While the number of outpatient treatment available has skyrocketed, the number of treatment beds available for the poor and uninsured has fallen dramatically.
Last week, John Brooks Recovery Center in Atlantic City sent out a news release that unintentionally encapsulated the strife facing New Jersey substance abuse treatment.
The release feted two new outpatient treatment centers, slated to open this week. But the last line noted that it's residential treatment center, the largest serving the poor and uninsured in South Jersey, was still securing financing to remain open and relocate.
In November, CEO Alan Oberman said the facility would close this year if funding was not secured.
New Jersey's substance abuse treatment network has undergone a major upheaval in the last five years, with beds for the neediest disappearing, expensive for-profit institutions moving in and the state's outpatient capacity skyrocketing, data obtained by NJ Advance Media shows.
The state has lost more than 40 percent of its substance abuse treatment beds for the poor and uninsured since 2010, a blow to the indigent population as a heroin epidemic that has enslaved at least 128,000 and killed thousands rages on.
According to the state Division of Mental Health and Addiction Services, the state is currently funding 619 beds for the indigent, down from 1,098 in 2010. It represents a dramatic shift in how access to substance abuse treatment has changed in New Jersey in recent years, with the most intensive treatment, increasingly, only available to the rich and well-insured.
"I've never had anyone call me and ask for a favor to get someone into outpatient," said Earl Lipphardt Jr., Chief Residential Officer at Integrity House, the largest residential treatment provider in the state. "Nobody pushes for outpatient. They all want them in residential."
In the same timeframe, outpatient services have tripled, with more than 6,000 state-funded slots now available.
"The national trends and best practices encourage outpatient treatment over inpatient," said Nicole Brossoie, a spokeswoman for the Division of Mental Health and Addiction Services.
The efficacy of outpatient versus inpatient treatment has been debated for decades, with no scientific consensus reached. It is, however, far cheaper and more openly supported by insurance companies.
State Sen. Joseph Vitale (D-Middlesex), himself the author of more than 20 bills addressing addiction, rejected the state's interpretation that a shift to outpatient is the result of "best practices."
"Some people can be treated in intensive outpatient, but most of the folks who have a serious addiction need inpatient ... for 30 days or more," he said. "If you're in this state and you haven't committed a crime and are uninsured your chances of getting a bed aren't very good. We need to do more to address that."
Committing a crime may allow entry into the state's drug court program, which sets aside beds for residential treatment if an alleged perpetrator is willing to accept it in lieu of jail time. But Lipphardt said during the first several months of 2016, referrals from drug court were down more than 10 percent.
Brossoie said It isn't that the state isn't willing to fund more beds. Rather, she said, the market has changed.
In the past year alone, treatment centers like Sunrise House in northern New Jersey and Lighthouse Treatment Center in the southern half of the state, have been purchased by larger for-profit providers. In doing so, they've eliminated state-funded beds in favor of serving more commercial-insurance backed clients.
"It comes down to a funding issue," said Michael Cartwright, CEO of Addiction Centers of America, which purchased Sunrise house last year. "Addiction in one of the few diseases that's underfunded at every level and those funding streams have not changed in 15 years. It's not even so much a New Jersey problem as it is a United States problem."
The trend could have a particularly significant impact on heroin users. Heroin users not only are the largest group seeking treatment for substance abuse in New Jersey, but they also have the highest rates of unemployment and homelessness.
Welcome to Herointown, N.J., Population: 128,000
From May 1 of 2013 to April 30 of this year, more than 75 percent of heroin users at state facilities came in unemployed or out of the work force, while more than 23 percent were homeless or dependent on an institution for housing.
"The demand for services is largely for indigent care. There's a huge indigent population and there's insufficient capacity," said Tony Comerford, CEO of the New Hope Foundation.
Overall, the federal government estimates more than 76 percent of illegal drug users in New Jersey did not receive addiction treatment in 2015.
A long-awaited change may soon alter the treatment dynamic, or at least has providers optimistic. Gov. Chris Christie has proposed raising the state reimbursement rates for substance abuse treatments as part of his state budget.
If it passes, it would raise the reimbursement for long-term residential treatment for the indigent, for example, from $68 a day to $102 a day. It's not exactly ideal, treatment providers say, but it helps.
"It's not going to be a negative, we'll put it that way," said Lipphardt.
Comerford said it could make providing care to the poor and uninsured more attractive to for-profit providers who have shunned it.
"Right now, they're fighting for a limited number of clients," he said. "We might see them start to take on a few of these clients once the rates go up."
In the meantime, however, finding a bed as a down and out heroin addict in New Jersey continues to be difficult. Lipphardt can rattle off the amount of time and number of patients waiting for a bed on any given day.
For several years, the time has been measured in weeks and the list of names has been several dozen long.
Stephen Stirling may be reached at sstirling@njadvancemedia.com. Follow him on Twitter @sstirling. Find him on Facebook.