psychiatry at Nassau University Medical Center.

Last Sunday, 22-year-old William Earle II of Elmont, a user of heroin, cocaine and other drugs, signed himself into NUMC's 20-bed detox unit for drug treatment, said a doctor at the hospital. The doctor talked about Earle's treatment after the Earle family gave permission Thursday.

Against the protests of medical staff, he left Tuesday about 8 p.m., saying he wanted to help another patient who'd left earlier, the doctor said.

Twelve hours later, Earle and 20-year-old Emily Weidemann, who his family said he met at NUMC, were declared dead in his basement. Drug paraphernalia and heroin were found nearby, said Nassau police, who suspect that the pair died of heroin overdoses.

Ioannou estimated that 20 to 30 percent of all addicts leave NUMC's detox unit "AMA" - against medical advice. For users of heroin and pills like Oxycodone, the number rises to 35 percent, he said.

Younger opiate addicts, who have increasingly filled the unit in recent years, are even more likely to leave before the planned stay, typically five days.

"There is something distinctly more difficult with this population, to keep them in and keep them engaged," he said.

Speaking generally about the risks of such early exits, Ioannou said addicts who leave before finishing detox - nearly all quickly relapse into drug use - are at a twofold risk of overdose.

Detox patients may have methadone and other prescription medications in their systems that combine with street drugs in a dangerous mix. A patient's tolerance level can also drop quickly, adding to the risk of returning to previous levels of drug use.

While in the detox unit, Earle had been given methadone and Librium, Ioannou said.

According to a 2009 study by the Agency for Healthcare Research and Quality, people hospitalized for alcohol and substance abuse disorders are more than 10 times more likely than other patients to leave AMA, the study found.

At the 10-bed detox unit at Eastern Long Island Hospital in Greenport, Helene de Reeder, director of behavioral health services, said about a quarter of the about 800 detox admissions a year leave against the advice of staff.

"They're in relapse mode before they ever pick up the substance," she said.

Nurses and counselors are trained to quickly intervene when a patient announces a desire to leave, relating the risks and the reasons the patients gave for wanting to get clean. Delay tactics as simple as a reminder that a patient doesn't have cab fare might give a person enough time to change their mind.

"Putting time and distance between the desire to leave and the act of leaving can be very powerful," said Richard Buckman, a recovering addict with 20 years experience in the treatment field. With Matthew Chayes