Facing an epidemic of heroin and opioid addiction, Ohio must add hundreds of new inpatient, residential treatment, and recovery housing beds. Waiting lists for short-term, medically supervised detoxification, and for housing where addicts can stay six to nine months or longer, are placing thousands of addicts at risk of relapse or even death.

Most of Ohio’s 88 counties, including Henry, Defiance, and Ottawa counties, provide no residential treatment, recovery housing, or halfway houses, according to surveys by the Ohio Department of Mental Health and Addiction Services (OMHAS). In Lucas County, more addicts detoxify in jail than in any area treatment center. That’s sad and shameful, but hardly surprising, given the glaring lack of inpatient and residential treatment here and across Ohio.

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Lucas County has fewer than 25 inpatient beds for drug treatment that are eligible for Medicaid reimbursement. By contrast, on any given day, the county jail holds 10 to 15 people who are detoxing, mostly from heroin and prescription painkillers. That amounts to hundreds of cases each year, Sgt. J.A. Gorney of the Lucas County Sheriff’s Office told The Blade’s editorial page.

To its credit, the sheriff’s office works with local providers to move addicts who leave the jail immediately into community-based outpatient and residential treatment. Still, detoxing in jail, without treatment, is harrowing and risky. Dope-sick addicts experience wrenching body aches, chills, vomiting, diarrhea, spasms, sweating, nausea, and depression.

Part of the problem is an outdated 1965 law that bans Medicaid reimbursements to hospitals and other providers with more than 16 beds. The Institution for Mental Diseases (IMD) exclusion made sense 50 years ago to discourage the warehousing of mentally ill patients. But today the cap, which also applies to drug treatment, undermines efforts to fight an opioid epidemic that this year is expected to kill 150 people in the Toledo area alone.

The law aggravates waiting lists for inpatient treatment across Ohio, amounting to days and even weeks. Such delays discourage addicts from seeking treatment and inevitably lead to more fatal overdoses, now Ohio’s leading cause of accidental death.

Good new bill

A measure before Congress would change the law and expand treatment. The Breaking Addiction Act would remove the Medicaid bed cap for drug treatment in participating states. Congress ought to approve it.

Despite a growing need for inpatient beds, the IMD cap has prevented treatment providers, such as Zepf Center in Toledo, from expanding beyond 16 beds. Zepf’s 144,000-square-foot building on Ashland Avenue, a former nursing home, has more than 100 beds that could convert to inpatient treatment, including five-day detox, said Chief Executive Officer Jennifer Moses.

At minimum, the 16-bed cap should rise to 32. Even with that many inpatient beds, Zepf, as a regional treatment center, would remain full or nearly full, Ms. Moses said.

Expanding other residential beds and recovery housing that are not under the federal cap would also help. Residential programs can offer off-site treatment similar to that of inpatient care.

Within a half-mile of its 16-bed inpatient unit, Zepf has about 45 beds in a sober-living program on Collingwood Boulevard, where Zepf plans to create 100 units of recovery housing. Zepf will build studio apartments and two-bed dormitories, with help from a $482,000 grant from the state attorney general’s office and a $167,000 grant from OMHAS.

Recovering addicts will remain there, typically for six to nine months, while they continue treatment, get peer support, and seek employment and permanent housing. With grants to other nonprofit providers, Ohio could expand residential care and recovery housing across the state.

A bill introduced by state Rep. Robert Sprague (R., Findlay), calls for a more uniform and comprehensive treatment network. The General Assembly failed to pass the bill this year, but included its “continuum of care” provisions in the revised two-year state budget.

These changes require counties, through local behavioral health boards, to provide coordinated resources for detoxification, medication-assisted treatment, individual and group therapy, residential treatment, and peer mentoring.

Within that framework, Ohio is moving forward. OMHAS just announced $10 million in grants for 658 beds of recovery housing statewide, including 50 in Lucas County.

Inventory needed

To guide future investments, the state must develop an inventory of residential treatment, recovery housing, and inpatient beds in every county. It must determine what else the system needs to ensure that every addict in Ohio has a real chance to get well.

Building an adequate statewide treatment system will require more funding over the next several years. Determining how much will require the state to gather better information on how much treatment is now provided across Ohio.

Closing the treatment gaps won’t be cheap. It will cost less, however, than the attendant costs of relapse, including ongoing and acute care, property crimes, emergency services, and encounters with the criminal justice system.

The story of Kyle Snyder, 28, a recovering heroin addict from Toledo, is typical. He relapsed in January, three months after he detoxed at a Compass treatment center. He didn’t find work — a part-time job at Meijer — until four months after he left treatment.

“I knew, deep down, I wasn’t ready,’’ he told The Blade’s editorial page. “All of a sudden, you’re on your own and there’s no structure. You’re looking for a job, trying to get to the next step in your life. But you’re hanging on by a thread to stay clean.”

After resuming treatment at Zepf seven weeks ago, Mr. Snyder, who overdosed twice, stays in a sober living unit. “You can keep working [on] the program around people you know,” he said. “They’re not just throwing you out on the street.” Mr. Snyder plans to stay at Zepf another month before moving to a halfway house and finding a job as a nurse’s assistant.

As every recovering addict knows, detox is only the first step in the journey from the chaos of addiction to a sober and productive life. Temporary housing enables providers to offer treatment in a stable setting, working on mental health, employment, and other issues, as well as addiction.

“Housing isn’t considered a clinical support, but it’s absolutely essential in people’s ability to get well and stay well,” OMHAS Director Tracy Plouck told The Blade’s editorial page.

An estimated 200,000 Ohioans remain addicted to heroin or prescription painkillers. By helping local communities expand recovery housing and inpatient and residential treatment, the state can keep more of them from returning, again and again, to the nightmare of addiction.

First Published November 9, 2014, 5:00 a.m.