Miriam Landa doesn't sleep anymore. She lies awake thinking of ways to get help and treatment for her struggle with drugs that dates back 18 years.
"I feel hopeless," she said. "I have to push myself to take a shower, to eat and to do the normal things people do." She said she has no motivation because she knows what awaits her. At any moment, she could be sent back to jail.
Landa, a resident of Havre de Grace, is 30. She has an 8-year-old daughter and is five months pregnant. She is a prescription drug addict and could face her second jail stint on prescription fraud charges.
Right now, she said, she is in violation of her probation by not receiving outpatient or inpatient treatment from a facility.
"There is a 99 percent chance that I am going to jail," she said.
If she goes back to jail, she said, her fetus will die. "They will take me off methadone," Landa said. "I will probably lose my baby and begin using again."
Last month, she began taking methadone for the safety of her fetus. The synthetic opiate replacement is the only medication used for the treatment of pregnant and postpartum opioid addicts, said Vickie Walters, program director of the Center for Addiction and Pregnancy at the Johns Hopkins Bayview Medical Center.
"There is no evidence to prove that methadone is harmful as far as we know," Walters said.
Landa and her husband, Barry, are frustrated and say Maryland's system dooms recovering addicts to failure.
"I don't qualify for medical assistance because of my husband's income," she said. Barry Landa earns about $200,000 a year as a finance director for a Northern Virginia car dealership, but if the Landas' income were less than $600 a month, they would qualify for assistance. Miriam Landa said she has depleted their funds on drugs, legal fees and treatment centers.
Another problem, she said, is that she receives only 30 days of treatment at a time. "It's not enough time," she said. Landa said she needs long-term care to stay clean.
Landa began to seek help but hit many roadblocks, she said. "I would call and I say I didn't want to live anymore, and the first words out of their mouths would be, 'What type of insurance do you have?'" she said.
Landa is one of many addicts seeking treatment but running into red tape, said Bonnie Wyant-Heisler, New Life Addictions Counseling Services Inc. program director of the intensive outpatient treatment center in Baltimore County. "All the Miriams out there deal with those same frustrations."
"If they have to wait, they could go back on the streets or start using again," she said. "If they have to wait, nine times out of 10 we lose them."
Wyant-Heisler said the drug detoxification process used to take seven days, but now it's three days. "That is not adequate enough time because addicts aren't even out of the fog yet, and how long someone should be in treatment depends upon the individual and the circumstances in their lives," she said.
Funds are limited in the state, Wyant-Heisler said. "I see people continuously struggling," she said. "It's a fight, and it shouldn't have to be this way."
In the past couple years, Wyant-Heisler said, many inpatient facilities in the state have closed. And many treatment facilities are full and have waiting lists, she said.
Ray Miller, chief of treatment services at the Maryland Alcohol and Drug Abuse Administration, said there are limited funds for inpatient 28-day public facilities in the state. And many private centers have closed, Miller said.
"The biggest reason is due to private insurance not paying for treatment," he said. The best private facilities cost $500 a day, which most people can't afford, he said.
From 1994 to last year, the number of public and private facilities in the state has decreased from 28 to 19. "Most of the ones that have closed are in the private sector," Miller said.
In Harford County, there are four treatment facilities. Two are inpatient facilities - Father Martin's Ashley in Havre de Grace and the Phoenix Recovery Center in Edgewood. The two outpatient programs are operated countywide by the Harford County Health Department and Treatment and Recovery Works.
"There are not enough places to detox in the county," said Joe Strovel, director of addiction services for the Harford County Health Department. The Health Department is not receiving enough money to do the treatment. "Some people are going untreated," he said.
Prescription abuse up
Harford County also has seen an escalation of prescription drug abuse. In Harford, Strovel said, the most prevalent drugs are the painkiller OxyContin - because it has a longer-lasting high - heroin, and hydrocodone, a cough-suppressing opiate.
"This is an increasing problem. There are more people coming in, and there are more OxyContin patients than last year at this time," Strovel said.
In response to the increasing number of drug addicts, the county Health Department has seven programs: a methadone program, a 100-day detoxification program, a nine-week intensive outpatient program, an eight-month relapse prevention program, drug court in Edgewood, a re-entry program, and a new family therapy program.
