Heroin drove Katy Austin to a place she had never imagined.
In the depths of her addiction, she spent all of her income on drugs and stole her sister’s identity.
She shot up whatever she could find — cocaine, meth, pain pills, bath salts.
She cashed out her student loans and blew through $5,000 in a week. She couldn’t keep a job. She stopped paying rent.
Austin had held it together before on other drugs, but when she switched to heroin, she knew she had lost control.
"That was my hard line, that at least I didn't put a needle in my arm," she said.
Austin hit bottom within a year. She was arrested and sent to court-ordered rehab, but the clinic was full, so Austin was put on a waiting list. She was told it could be months before she could get in.
In the search for treatment, Austin’s story is all too familiar.
As heroin use soars, addicts such as Austin are waiting longer to get into facilities that only have a fraction of the beds needed to treat them.
Many clinics are running at capacity; hundreds of people wait six weeks to three months for a bed at the state-funded programs.
“People are in crisis,” says Rich Jones, executive director of FAVOR, an addiction recovery group in Greenville. “They don’t know how to negotiate that.”
COST OF RECOVERY
Everyday at FAVOR, the phone rings with parents desperate to get their children into rehab.
Counselors help them navigate the system, but “the options are very limited if you’re not well off,” Jones says.
Private treatment centers in the area cost anywhere from $5,000 to $30,000 a month, with strict rules that shut many addicts out. Insurance companies often decline coverage, and Medicaid won’t reimburse for certain drugs used to help treat addiction.
For addicts unable to pay, that leaves the state-run programs — Holmesview in Greenville, Palmetto Center in Florence and Morris Village in Columbia.
The facilities have a total of 228 beds, mostly for hardcore drug users in need of 24-hour residential treatment.
Demand for such care is huge.
David Turnipseed, area supervisor for the S.C. Vocational Rehabilitation Department, which runs Holmesview and the Palmetto Center, says clients often wait a month before getting treated.
Some 300 people are currently on the waiting list at Morris Village, where drug users suffering from co-current mental illnesses are also accepted.
Officials say more treatment and detox beds are needed to fight the spike in heroin cases rare just five years ago.
About 30 percent of addicts in South Carolina were enrolled in opioid treatment programs on a single day in 2013, up from 13 percent a decade earlier, according to the U.S. Department of Health and Human Services.
In a single day, nearly 16,000 people in the state sought help for substance abuse, a 25 percent increase in the past decade.
Austin found herself on a waiting list for rehab in 2012.
She had already been through rehab twice and tried living in a halfway house, but she couldn’t stop using.
There was no pleasure in it now. By the time the police caught up to her in a hotel room in Greenville, Austin was doing heroin just to keep from getting sick.
Austin, who had a prior record, was arrested and charged with possession of drug paraphernalia.
She went to jail, vowing to stay clean when she got out.
“I had all these grand plans,” Austin said.
She’d borrow money from her parents for an apartment, find a job, go back to school. She was tired of living that life.
After three weeks, Austin was released. The first thing she did was get high from shooting up cocaine.
“I didn’t even mean to do it,” Austin said. “I had no control.”
She was ordered to go to rehab for violating her probation and spent three months in a jail cell — long enough to go through withdrawals — before landing a spot at Morris Village.
“My brain was clear for the first time in years,” Austin said.
Other addicts wind up detoxing in the ER or at the Phoenix Center, Greenville County’s addiction services provider.
Some will try to kick the habit alone but instead go find heroin when the pangs of withdrawal get too bad to ignore, says Adam Brickner, executive director of the Phoenix Center.
The danger is that users don’t know if the bag they’re buying is pure heroin or heroin laced with other drugs.
“The same $10 dose that gives them a high today can cause them to overdose and die next week,” Brickner says.
After years of decline, heroin is back. The Centers for Disease Control and Prevention says heroin-related deaths nationwide have nearly quadrupled in the past decade, with 8,300 people dying from the drug in 2013 alone.
Fentanyl-laced heroin has only added to the threat of overdose. An opioid 30 times more powerful than heroin, fentanyl has been linked to 32 drug poisoning death from Jan. 1 to Oct. 5 of this year, according to data from the Greenville County Coroner’s Office.
Combined heroin and fentanyl deaths have jumped from nine in 2013 to more than 45 this year.
At the current rate, drug overdoses are killing more people in this county than car wrecks.
Austin is now in her third year of recovery. She’s stayed on track with her 12-step program and wants nothing to do with heroin.
She works as a bartender at a nice restaurant. She’s back in school at Greenville Tech and is a straight-A student.
But Austin’s story is the anomaly.
Many more heroin addicts are never treated for any numbers of reasons: They’re in and out of jail. They self-medicate, or they don’t want to deal with the stigma of addiction.
Expanding services to fight the drug’s spread is another challenge, Brickner said.
In January, the Phoenix Center will open Greenville’s third methadone clinic with enough room to treat up to 300 people.
A majority of heroin addicts treated in the state are put on methadone, a drug that helps wean users off heroin but is hard to get and heavily regulated.
The drug is so regulated that opening a new clinic was a three-year process. The Phoenix Center first had to raise the money to hire board-certified clinicians, then go through the state's lengthy approval requirements.
Another treatment drug, Suboxone, doesn’t require people to show up at clinics to get their daily dose, but it can only be dispensed by doctors who go through special training. Certified physicians are also limited to treating up to 30 patients at a time — or up to 100 with federal approval.
The state currently has 51 such doctors.
HARD TO GET CLEAN
Sometimes, against all the odds, recovery sticks.
Austin, now 38, has even found her calling in advocacy. Twice a month, she leads a group therapy session at the Phoenix Center. The rest of her time is spent at FAVOR trying to get as many people into treatment as she can.
She wishes she could do more, so she tells her story about addiction and how the road back couldn’t be more daunting.
“I found prison before I found any kind of treatment or recovery,” Austin says. “There has got to be a better way.”
For more information about treatment and referrals, call the Phoenix Center at 864-467-3790 or visit phoenixcenter.org. The Phoenix Center is the legislated substance abuse authority for Greenville County and offers a full range of services to treat substance abuse, including a detox center and outpatient programs.
For more information about the addiction recovery community, call FAVOR at 864-385-7757 or visit favorgreenville.org. The nonprofit provides intervention and counselling services to those seeking recovery.