This story originally appeared on Spotlight PA.
Waking up on June 14, Colleen Moskov couldn’t remember what had happened the night before. She had blacked out from another episode of binge drinking, a frequent occurrence over the past six months. But that morning, Moskov decided she’d had enough.
She called Avenues Recovery Center near her Maryland home, hoping to start treatment immediately. The facility said it was full, but there was an opening at one of its Pennsylvania locations, near Scranton. The 28-year-old packed her bags and headed north.
When she arrived, the staff asked if she had been in contact with anyone who had tested positive for COVID-19 or if she had a cough, and they took her temperature.
Then she was admitted. To Moskov’s surprise, no one asked her to get tested for COVID-19 or to quarantine as a new patient.
Over the next month, none of the staff she encountered wore a mask or tried to keep six feet apart, she said. Clients who relapsed and spent days in the greater Scranton area — recently a hotbed of coronavirus cases — were allowed to re-enter without any quarantining. Cleaning products were in short supply, and guest speakers were invited to the facility almost daily.
“It was like COVID-19 didn’t exist there,” Moskov said.
And it’s not the only treatment facility said to be flouting basic coronavirus protocols. Staff and residents at a handful of facilities across Pennsylvania told Spotlight PA they fear a lack of protective measures could endanger their recovery — and their lives.
Of the state’s approximately 800 treatment facilities, 115 have reported COVID-19 cases to the Department of Drug and Alcohol Programs, which licenses them. Since March, the agency has received 170 complaints about facilities failing to implement protective measures.
So far, however, the state has issued zero citations.
In many instances, addiction advocates and treatment providers said that while facilities are making an honest effort to implement precautions, they struggle without specific guidance from state and federal authorities. They also face challenges getting staff and clients to consistently wear masks, and don’t have access to rapid testing needed to keep the virus out while still letting new patients in.
Ultimately, patients are left to battle two monsters at the same time — the coronavirus pandemic and the addiction epidemic — with many forced to choose between going to treatment and risking getting the virus, or staying at home and struggling with substance use alone.
Moskov said her entire stay at Avenues Recovery Center at Lake Ariel was marred by worries of contracting the virus, or worse, bringing it home to her husband and 1-year-old daughter at the end of treatment.
“I didn’t want to drink anymore, and stopping on my own hadn’t worked,” Moskov said. “But the constant tension between some of the patients and some of the staff over COVID-19 was distracting to my treatment.”
Fear of COVID-19 — and retaliation
Pennsylvania’s drug and alcohol department, like many other state licensing agencies, has not issued specific COVID-19 guidelines for treatment providers. Instead, it refers facilities to state and federal guidance, including Health Secretary Rachel Levine’s mask order.
But clients told Spotlight PA that some facilities aren’t even following those basic rules.
Interviews with four patients from Avenues at Lake Ariel, along with a review of photographs taken inside the facility, revealed a host of problems. A bag of facemasks sat by the front desk, clients said, but was largely untouched. Some visiting speakers took them, but staff and most patients never wore them, even at group therapy sessions where dozens of people sat close together. The thermometer used to check incoming staff and clients’ temperatures often malfunctioned, and one patient who felt feverish said he was told not to worry, it must be allergies. Social media posts show at least two staff members at the facility have had COVID-19.
When Moskov and a few other patients raised concerns about the lack of precautions to the clinical director, he dismissed them.
“He said, ‘Were you worried about COVID-19 when you were getting drugs off the street?’” Moskov recalled.
In a statement, Avenues Recovery Center said it follows all national and state recommendations, including screening staff and clients before they enter the facility, regularly cleaning the building, and mandating sick staff stay at home until cleared by the health department.
“Avenues has gone above and beyond to try to provide high quality substance abuse treatment in the safest environment possible,” the statement said. “Our staff take the responsibility of client care seriously, understanding that what we do matters.”
Erica Mortimer, director of quality assurance, cast doubt on concerns raised by clients, saying, “It is not uncommon for clients in active addiction to distract attention away from their own behavior by altering facts and manipulating situations to serve their purpose.”
Several individuals in treatment told Spotlight PA they were reluctant to raise concerns publicly or file complaints in anticipation of exactly this kind of response. They worried people wouldn’t believe them, staff and management at the facilities might retaliate, and judges or probation officers would misconstrue their fears as an attempt to avoid court-mandated treatment.
“I wish I could choose not to go in person and just do telehealth,” said one client who attends outpatient services at a Gaudenzia facility in Norristown as part of a drug treatment court mandate. “But I don’t want to get sanctioned by the court for not doing what they’re asking.”
The client said group therapy often involved 20 people in a room, most without masks. Chairs were placed close together and books, pens, and other items were passed around — despite Narcotics Anonymous guidelines discouraging that.
