NUMC set to trim inpatient detox unit

In the next two weeks, the Nassau University Medical Center will decide whether to downsize its inpatient Chemical Dependency Detoxification Unit and expand its outpatient services. The decrease in the number of beds would allow NUMC to qualify for a New York State Department of Health grant.

The inpatient detoxification unit, which currently has 20 beds, helps patients withdraw from alcohol, opiates and other addictive drugs, and is one of only two inpatient facilities on Long Island.

The grant, Restructuring Initiatives in Medicaid Redesign, was developed to help hospitals and other facilities close, merge, downsize or restructure, while providing more-efficient quality care. “Excess bed capacity in hospitals and nursing homes promotes unnecessary inpatient admissions and longer lengths of stay,” the grant’s request for application states.

In order to avoid closing the entire detox unit, Civil Service Employee Association President Jerry Laricchiuta addressed the NUMC Board of Directors at its meeting on Jan. 18. “As we see people dying from overdoses of opiates … as the only public hospital in Nassau County, do you really think it’s a wise decision to shut down our detox unit?” Laricchiuta asked the board.

“We have lost hundreds of detox beds in Nassau County in the past 25 years,” added Claudia Ragni, executive director of the Kenneth Peters Center of Recovery in Syosset. “What we are looking at now is the absolute worst drug crisis Long Island has seen in history. We are losing 40 kids a month to opiate overdose.”

NUMC spokeswoman Shelley Lotenberg clarified the situation on Jan. 19, saying that the detox center would not close, but it might be downsized to comply with the requirements of the Restructuring Initiatives grant. Discussions among the board members are continuing, but a decision will be made before the grant’s request for application deadline of Feb. 10.

The director of alcohol and substance abuse at the Long Beach Medical Center, Pat Hincken, told the Herald last week that she is concerned about downsizing at the NUMC facility. “I think it could definitely have a very negative effect,” Hincken said.

The Long Beach facility, which has eight inpatient detox beds and has asked for eight more, is having a difficult time meeting the needs of patients. “A lot of times we’re turning them away,” said Hincken, estimating that the facility is usually 90 percent full.

Most patients in the LBMC facility are 20- to 25-year-old prescription drug users, but Hincken is worried that they will turn to heroin if they are unable to receive medical treatment while in withdrawal. “With less prescription drugs available, because of the crackdown on doctors, patients will turn to heroin use,” said Hincken, adding that a single dose of heroin costs as little as $7, while a single prescription pill can range from $30 to $50.

It may seem like a dramatic progression to move from prescription pills to heroin, but Dr. Constantine Ioannou, clinical vice chairman of the Department of Psychiatry at NUMC, said it happens. “It’s only a really drastic jump if you’re not chemically dependent,” Ioannou said, “but if you’re in the throes of withdrawal, it makes perfect sense.”

The NUMC detox unit is commonly 90 percent full, and about half of its patients are uninsured, which is a very high percentage, Ioannou said. Around half of the patients are usually Nassau County residents, with others from Queens and Suffolk County.

Ioannou said that most people in the facility are younger than 35 and addicted to opiates, like heroin. They are also commonly repeat visitors because addiction is a chronic disease.

Many patients Ioannou sees start smoking marijuana and drinking in their early teens and moved on to opiates by age 16 or so. “Their brains have never really developed without drugs,” he explained. “There’s a difference between being sober and not wanting to get heroin today.”

“The board and management are reviewing a number of proposals related to our detoxification and chemical dependency services,” Arthur Gianelli, NUMC’s CEO, said in a statement. “What I can say is that there is no scholarly evidence to support the claim that inpatient addiction services are superior to outpatient services.”

“The majority of people can be detoxed in outpatient,” Ioannou told the Herald, but inpatient services are used for both medical and social interventions. Many patients can successfully undergo outpatient detox, but often a patient’s parents will not allow their child to come home. “So, where to do you put him at night?” Ioannou asked.