Voice of San Diego is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in select states across the country.
On a recent day earlier this month, Jerry Shirey’s team at San Diego Freedom Ranch had a list of more than 30 people seeking a detox bed to start the agonizing process of withdrawing from drugs or alcohol. Freedom Ranch had one bed left to offer.
“I have to choose between 32 people for it,” Shirey said.
That day’s tough call wasn’t unusual. Shirey said some clients have recently waited as long as two months for a spot at his Campo facility.
For many San Diego Diegans who want to escape addiction but are confronting the horrifying ordeal of withdrawal symptoms, quick access to residential treatment is like winning the lottery, especially if they have Medi-Cal health insurance. Countywide, overdoses left 1,300 people dead last year. Even if a very small portion of the people struggling with addiction who rely on subsidized health care wanted to stop and sought help at a residential facility, there aren’t close to enough spots to support them. This reality endures despite agreement among experts that detox should be available on demand because people can die while waiting for care.
While San Diegans with private health insurance and financial means have more treatment options, the county has just 72 withdrawal management – or detox – beds for the nearly 1 million San Diegans with Medi-Cal insurance. These are places where trained workers typically support and keep tabs on people for seven to 14 days while they deal with symptoms such as pain, diarrhea, vomiting and exhaustion. Only two of these detox beds for Medi-Cal patients are in the city of San Diego, which until recently had no beds for these patients. The county and providers expect to bring another 10 beds online in the coming weeks – and have said they are determined to add more.
Some who are lucky enough to get a detox bed often next try to secure one of the county’s just over 1,000 longer-term residential treatment beds where Medi-Cal patients can stabilize for weeks or months after they have started the withdrawal process. Others pursue these programs absent a stay in detox. People in both situations also are often stuck waiting for a spot, making them vulnerable to relapses and overdoses.
The limited number of these beds isn’t the only challenge contributing to the access crisis for Medi-Cal patients who want residential substance abuse treatment.
Intake processes often require repeated and even daily phone calls, which can be onerous for people in the throes of addiction and particularly difficult for homeless patients who often struggle to maintain a charged cell phone on the street. Most programs also can’t treat people who are also experiencing medical issues, a gap that can make it difficult for someone with a condition such as incontinence or with wounds common among drug users to access treatment.
The outcry for detox beds in San Diego County escalated a couple years ago when a 120-bed Volunteers of America facility in National City that supplied 66 detox beds for Medi-Cal patients shuttered. The county has since taken possession of the property and expects to eventually deliver yet-to-be-specified services there.
A county spokesman declined to provide an update on efforts to reopen the facility.
Even as the county tries to expand both residential and outpatient detox options, county officials have noted that most San Diegans don’t need detox services to begin substance use treatment. Most of the county expansions have come in the form of detox programs people with Medi-Cal can visit for therapy, support groups and to get medication that helps them stop using. The county has also ramped up spending to increase access to homes where San Diegans can stay while they get treatment elsewhere.
But many low-income and homeless people who want to get clean say they need places where they can stay and get more on-site support.
Data from the county’s Access & Crisis Line shows 54 percent of the 6,395 referrals for substance use services via the call system were for residential treatment options including detox in the fiscal year that ended in June. There were more referrals for detox than any other service.
Getting a detox bed is especially challenging. In the last six months of 2022, the McAlister Institute reports that less than 8 percent of the 322 people who requested detox services after being brought to the sobering center it operates just outside downtown were linked with a detox bed within the 23 hours they could remain there.
Waits for treatment beds that often extend long beyond a single day can be excruciating for people desperate to start the recovery process.
This month, Bonnie, 43, and her husband called one provider almost daily for two weeks hoping to secure a treatment bed for her husband for his oxycontin addiction. As of Tuesday, he was on a wait list to begin a residential program and decided to detox at home while he waited. Late last week, Bonnie said her husband’s uncertainty about when he’d get in led him to pursue non-residential treatment options so he could try to move forward. The San Marcos couple is now hoping for the best.
Bonnie, whose real name Voice of San Diego is not using for privacy reasons, predicted the long wait and uncertainty after her own experiences with addiction and getting clean. In 2012, Bonnie said she called the McAlister Institute 16 days in a row hoping to get a bed so she could stop using heroin and meth.
“At 16 days, I just stopped calling,” said Bonnie, who eventually accessed treatment and has been clean for almost nine years.
The situation hasn’t changed since then. Providers and advocates say many San Diegans now give up when treatment isn’t readily available.
Waits and barriers can derail vulnerable people who may quickly change their minds or get caught up in the fog of their addiction again if they don’t get help soon after they ask for it.
“You have the golden hour,” said Paul Armstrong, a vice president at the homeless-serving nonprofit San Diego Rescue Mission. “We miss out 99 percent of time.”
Workers at some of the region’s largest providers constantly confront their inability to quickly aid people desperate to start treatment.
East County-based McAlister Institute and Interfaith Community Services in Escondido say they receive dozens of calls for help each day. Many who call never get a bed.
“You get a lot of, ‘If I don’t get in now, I’m going to die,’” said Dannielle O’Brien, an intake specialist for McAlister’s adult detox program, said earlier this year.
O’Brien said at least one person each week hurries to her car as she arrives for work in the morning, begging for a detox bed.
Interfaith Community Services CEO Greg Anglea said the agency’s residential program gets 10 to 15 calls a day for what typically amounts to one to two openings a day – and about 40 daily calls about its 11 detox beds.
County spokesman Tim McClain wrote in an email that the county continues to try to expand both outpatient and residential detox options and has backed some new residential detox options, including the two new beds in the city and a still-in-the-works young adult-focused program with four detox beds. The county has also boosted funding to increase access to homes where people can live while they participate in treatment elsewhere, fueling a 32 percent increase in the number of people who have received county support to stay in recovery residences the past couple years.
But some people need more robust residential programs – particularly detox – to start their recovery journey.
Experts and advocates say that’s especially true for people with alcohol addiction and people without adequate support systems or stable housing to stay in while they experience what can be a painful withdrawal process.
“With the population of people who are not securely housed, it’s really hard to accomplish this without 24-hour care settings,” Dr. Keith Humphreys, a Stanford University psychiatry professor and former Obama administration drug policy adviser, told Voice earlier this year. “Period.”
Indeed, data the McAlister Institute provided ahead of a Wednesday San Diego City Council committee meeting showed the majority of San Diegans it serves in its residential treatment programs lack stable housing. The nonprofit reported two-thirds of its 1,749 admissions last year involved people who were homeless when they entered the program.
Nearly every day, Shirey said he and his staff are reminded of the demand for their treatment beds – and must tell desperate people that they’ll need to wait.
“We have such a shortage,” Shirey said. “This is such a need in the county.”