COLUMBIA — People with drug addictions come to Columbia from all over the state to seek treatment.
But none of the city's six drug treatment centers can care for women with withdrawal symptoms that require medical attention.
That means a woman must wait to begin rehabilitation in a treatment center until after she receives medical attention from either a hospital or a detoxification center in another city.
Detoxification centers in many cities have waiting lists, and it could be several days before a woman can receive help, when her window of opportunity for kicking the addiction might have passed.
In Columbia, the emergency room is the only option for medically treating women for withdrawal symptoms, said Beth Berhorst, director of the McCambridge Center, which helps women overcome addictions.
McCambridge Center served about 500 women last year, and roughly two to three women per month required a medical detoxification, according to Berhorst. The center is connected with the Family Counseling Center of Missouri, a not-for-profit organization that receives state and private funding.
The lack of a drug detoxification center is one of the biggest concerns at the McCambridge Center, Berhorst said.
Drug detoxification can be miserable. According to the Substance Abuse and Mental Health Services Administration, withdrawal symptoms can include hallucinations, insomnia, dangerously high body temperature, seizures, nausea, vomiting, abdominal cramps, bone and muscle pain, hypothermia, anxiety, delirium and gastrointestinal bleeding. The symptoms are different for each person and drug.
McCambridge has been trying to add a detoxification center for years, but the center does not have enough funding, Berhorst said.
Men can go to Phoenix Programs, a treatment center for men on Leslie Lane that has a detoxification center. Heather Harlan, prevention specialist at Phoenix Programs, said that for a few months in 2009, Phoenix Programs offered detoxification to women as well as men. But the funding for the women's program was lost because of state budget cuts.
If a woman who needs medical supervision has no safe place to begin her treatment, the consequences can be dire, Berhorst said. The women often give in to their pain and cravings and begin using again to make it all stop.
"They won't stick it out," she said.
No drug detoxification center
Jeff Hoelscher, media relations coordinator for University Hospital, said the hospital's emergency room will treat women for medical issues involving drug detoxification, as it would treat anyone who arrives in need of medical care, but the hospital does not have a center that specializes in drug detoxification.
A drug detoxification center can manage patients who might require more specialized care because certain drugs are more medically dangerous to stop "cold turkey" than others.
Harlan said it depends on the drug and frequency of use, as well as the person's tolerance and medical history. She said conditions like diabetes, high blood pressure and a history of seizures combined with withdrawal are carefully screened and the person could be referred to a hospital.
Detoxification in conjunction with treatment in the same center would give women continuity, Harlan said. The lack of continuity can compel women to be shuttled back and forth between a hospital and treatment center.
If a woman is deemed medically unstable for treatment at McCambridge Center during the preliminary physical, she must be taken to a hospital to be assessed.
A woman who goes to the emergency room is often given fluids for dehydration and sent back to McCambridge Center, rehydrated but still suffering, said Melynda Surber, a case manager at McCambridge Center and former addict.
But McCambridge cannot keep anyone who still needs medical supervision, so women may be bounced back to the hospital. Some people need constant medical supervision while the drug is leaving their system, Berhorst said.
This can lead to frustration, she said. That, along with a stigma about addicts, hurts the care of her clients.
"It prevents my clients from receiving the medical attention they need," she said.
Hoelscher rejected the notion of a stigma among hospital staff.
"Once an individual has been treated for his or her medical issue and is stable, the possibility of transfer to a treatment center specific to the patient's needs is then considered," Hoelscher said in an email.
After a woman is released from the hospital, she often encounters another stress factor — hospital bills that add to the teetering tower of other issues during addiction treatment. Financial stress is a huge trigger to begin using again, Surber said.
Detoxification in jail
Sometimes, women must detoxify in jail. Warren Brewer, chief jailer at the Boone County Jail, said the facility follows a protocol for those who need medical attention. Inmates are referred to the jail's medical department where they are continuously monitored.
“Our main concern is for their medical health,” Brewer said.
Symptoms might be undetected, particularly when inmates do not want to admit they are in drug withdrawal, he said.
Surber said she knows women who have suffered through withdrawal on the cold concrete floor of a jail. She said she was lucky to have a mild detoxification that did not require medical attention.
"I was tired," Surber said. "My body ached, and I just wanted to sleep."