JANESVILLE—Speaking with a slow, dry and weary voice at his mother's Janesville apartment, Michael Cottone was sick.
It had been a few days since he'd last used heroin.
Using was never about the high for him, he said. The heroin feels just like the pain pills doctors prescribed him after his shoulder surgery in April 2014, except it's cheaper and easier to get.
Today, he needs the heroin to function.
“Honestly, it's like the worst kind of flu your body probably will ever endure,” Michael said. “Your body hurts, sweats, throwing up, stomach problems, sneezing, running eyes, nose, hot and cold.”
The worn-out voice emptiedfrom a 31-year-old man whose body depends on heroin; a man who has sent out hundreds of letters, emails and messages seeking treatment.
Comprehensive treatment that includes the medicine to get him through withdrawal is not easy to find. His loved ones share his frustrations of a fruitless search frustrated by wait lists and high costs.
“The inpatient treatment center is about $1,000 a day. I've contacted them. I said, 'I'll sell my soul.' But they told me they don't take souls,” said Michael's mother, Christine Cottone. “But the heroin took his.”
Addicts, their families and even treatment providers stress over the lack of affordable and readily available treatment options for heroin addicts in Rock County, even though the state is years into what elected officials call “the heroin epidemic.”
The wait lists can be lethal: More people are dying each year. Twelve people died from heroin overdoses in Janesville last year, which is triple the amount of such deaths in 2015, according to Janesville's 2016 crime statistics.
'ALWAYS ABOUT THE MONEY'
Michael loved motorcycling.
Then, on Oct. 13, 2013, he fell off his bike and messed up his shoulder. He needed surgery.
He was prescribed a substantial amount of pain pills, he said. As time went on, he noticed he was getting sick without them.
Michael said he told the healthcare employees about the sickness and that he had violated the terms of his “pain contract” by taking what he said was about five or so pills sooner he should have, thus finishing his total a few days early.
Michael said he was then “red flagged” for being drug dependent and was taken off the medications completely.
Without the medication, the sickness became unbearable, he said. Then, people told him about a cheaper alternative: heroin.
“And eventually--just being sick and not having any way to get any pain pills--I tried it,” he said. “At first, I didn't even like it, but I didn't feel sick so it pretty much got, I believe the next time I used, it was like a pain pill to me. It was the same thing.”
Michael desperately wants treatment for his addiction. Michael's girlfriend, Crystal Brook, and his mother want treatment for him, too.
“I fought for him every day. I can't tell you how many hours I spent on the phone or how much research, every place I tried,” Christine said. “'Our doors are always shut.' It's always about the money.”
To help addicts manage dependency, doctors or psychiatrists sometimes give them Suboxone or Vivitrol.
As Michael fought the bureaucracy of losing and finding new insurance, he was told the out-of-pocket costs for some of those drugs could be $1,000 a day, he said.
It's money he doesn't have, he said.
“It's still a money thing to get help,” he said. “That's all it is.”
Christine said she tried to buy him Suboxone off the street so he could think straight and not be so sick.
Not only is medicine-assisted treatment expensive, it is largely absent in Rock County facilities, addiction treatment officials said.
Tim Perry is the administrator at Crossroads Counseling, 17 S. River St., and has 30 years experience in the field. He said they offer intensive outpatient treatment, but when dealing with a serious addiction, they probably would have to refer a person to an inpatient facility for detoxification.
“With this population, it's such an intense addictive process, and doing outpatient is underserving them,” Perry said. “My belief is they need some type of inpatient or residential care for some period of time … There's no options for it (in Rock County).”
'THE SIGNIFICANT SHORTAGE'
A case study of one patient by Compass Behavioral Health Clinic, Janesville, showed the full scope of treatment she received over a two-and-a-half-year period was worth $18,000.
For the case study patient, Compass was reimbursed $5,000.
“It's a real struggle,” said clinic Administrator Justin Marko. “Unfortunately for all of us who are in this field, we're here to help people, but we get stuck within the bureaucracy of insurance companies and third-party payers. We can't provide free services because we won't be able to function as an agency.”
Addicts are susceptible to getting lost in the insurance bureaucracy even when things are going well for them, Marko said. If they find a new job but they're making only $8 an hour, they might lose one insurance option yet not make enough to buy other insurance in the marketplace.
Marko said this recently happened to some of his clients. After losing their insurance, Compass was “scrambling to figure out what to do with them,” he said. For someone attending two sessions a week, it might mean Marko suggesting they come to only one.
“Even though it's not optimal, it's trying to do something to work with the restrictions," he said.
When patients are referred out of the county for medicine-assisted treatment, there aren't many options. One place people can go to is a Rogers Memorial Hospital facility.
Kim Effertz, vice president of admissions services, said Rogers has three hospitals providing inpatient hospitalization for detox: Oconomowoc, West Allis and Brown Deer. Rogers has medicine-assisted treatment in West Allis and Brown Deer that is coupled with an intensive outpatient program.
But those programs may be too costly for someone who does not have insurance.
“The best bet if they don't have insurance and they're wanting that type of treatment, they should really seek services through their county,” Effertz said.
Some public money is coming into Rock County as state legislators take on the epidemic, but Perry said the money burns up fast.
For 2017, Rock County has budgeted for $553,000 for alcohol and other drug abuse funding, said Greg Winkler, behavioral health division manager for Rock County. Of that, $343,000 is from the Alcohol and Other Drug Abuse Block Grant from the state, and the rest is local tax money.
The funding has increased 45 percent since 2012, Winkler said in an email. The county uses $362,000 to fund substance abuse treatment and detox for people treated at contracted agencies.
Another $123,000 goes toward the county's walk-in clinics and other community outreach through Lutheran Social Services, Winkler said.
Winkler said counselors match people with facilities, and workers at the walk-in clinic can help people understand their insurance situations.
Lutheran Social Services has a case manager who helps people who might be stuck on waiting lists, Winkler said.
Those services can only do so much, however.
“We can get people into treatment, into a counseling type of treatment fairly quickly,” Winkler said. “The significant shortage is in the ability to get medication prescribed, and often people want that right away to help with the discomfort of withdrawals.”
Although some facilities offer medicine-assisted treatment, Winkler said psychiatrists are limited in how many patients they can see, creating wait lists, “which flies in the face of common sense when talking about opiate addiction.”
“Nevertheless, it's a resource issue,” he said. “So people could be waiting.”
'IF EVERYTHING GOES RIGHT'
Before his shoulder surgery, the pain pills, the heroin, the depression, the unreturned letters for help, Michael said he was always in a good mood. He always made people laugh, and he loved fishing and hunting.
He said the younger Michael was optimistic, but this is a trait he still shows.
“Well, I know I'm not going to give up, so I think I have a good chance (of recovering),” he said. “I can see why people give up, though, because I want to give up, too, sometimes, but I got a daughter and a family. This ain't me. And I'm not going to let it define me.”
Christine, whose picture Michael has tattooed on his left arm under the words, “Dear Mama you're appreciated,” shares his optimism.
“Where there's life, there's hope,” she said.
Michael said, “If everything goes right,” he will be set up on new insurance. Six weeks from now, he can get in and see a professional and three weeks after that he can receive some medicine-assisted treatment, he said.
“Like in nine weeks, if everything goes good, I should be able to get help,” he said. “It's a joke. They even tell me, 'We don't expect you to quit using.' Well, what do you expect me to do? I don't know.”