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D.C. once had plenty of accessible inpatient detox programs, but one by one, they have gradually been shut down. Now there is just one left. Since October 2017, the Psychiatric Institute of Washington (PIW), located in Tenleytown, has had the only such program in the District and been the sole inpatient detox option for residents on DC Medicaid or without insurance. It is starting to run out of space.
When a person has a severe enough opioid addiction to require inpatient detox and is willing to go through that process, it is a medical emergency. Withdrawal sets in quickly, and remains extraordinarily painful for five to ten days; it can even be life-threatening. Medication can make withdrawal less dangerous and ease these symptoms, and in many cases, the meds require a doctor to manage them. Inpatient detox programs prevent patients from relapsing during the most agonizing moments, and provide an environment where there are doctors who can administer the medication and who can monitor for complications.
The District government used to have its own inpatient detox program at DC General Hospital, but the hospital closed in 2001. At the beginning of 2017, which was the deadliest year yet of the current opioid crisis in D.C., there were only two programs in the city: one at Providence Hospital and one at the Psychiatric Institute of Washington. Then, that October, Providence shut its program down.
In the year prior to October 2017, PIW received 900 patients for inpatient detox (including detox for alcohol and non-opiate drugs), according to a PIW representative. In the year following Providence closing, they received 1,500, almost a thousand of whom live in Wards 7 and 8.
Maria Paige is an addiction specialist at the community health nonprofit Mary’s Center headquartered in Adams Morgan, and she says that the availability of detox beds has only recently become a problem in the District, ever since Providence’s program closed.
She reports that in 2018, the Center referred or tried to refer about 90 to 100 patients to detox at PIW, and there was no available spot for roughly one in 15 of them: “And we’re having all of these overdoses… We need to expand,” she says. After all, “this is Washington, D.C. How can we have only one provider?”
For those patients who could not enter PIW, she says that “the only option was to call the ambulance or to transport them to the hospital.”
Dr. Dan Smith, who leads the addiction treatment programs at Mary’s Center, says that waiting a day to put someone into detox can mean wasting a rare opportunity to get someone into care. “You need to be able provide patients with any substance use disorder with treatment at the moment they’re asking for it, because those windows are very, very short—particularly with opiates,” he says. “The amount of time between being the completely clear, level-headed, normal you and being in acute, really painful opiate withdrawal is just a matter of hours.” The agony of withdrawal often drives people to give up and go back to using.
PIW says it’s unclear whether the increased number of detox patients they have received is due to Providence closing; the combination of the opioid crisis and population growth may mean there are more D.C. residents dealing with addiction.
What is clear, though, is that the uptick is stretching the Psychiatric Institute’s capacity for care. PIW says that they work hard to make sure they fill every spot they are legally allowed to fill, but more and more often they simply have no beds left. The problem has been getting worse in the past four months, during which, PIW estimates, their detox program has been completely full about two days a month. They have to send people to the emergency room instead.
While emergency rooms are medically equipped to treat withdrawal symptoms and make them less dangerous, they do not have the same resources as proper detox programs. PIW says emergency rooms lack the addiction counselors, support groups, and peer recovery coaches that help patients through the withdrawal process and connect them to further treatment.
An inpatient detox lasts several days to get people through acute withdrawal, which peaks two to three days in. But Paige says that when she has to transport patients to the ER instead, they usually get discharged after just a few hours. Paige has been working in addiction treatment in D.C. for decades, but this can exhaust her ability to provide care. “There are days when I’m like, ‘What am I going to do next for this client?’”
Photo courtesy Matthew Perkins on Flickr