In a statement, Gaudenzia said that since mid-March, all staff and clients have been required to wear masks in common areas and groups have been limited to 12 people. Management has done two unannounced visits to check for compliance, and the facility has had no COVID-19 cases, the statement said.
However, two people familiar with the program said the protocols were only enforced in late July, after Spotlight PA contacted Gaudenzia.
Rather than issue citations, the state drug and alcohol department educates facilities and helps them overcome obstacles, Secretary Jennifer Smith said in an interview. The facilities are marked compliant as long as they’re making an effort.
“It’s pretty rare in my experience to come across a provider who is just belligerent and absolutely insisting that they don’t want to follow the protocols,” Smith said. “They usually want to, but in a lot of cases, there are real barriers.”
Facilities struggle with masks, testing
In Pennsylvania, treatment providers have pointed to challenges accessing personal protective equipment, getting insurance companies to reimburse telehealth, and finding space to isolate COVID-positive individuals from others. Many facilities are running low on funds, as they are admitting half as many clients as usual but are also hiring more staff to cover for employees who are out sick or need to care for family members.
But the state can only offer limited help. It has no dedicated coronavirus funding for these facilities and a finite stockpile of masks to share among healthcare providers, including nursing homes. Instead, the drug and alcohol department has a list of COVID-19 resources on its website and has been trying to connect facilities with suppliers to acquire protective equipment.
Providers say it’s far too little. Across the nation, addiction experts are calling out a lack of support and guidance for treatment centers during the pandemic.
“There are essentially no specific guidelines other than to act with safety around people who are at risk for developing COVID,” said Paul Earley, president of the American Society of Addiction Medicine.
It’s particularly concerning, he added, since individuals with substance use disorder are at high risk for contracting COVID-19 and are also more likely to spread the virus to others.
“Every state should be taking action now to help support this population,” Earley said. “From something as simple as dropping off a case of N95 masks to providing financial support to figuring out how to help with safe housing, there are myriad needs that our industry has that not only serve the addiction population but the population at large.”
The society has created its own guidelines to help fill the void. It advises providers to screen patients by phone and in-person, practice social distancing, quarantine newly admitted patients, and divert people to telehealth when possible.
Above all, it emphasizes the use of masks.
“Wearing masks is the single most important thing we do to prevent COVID transmission,” Earley said.
Many treatment providers across Pennsylvania agree, but said it’s not always easy to get clients to comply.
Vince Mercuri — executive director of The Open Door of Indiana, Pa., an outpatient drug and alcohol treatment facility and mental health crisis line — said he often has to stop clients in the hallway and ask them to put on a mask. He wears his own any time he steps out of his office to encourage similar behavior.
In residential treatment, social distancing and wearing masks become even more difficult, said Michael Watterson, executive director of ARC Manor Addiction Recovery Center in Kittanning.
“It is their home and it feels overwhelming to keep masks on every time they are not in their own room,” he said.
Ideally, Watterson would like to test every patient for COVID-19 before they’re admitted. But as testing demand across the nation has soared, labs have become backlogged and it can take days or even weeks to get results. It’s not practical to keep someone quarantined for up to a third of their treatment, waiting for those results, Watterson said. Even isolating clients for a day or two has been so distressing that some have left against medical advice, he said.
Rapid testing, which produces results in as little as 15 minutes, could solve the issue. But right now, it’s not widely available in Pennsylvania — a concern raised by nearly all patients, staff, and management interviewed for this story. (The state recently announced a $1 million investment in a Lehigh Valley company that aims to develop rapid tests by the end of the year.)
Widespread testing with quick results was key to mitigating a COVID-19 outbreak at the Kirkbride Center in Philadelphia. After six patients showed symptoms of the coronavirus in early April, the facility enlisted the help of a local hospital to test everyone on that unit.
By early May, 46 patients at Kirkbride had tested positive. They were all isolated at a city quarantine site, preventing the virus from spreading to hundreds of other patients, said Fred Baurer, Kirkbride’s medical director.
Since then, Kirkbride has instituted a universal mask policy, educated patients about social distancing, and kept new admissions apart from other patients. From mid-May to mid-June, Kirkbride only had two positive cases, and none have been recorded since.
Across the border in West Virginia, the Valley HealthCare System has been using rapid testing to ensure all patients are COVID-negative before entering their residential programs. The facility connects patients with nearby rapid testing sites and can also transport them there, said Gerry Schmidt, chief operations officer of the system and former president of NAADAC, a national association for addiction professionals.
As the pandemic lingers, it’s crucial that patients feel safe coming to treatment, Schmidt said, especially with overdose deaths rising nationwide.
“It would be difficult to immerse yourself in a treatment program where you didn’t feel safe, regardless of how bad your addiction is,” he said. But when facilities take proper COVID-19 precautions, it shows clients “that we care.”
“We care about them, we care about the general public, and we care about each other.”