There came a day last June when Ann Weeks drove her shaking stepdaughter around to hospitals and drug treatment centers in Pasco County. Ann was exhausted and frustrated. She'd spent three sleepless nights trying to help Karen Hanratty, 27, withdraw from Oxycodone and Xanax at home. She'd watched Karen scream and cry that it hurt. But Karen's kids had been taken away from her for driving under the influence of prescription drugs, and if she wanted to get them back, she needed to get off the drugs.
So Ann, 43, took Karen to three hospitals — all of which refused to take her unless she had threatened to kill herself. Ann and Karen briefly discussed Karen lying. But Karen feared it could stop her from ever reuniting with her children.
Ann pulled her old Cadillac into one last nonprofit drug treatment center in New Port Richey. She'd called before, but she thought that maybe if they saw Karen, they might find a place for her.
A nicely dressed woman answered the door. Ann told the woman that if she didn't get Karen help, she thought Karen would die from an overdose.
The woman looked down at Karen, nauseous and shuddering on the ground, and nodded sympathetically. She told Ann there was simply no room.
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More than 900 drug and alcohol treatment providers operate in Florida.
Three-quarters of them are for-profit companies. They'd like payment up front. Insurance may cover a 30-day treatment, but very few plans do.
Most of them are out of reach for someone like Karen Hanratty, a mother of two who was on disability and Medicaid.
Karen, and people like her with little or no money, do have options. Hundreds of thousands of people find their way to the nonprofit treatment centers that receive money from the state, such as Operation PAR in Pinellas County or DACCO in Hillsborough County. But penetrating the wall of wait lists at nonprofit treatment centers requires luck and perseverance.
Operation PAR, for example, has up to a three-month waiting list to get a bed. The wait for detox is up to a week. The 220-bed operation has lost 100 beds in the past few years.
"Every treatment provider has empty beds," said Sara Romeo, CEO of Tampa Crossroads, a nonprofit treatment program that receives government funding, "meaning we have beds, but they are not paid for by anyone so we can't put a client in them."
Most of these nonprofits get a large part of their funding from the Department of Corrections, which means those who commit crimes get most of the beds.
Very few spots are reserved for the low-income person like Karen who steps in off the street. At the 236-bed DACCO, for example, there are just 14 beds for such people and there is a four-month wait list. But there are 120 beds for felons.
So there's been a shift to outpatient treatment. It's cheaper, more available. It works for some, but not all.
The first step is typically to get into a detox center. Karen couldn't even get into one of these. Her chances of detoxing on her own were slim.
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Karen's family speculates she had been taking Oxycodone for more than a year when she was pulled over on Nov. 17, 2009, by an officer in Pasco County. She had been driving 70 mph in a 45-mph zone on U.S. 19. She nearly hit the car in front of her and almost sideswiped another car.
"What did I do?" she asked the officer.
She stumbled through the sobriety tests. And her then-8-year-old son, Jacob, was in the back seat.
Karen had already been on the radar of child protection investigators. Just weeks before, a police officer had seen her in the parking lot of a gas station, slumped over the steering wheel. Neither her son nor her 2-year-old daughter, Susan, were in the car. But the incident prompted a call to the child abuse hotline.
This time, child welfare investigators removed Jacob and Susan from her custody and placed them with relatives.
Karen was devastated. She was, her family said, a dedicated mother. She read to her kids and threw them birthday parties that she couldn't afford.
Months after the arrest, sometime in March, she showed up in court with her mother, Melissa. Maybe she could get the children back, Karen thought. After all, she had been taking only what her doctor prescribed her.
Melissa knew her daughter suffered chronic pain. She had been sickly growing up and had undergone her first surgery for scoliosis when she was 13 or 14. They had cut her open from her neck to her tail bone again when she was in her early 20s. An infection from that surgery led to a third surgery. She was also diagnosed with fibromyalgia, a chronic pain disorder. Karen's pain was so severe that doctors sent her to a pain management doctor in Zephyrhills in 2008.
Circuit Judge William Webb wanted to see her prescriptions. How many pills was she being prescribed exactly? The answer surprised everyone.
Karen, who was 110 pounds, was taking one 30mg of Oxycodone every three hours. That was eight a day or 240 a month — "too high," Webb said. She didn't tell the court but she also had a prescription for 90 Xanax a month, though she claimed she had stopped taking them.
If she wanted her kids back, the judge told her, she was going to have to get off all prescription drugs. Webb didn't tell her how to get off the drugs or where to go. He would have ordered her into a program, he said, if she'd asked.
