Courtney Griffin was addicted to heroin and ready to get help. She packed up her things, and her mom drove her to a residential treatment facility about an hour from their home in New Hampshire. There was a bed waiting for her.
But unfortunately, that's not where her story ends. Ninety minutes after they arrived, Pamela Griffin said, her daughter was back in the waiting room, shaking her head. Their health insurance company declined to cover the treatment.
"They declined, saying that it wasn't a matter of life and death," said Pamela Griffin, recounting the rejection. "And Courtney said, 'This drug is going to kill me.' She knew."
Without insurance, the treatment would cost $12,000. They left not knowing what to do. The hope of treatment and the letdown of not being able to get it were devastating for the Griffin family.
Less than two months later, Courtney Griffin was dead.
"When you're the parent of an addict, you're always afraid of the call," said Doug Griffin, who signs his emails "Courtney's Dad."
He said, "you always know the call is going to come," but when it did, he was shocked anyway. When the phone rang, Doug Griffin was at home, full of hope, looking at pictures of Courtney during happier times. With the help of a local police officer and after some time on a waiting list, Courtney was supposed to start treatment the next day.
Instead, Courtney died of an overdose of heroin and fentanyl. She was 20 years old and alone.
Her story points to challenges many encounter — not enough capacity in treatment programs, and insurance that doesn't cover the treatment people want or need.
And those delays can be deadly, said Tym Rourke, chairman of the New Hampshire governor's commission on substance misuse. He said wait lists and insurance denials send the wrong kind of message to people who desperately need help.
"Then the belief is, 'Nobody can help me, and I'm trapped, and nobody can help me,' and therefore they use again, and with this particular epidemic around opiates, there's no safe use," said Rourke. "The next time somebody uses could kill them."
There is no good real-time tracking of treatment availability or statistics about insurance denials, but one recent study found only about 20 percent of people with moderate to severe drug use disorder received treatment. And when you talk to the family members of people struggling with addiction, you'll hear countless stories like Courtney Griffin's.
One issue is that when most people think of treatment, they think of a residential program, 28 days, abstinence and 12 steps. And there simply aren't enough beds available to help all the people that want that kind of treatment. Many don't realize there are other options, like medication-assisted treatment. But there aren't enough doctors who do that, either. So there are wait lists for all kinds of treatment.
In 2012, Dean Lemire had been using heroin for about 18 months when he decided he needed to stop.
"The heroin wasn't doing what I wanted it to," said Lemire. "When I wasn't high, I was suicidal."
But when he went to a state-funded treatment center, Lemire was put on a waiting list.
"I had to call every day, three times a day for three weeks," said Lemire. "By the end of two-and-a-half weeks, I gave up."
He said he downed a fifth of cheap Canadian whisky from a plastic bottle and got in his car looking for heroin.
"I got in three car accidents, totaled my car. On the third, woke up in a jail cell," said Lemire. "And when I finally got back home I called the rehab, and I guess they deemed me serious enough to require their services, so they bumped me up and got me in."
It worked. Lemire is in long-term recovery now. He's married with a young child, and he's the substance misuse educator at Goodwin Community Health in New Hampshire, working to help others like himself. But Lemire said the situation hasn't improved.
"That wait period, you know, has not gotten better," said Lemire. "It's actually gotten worse."
The problem with these wait lists, as Dean Lemire's experience makes very clear, is that moment of clarity when someone who is in the grip of these drugs reaches out for help can be fleeting. And the system as it exists now isn't always there with a warm embrace.
Addressing The Problem
Elected officials are now racing to address the obstacles to treatment. States are holding special legislative sessions. The U.S. Senate has already passed a bipartisan package of bills to deal with the opioid crisis, and the House is taking up 18 different bills this week related to opioids. The Centers for Disease Control and Prevention just came out with new guidelines for doctors prescribing these drugs. There is also a White House task force on insurance coverage for drug treatment.
In the inside pocket of his suit coat, Michael Botticelli, the director of National Drug Control Policy (aka the White House "drug czar") carries a small laminated card with a smiling picture of Courtney Griffin. It's a prayer card from her funeral. Doug Griffin gave it to Botticelli when he met him briefly to talk about addiction issues. Botticelli carries a few of them daily to remind him of the more than 120 people each day, on average, who die from overdoses in America.
"I take them out of my pocket at night and say, 'What did you do today, to make a difference?' " said Botticelli. "There are real people behind these numbers."
He said access to treatment is a very real problem he hears about regularly.
"Too few people are asking for help," said Botticelli, who himself is in long-term recovery. "And it's really tragic that people aren't able to get care and are often dying when they are on waiting lists. We know addiction is a disease. Every other disease, you get treatment on demand, and that's what we want."
What The Presidential Candidates Are Saying
When the candidates started going into New Hampshire last year, they were surprised by how much they heard about this issue. They quickly started incorporating it into their campaigns, talking about personal experiences, friends or family members they had lost to addiction.
Donald Trump says he'll get people as much help as he can, but he doesn't get more specific than that. He says the border wall he wants to build will also keep drugs from coming in from Mexico. He is calling for a repeal of the Affordable Care Act, a law that has expanded access to drug treatment to many who didn't have coverage for it before, but he insists he will replace it with something "terrific."
Hillary Clinton released a plan last year that has a lot of overlap with what the White House and Congress are working on now. It called for enforcing insurance parity so mental health is treated the same as other medical conditions — making treatment more available, while emphasizing treatment and rehabilitation over prison. She has held multiple town hall-style forums on addiction issues.
Bernie Sanders regularly says addiction should be treated as a disease and not a moral failing.
"When somebody is addicted and seeking help, they should not have to wait three, four months in order to get that help," Sanders said in a debate moderated by ABC News earlier this year. "They should be able to walk in the door tomorrow and get a variety of treatments that work for them."
This, he says, is one of the reasons he advocates for a Medicare for all plan.
States where this has been a big problem — like New Hampshire, Ohio, Pennsylvania and West Virginia — are likely to be swing states targeted in the general election.
It looks to be a campaign issue up and down the ballot, too. Ohio, Pennsylvania and New Hampshire all have competitive Senate races.
In New Hampshire, two of the candidates for governor kicked off their campaigns at the same drug treatment center.