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"We will no longer offer that service," says Dean Taylor, director of the county's Department of Human Services. "We know there is a need and we don't like this any more than anyone else, but the budget just isn't there."
This past January then-County Manager Armando Vidal ordered Taylor to trim two percent from his department's $116.8 million budget for the year ending September 30. Taylor and his staff chose to close the detox unit, which helped people through withdrawal symptoms in the first days after they had stopped using alcohol and drugs. The Miami-Dade County Commission confirmed that decision May 19.
The closing of the detox unit, which had a staff of thirteen and was located at 2500 NW 22nd Ave., will save the county some $175,000 this year, says Taylor. It will save $926,000 next year.
It is closing despite increasing demand. Last year 808 people were admitted, says Dr. Carolina Montoya, director of the county's Office of Rehabilitative Services. There were 560 in-patient clients in 1996 and 566 in 1995. The reason for the increase is obvious, says Jim Gilliland, community services director at the Village, a 119-bed private nonprofit drug treatment center in Miami. "Heroin use is on the rise again," Gilliland says. "We knew this was coming because a few years back, the Colombian drug cartels went into the heroin business. Lots of people on the street have witnessed the devastating effects of crack, so we are seeing that use decline. But they haven't seen what heroin can do. And the heroin we are seeing on the street today is much more potent than in the past. It hooks you fast."
It can kill you fast too. In 1990 ten people in Miami-Dade County died from heroin overdoses, according to the medical examiner's office. In 1996 that figure rose to 43 and in 1997 to 66.
The timing of the unit's closing couldn't be worse, say many drug treatment professionals. Last May the state withdrew funding for Miami-Dade's only public methadone program. The number of heroin addicts showing up at the unit then increased dramatically, Montoya says. In the last three months of 1996, 21 junkies entered the detox unit. During those same three months in 1997, 78 were admitted. But Montoya faces a plummeting allotment for all substance abuse treatment. "Four years ago I had a budget of $21 million and now I have $14 million," she says. "Four years ago I had 330 employees. Now I have 179."
Montoya contends that the detox center is unsuitable for heroin addicts. It shares a 24-bed medical facility with a county service that treats poor people with communicable diseases, which will remain open. Of the 808 people who checked into the detox unit last year, 206 walked out before completing the five- to seven-day program. Many of those who left early needed more specialized help, says Montoya. "We've done the best we could under the circumstances, but someone with bigger facilities can do this better," she says.
The center gave patients a bed, food, medications to ease withdrawal, and medical attention. Once addicts finish the agony of withdrawal, they move to longer-term treatment and counseling programs.
The detox unit did a good job, insists Gilliland. While several hospitals and other private providers offer detox for patients who have insurance or cash, there is no other facility for indigent people. "[The unit was] a resource. We and other nonprofit treatment centers don't have the facilities to do detox because we don't have round-the-clock nursing," Gilliland says. "Detox patients go through a lot physically. We can take someone who has been through that unit after five or six days and admit them to our program. We have done it. It seems like the only growing budget in the state of Florida is the Department of Corrections. And the prisons have higher recidivism than drug treatment programs. They are also more expensive. It makes no sense."
Closing the center is wrong not only for practical reasons, but also for philosophical ones, says Bruce Hayden, CEO and president of Spectrum, another large nonprofit drug treatment program in Miami-Dade. "The message is 'We are closing the facility because we have won the war on drugs,'" he says. "And that isn't true." Judge Stanley Goldstein, who runs the county's drug court, agrees. "The moment will come when the county regrets this," Goldstein says. "Nobody cares about this kind of thing until it is their own kid who needs the help and can't get it."
Where will addicts go when they discover the detox unit is closed? Most will likely show up at hospital emergency rooms, especially Jackson Memorial Hospital's, say treatment professionals. "But we aren't equipped to act as a detox unit," says Jackson spokesperson Conchita Ruiz-Topinka. "No overtures have been made to us and there has been no discussion about what will happen when that facility closes."
There may be a last-minute way to save the detox unit, according to Frank Rabbito. Rabbito is vice chairman of the Addiction Services Board, an eighteen-member citizens panel that oversees substance abuse programs. He says the Public Health Trust, which runs Jackson, owns the building where the detox unit was located. Rabbito suggests that the trust and the county share expenses for the detox.