In one wing of the fifth floor of Advocate Good Samaritan Hospital in Downers Grove, the hand sanitizer dispensers are in the hall instead of inside each room.
Visitors must store their purses and bags in a locker at the entrance to the unit.
Part 1: More detox optionsAs heroin and opioid addiction continue to claim lives in the suburbs, the Daily Herald takes a look at the increasing options for detoxing from drugs, and the need for continued treatment.
When someone enters the wing, the door automatically locks behind them. And when someone leaves, it sounds an alert.
This is the detox unit, where up to 10 patients at a time can be medically monitored while they're helped through withdrawal symptoms of drugs and alcohol. Here, security precautions are in place to prevent patients from accessing the very substances they are trying to quit.
The unit at Good Samaritan is among the first of its kind in the suburbs, where detox services typically are offered in a behavioral health hospital or through an outpatient clinic.
The difference with a program such as Good Samaritan's is the focused level of medical monitoring, which provides a safer and more comfortable detoxification experience for patients coming off addictive substances.
"The goal here was to improve the treatment for the addicted client," said Karen Fergle, a registered nurse certified in treating addictions, who runs the detox unit. "The work we're doing here significantly improves the chances of somebody getting into treatment, significantly reduces any type of consequences from withdrawal."
Back on the street
The model of medically monitored detox is catching on. Two other hospitals in the Advocate system -- Lutheran General in Park Ridge and Christ in Oak Lawn -- are planning to open their own units, as is Adventist Hinsdale Medical Center in the AMITA system.
Advocates, though, say detox is just one step in the recovery process.
While most hospitals will care for patients in need of detox in a regular room or send them to a behavioral health center, substance abuse experts say the region needs more facilities to treat the increasing numbers of heroin and opioid users trying to get clean.
"The issue is there's not enough room for people who need detox," said Kathleen Burke, Will County director for substance use initiatives. "You need people who understand the narcotics (that patients) are taking."
The shortage of facilities means someone looking to end an addiction to heroin or a prescription opioid, such as Vicodin, Dilaudid or Norco, might not be the priority patient when a rare bed opens up, said Donna Rennard, clinical director of Serenity House Counseling Services in Addison.
In addition, their insurance might not cover the service.
"If I'm a heroin addict, I might not get into detox," Rennard said. "That, to me, is where we underserve our heroin clients."
Withdrawal from opioids is painful, nauseating and can cause dehydration.
"They're going to be uncomfortable," Mary Sue Dailey, an advanced practice nurse in the good Samaritan detox unit, said about opioid patients. "But it's not life-threatening."
Withdrawal from other addictive substances -- especially alcohol and a class of medications called benzodiazepines, which includes anti-anxiety drugs Xanax and Valium -- is much riskier. Withdrawing unsupervised from alcohol on benzos, as they're called for short, can cause seizures, heart attacks or strokes, doctors say.
So when available detox beds go to the highest-risk patients, experts say those trying to stop opioids can be left without a place to go.
"I do think," Rennard said, "that sometimes we put somebody back on the street who might die that night."
A medical focus
The medical detox unit at Good Samaritan tries to help opioid users by controlling the side effects of withdrawal that leave them "screaming at a cellular level," while their last dose leaves their system, addictions nurse Fergle said.
During a three- to five-day stay, detox nurses use a defined protocol based on severity of symptoms to dole out Bentyl for stomach cramps, Zofran for nausea and vomiting, Immodium for diarrhea, Ultram for aches and pains, Catapres for high blood pressure or hyperactivity, vitamins through an IV to treat deficiencies and nicotine patches for smokers. For some patients, the hospital prescribes tapering amounts of a partial opioid called buprenorphine, which also contains a partial dose of the opioid overdose reversal drug naloxone, to further quell cravings.
The availability of medications through IV is one major difference between a medical detox such as Good Samaritan's and detox units in mental care facilities, such as Linden Oaks Behavioral Health in Naperville or Northwestern Medicine Behavioral Health Services at Central DuPage Hospital in Winfield.
That allows nurses to treat sicker patients with more physical complications than can be handled with pills, Fergle said. As the addiction crisis continues, she said more patients are coming in with complex cases that require such care.
"Not every detox," she said, "is a one-size-fits-all."
Some behavioral detoxes, such as the chemical dependency inpatient unit at Central DuPage, offer a high level of medical expertise in a department of a medical hospital, but without a locked environment. Dr. Jeff Johnson, addiction medicine specialist says this helps addicted clients receiving the hospital's most acute level of care feel more at ease as they delve into the emotional triggers that led them to drugs.
"The access to hearing the message of recovery begins right at the start," Johnson said.
The AMITA health system offers behavioral detox at Alexian Brothers Behavioral Health Hospital in Hoffman Estates but also wants to create a medical detox unit at Adventist Hinsdale Medical Center as soon as next year, said Dr. Gregory Teas, Hinsdale's director of inpatient psychiatry.