'I couldn't take it'
Landa's struggles began early, she said. At 12, she began using hashish. By 16, she was using crack cocaine, she said. She continued to smoke crack until she was 19. At that time, she had lost a lot of weight and had cysts on her lungs, she said.
"I couldn't take it anymore," she said. "I didn't want to live anymore. I was deteriorating, and that was my bottom."
She checked herself into Suburban Hospital and spent the next 18 months at the Oxford House in Bethesda. Next, Landa moved into an apartment in Bethesda with two women from that program. She attended drug-abuse meetings, started school at Montgomery College and worked at night as a restaurant hostess, she said.
In October 1993, she became pregnant and moved back in with her parents and then into a condominium. Her parents helped watch her daughter while she worked three jobs, she said.
Landa joined the Army three years later. Military life was good for her, she said. "I never drank and I wasn't doing drugs," she said.
But her downfall came when she finished military school at Fort Jackson in South Carolina and was out driving with a friend, she said. They got into a bad accident, and she was thrown from the car and broke the lower part of her back.
After the accident, she was medically discharged from the service. For two months, she was hospitalized and was given painkillers.
"I honestly needed it in the beginning, but after three months I was taking more than needed," she said. For two years, she was prescribed pain medication.
In 1998, she was in another car accident and refractured her lower back, she said. She was in the hospital several more months. Doctors prescribed the pain medication Lortab, which contains hydrocodone, and she stayed on that drug for another year.
"I didn't even have to see a doctor," she said. "I would go to the office and the medication would be on the counter, and all I would have to do is leave my check.
"Without the meds, I couldn't take care of my daughter, I couldn't take care of the house," she said. One day, she went in to get her medication and the doctor said she couldn't get it anymore. "I got sick. I couldn't move. I thought I was dying."
She started taking friends' pain pills, then she began stealing prescription pads from her doctor's office. As long as you were a certain class, you could get your prescription, Landa said. In the next two years, her addiction progressed from 60 to 80 Lortabs a day, she said.
Landa was first arrested in 1999 in Parkville for prescription fraud, but her drug problems continued. In 2001, she says, she was arrested more than two dozen times in two states. She says she has served 60 days in jail, but could face prison sentences of 14 years. In March last year, while serving a 35-day sentence, she had a miscarriage.
A growing problem
The abuse of hydrocodone has increased in the past decade, said Howard Schiff, executive director of the Maryland Pharmacists Association. One of the reasons it has increased, he said, is because it is a Schedule III drug, which means the government does not consider it abusable. The Schedule III drugs are very effective and are not as abused as Schedule II drugs, he said.
Lortab, a combination of hydrocodone and acetaminophen, is inexpensive by prescription. Similar to other opiates, the adverse effects are dependence and tolerance development. Tolerance means as the drug is taken over a long period, the user requires a higher dosage to get the same pain relief, or, in an abuser's case, the same high.
Landa has been in and out of treatment centers for 14 years. Her first treatment center was in 1989 at the Suburban Hospital in Bethesda, which cost $300 a week. "We couldn't afford it, and I stopped after two months," she said.
Then she tried Father Martin's Ashley in September 2001. "I had to leave early," she said, because it cost $800 a day and $4,500 minimum at admission. After 21 days, she stopped treatment.
Then Landa tried the outpatient program Safe and Associates in Havre de Grace, an outpatient program, in the winter of 2001. From there she went to the Hope House in Crownsville last spring. Her insurance paid $2,800 of the $5,800 cost, but she ran out of time.
Her insurance company covers 30 days of treatment a year, which, Landa said, isn't enough to detoxify her completely.
Landa recently tried the Center for Addiction and Pregnancy. The cost was $300 a day, and Landa's insurance would cover only seven days.
'A good person'
Through the difficult times, Barry, her husband of two years, has continued to stick by Miriam because he doesn't want to see her die. "I think the world of her," he said. "I know she is a good person."
As of this month, her insurance will pay for another maximum of 30 days of inpatient and outpatient treatment. Landa is hoping that someone will see that she needs long-term care.
"I don't want to be another statistic," she said. "I want long-term help in order so I can live."
Right now, she said, she is just getting by. "I deserve to live, I just need someone to help me do it.
"I am an addict, but I am also a human being. I am all those bad things addicts are, but when you take the drugs away, I am a good person," Landa said.