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Experts say pain pill addicts need at least 90 days of treatment — inpatient and outpatient combined — to free themselves of the addiction. Anything less is considered a BandAid.
"Like taking aspirin for cancer," said Michael Flaherty, executive director of the Institute for Research, Education and Training in Addictions.
But Karen couldn't even get five days of detox. So last spring, she ping-ponged between bingeing on painkillers and trying to quit on her own with the help of her father and her stepmother.
Ann and Karen were not very close. Ann was strict, no-nonsense. But Karen, 27, had run off all the other family members who tried to help her, including her mother.
So her stepmother picked up the lit cigarettes she dropped on the floor when she passed out. She dragged her out of a drug house in Moon Lake. She found a batch of pawn slips for all of Karen's jewelry, including a gold heart with the word "Mom" on it. She had gotten $15 for it.
In those final months, Ann called every hospital and drug treatment center in the phone book. Then she got a list of centers and hospitals from around the state and started calling them, around 50 or 60 in all. Either they didn't have a bed or wouldn't take Karen's Medicaid. And private treatment centers quoted her $10,000 just for detox.
"We tried to detox her ourselves, but we don't know anything about it and we knew she could die at any time," Ann said.
Ann called Operation PAR, the publicly funded treatment center, but she said she learned it used prescription drugs such as Suboxone and methadone to wean people off painkillers. Operation PAR offers two ways to get off drugs, and one is drug-free. But Ann only learned of the one that uses prescription drugs. The judge had ordered Karen to quit completely.
Things came to a head at the end of May when Karen tried to detox on her own one last time. It lasted four days.
Then came June 1, the day that Ann loaded her into the car and drove around New Port Richey looking in vain for an open bed.
A week or so later, Ann and Karen's dad tried to have Karen committed under Florida's Marchman Act. In Florida, you can commit someone involuntarily for an out-of-control substance abuse problem. Ann found Karen a treatment bed in Polk County, but she said the judge wouldn't sign the order unless the bed was in Pasco.
In mid June, Karen showed up at home and admitted she had taken 10 Xanax. Her breathing was shallow, her eyes unfocused. Ann took her to a hospital in New Port Richey.
The next day, the hospital released her. They told Ann it was because Karen was no longer a threat to herself. Wasn't taking 10 Xanax the equivalent of trying to kill yourself? Ann asked.
Ann never understood why Medicaid didn't cover detox.
Shelisha Durden of the Florida Agency for Health Care Administration, the agency that oversees the state's $18-billion Medicaid program, said Medicaid covers detox only at hospitals and only if it's deemed by a physician to be medically necessary.
The term medical necessity has a lengthy definition which amounts to this: "necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain."
Medicaid doesn't cover inpatient substance abuse treatment, Durden said, but it does cover outpatient.
Later that day, on June 16, Ann sat down on her overstuffed, brown couch and opened the phone book one more time. She handed the phone to Karen.
"If you want help," she said, "if you want to be straight enough for that hearing on your kids next month, you have to do this."
Soon, Karen was on the phone with an intake counselor at Morton Plant Hospital in Clearwater. Crying, she explained she had lost her kids. She wasn't strong enough to quit on her own. Medicaid did not cover detox services, the hospital told her. But they had an open bed on the psychiatric floor, a cost Medicaid would cover.
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On June 25, Karen was released from the hospital to an assisted living facility in Clearwater. It wasn't for drug offenders, her family said. In fact, the man who ran it didn't even know Karen had an addiction. But there were AA and NA meetings nearby.
She was hopeful. She had gained 15 pounds. She started a diary: "I love my 2 beautiful kids and miss them soooo much! :( God give them back please I beg you!"
"I am off the pain meds for my back and only taking 3 mg of Zanex a day," she wrote on July 2. "I was in touch with a senator of Florida, to get him to pass a bill stating that Medicaid patients shouldn't have to fight a battle to detox and get help if they truely want it. . . ."
On July 21, Karen left the assisted living facility with a friend. She went to the apartment of a 27-year-old man whom she'd met at Publix that day.
She popped Oxycodone and Xanax until early in the morning when she started throwing up. The man put her in the bathtub, ran some water over her. Then he passed out. Next morning, she was dead of an overdose.
She died eight days before a custody hearing on whether she was making enough progress to get her kids back. She was one of about 267 people who died of a prescription drug overdose through July this year in Pinellas and Pasco counties.
Times researchers Shirl Kennedy and Connie Humburg contributed to this report. Leonora LaPeter Anton can be reached at firstname.lastname@example.org or (727) 893-8640.
Many private drug treatment facilities have opened as the prescription drug crisis has grown, but some are having trouble finding clients in a tough economy.