Detox Desert: Spending cuts, overdose undercounting leaves rural Nebraska with few resources

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The once-abandoned hotel on the outskirts of Hastings buzzed with activity as July crept closer.

Maintenance staff lugged donated furniture into rooms, patients met for group therapy and family visits and clinicians rushed to train nurses for the new detox center.

All the while, referrals, inquiries and pleas flooded into Tara Schroeder’s email inbox for a spot at Revive Inc. At any given moment, on any given day, there are more than 50 requests waiting for her.

Within the first month after transforming this abandoned Motel 6 and opening its new inpatient treatment center, Revive had filled every bed.

It doesn’t matter how many emails Schroeder, vice president of clinical operations, opens, how many people they can get in the door, she says. The messages just keep coming.

At first glance, it may appear that small-town Nebraska doesn’t have a drug problem.

Western Nebraska has some of the state’s lowest overdose rates. Some counties haven’t reported a single drug death in decades.

But those numbers probably aren’t accurate. The state has long undercounted drug deaths, say state officials, experts and a Flatwater Free Press analysis of Centers for Disease Control data showing that Nebraska’s nonfatal overdose rate and its death rate simply don’t match up.

By failing to acknowledge the size of the problem, we’re failing to address it, researchers and treatment workers say — sending few resources to more rural Nebraska counties to help combat substance abuse.

“It’s a literal desert from Lincoln to Denver,” said Revive CEO Kristine Kasperbauer. “There are very few, sporadic options for treatment.”

Nebraska has only 12 inpatient treatment centers outside of Omaha and Lincoln, according to a Flatwater Free Press analysis of data from the federal Substance Abuse and Mental Health Services Administration. Five of those are in Norfolk.

And only four of those 12 treatment centers offer a place to detox. Revive and a smaller center in O’Neill are the only two outside of eastern Nebraska, even though they are located in the center of the state, more than 300 miles away from its western edge.

Revive’s staff has watched the need for substance abuse treatment grow even as the available money shrinks — federal funding cuts and recent budget-cutting decisions made by the Nebraska Legislature mean less money for the Hastings treatment center.

And Nebraska’s undercounting likely hurts Revive, too. Overdose fatality data is often used to allocate both state and federal funding. Undercounting drug deaths can widen the gap between what a community needs and what it receives.

“It never ends,” Kasperbauer said. “The need never ends. We’re glad to be able to do what we can, but it’s not enough.”

In the year before Derrek Cocchiarella died, at the height of the coronavirus pandemic, he started asking for help.

“Mom, I need to get clean,” his mother Linette Cocchiarella remembers him saying. “I need you to help me out here, I need to go to detox.”

She started calling around. A treatment center in Lincoln had a bed but couldn’t take a patient from outside of the county because of COVID. Another treatment center in Grand Island, closer to their home, told them Derrek would have to detox on his own for five days first.

“It was just like one wall after another,” Linette said. “Getting him anywhere at that time was impossible.”

Instead, Derrek detoxed at home, then was sent more than 100 miles away to Norfolk for treatment, where he spent the final months of his life before he overdosed at the family home north of Hastings.

His sister Lindsey Lyons went on to become a substance abuse counselor at Revive, working to fill the gaps that her brother fell through.

Many of the existing detox options turn away people who use opioids, Lyons said, as well as people who have expressed suicidal thoughts. Revive doesn’t turn those people away — prospective patients simply need to be able to save themselves from an emergency like a fire, Kasperbauer said.

There’s not much choice, Revive leaders say: Their new detox center is the closest one available for most western Nebraska residents.

“It’s really disheartening to know that there’s just nothing out there,” Lyons said. “And those are some big cities out there, like Scottsbluff and North Platte. We get so many referrals from those particular towns, and that’s still six hours away. It’s awful.”

Butler County Attorney Julie Reiter sees those gaps firsthand as she works with problem-solving courts, an alternative program for nonviolent drug-related offenders, in four east-central Nebraska counties.

Case workers help people look for a bed, Reiter said, but there are no sober living houses, treatment centers or intensive outpatient providers in Butler County. If they need to go into a sober living situation, they must leave their community.

“There’s a shortage, and we’ve known that there’s a shortage for as long as I can remember,” Reiter said.

Almost all of Nebraska’s counties score among the weakest in the country for accessibility of recovery resources, said Michael Meit, director of East Tennessee State University’s Center for Rural Health and Research, which studies recovery ecosystems.

Sixty-two counties, mostly in central and western Nebraska, have no substance abuse treatment facilities and no hospitals or clinics that provide outpatient substance abuse care, according to a Flatwater Free Press analysis of federal treatment data.

Residents of Cherry County, for example, need to travel more than 60 miles on average to receive medications like methadone or suboxone from the nearest provider, according to Meit’s study.

“We might think that our services are very short here in Butler County,” Reiter said. “Oh, when I think about Scottsbluff, the Panhandle, Cherry County … we are blessed being as close in proximity to Columbus, Norfolk, Lincoln, where we are, because we could be a lot farther.”

Even people from Omaha and Council Bluffs, metro areas with more treatment options, seek care from Hastings’ Revive. Jails and other treatment centers have started to refer patients.

Finding quality service providers in western Nebraska is a major issue that troubles the state’s re-entry continuity advisory board, which works to improve resources, like substance abuse treatment, for people coming out of prison, said board member Jake Shaddy.

“A lot of the guys that are from western Nebraska, they’re either coming to Lincoln or Omaha because there are more providers here,” said Shaddy, who runs a sober living facility in Omaha.

People undergoing substance abuse treatment in Nebraska often are shuffled among hospitals and detox facilities, short-term inpatient treatment centers and longer-term options like sober living houses — many of which are nowhere near the patients’ homes, Kasperbauer said.

And each move means starting over, having to retell traumatic events and connect with new providers. It isn’t an effective way to recover, Shaddy said. He sees patients build a great foundation at treatment facilities in Omaha.

“But once they have the option to go back home, who wouldn’t want to go back home?” Shaddy said. “They go back to their families … and once they get back, they lose everything they’ve just built.”

Shaddy now works with Revive to ease patients’ transitions back into the central parts of the state. He usually has six or eight clients waiting to get into a treatment center. Some wait months for a bed to open up.

When a person decides to seek treatment, Schroeder said, they’re often not in a stable situation, and Revive needs to get them through the door quickly.

“If they reach out for help,” Schroeder said, “it is a matter of life or death.”

People are dying of drugs in Hastings, Revive’s leader says. They just aren’t being counted.

Kasperbauer said she personally knows of four people who likely overdosed in the past year. She learned how they died only by word of mouth.

Adams County, home to Hastings, had 21 reported drug-induced deaths over a five-year period. Some years, it has reported only one or two deaths. Revive’s clinicians say those numbers don’t match what they’re seeing.

Schroeder said she knew of at least three apparent suicides within a two-week period that may have actually been overdoses. Her clients all have multiple friends who have died of drugs.

“It’s an outright tragedy for Nebraska to say overdose isn’t an issue here,” Schroeder said.

From 2019 to 2023, 25 different rural Nebraska counties reported no drug-related deaths at all, a Flatwater Free Press analysis found.

Those apparently low overdose numbers across rural Nebraska influence policy discussions in Lincoln and play into the broad perception that drugs aren’t a problem in rural parts of the state, said Lyons, the Revive counselor whose brother died of an overdose.

Nebraska receives federal funding to reimburse counties for toxicology tests that coroners order for suspected overdose deaths. The point of this funding: improve data quality.

But the 11 counties in the Nebraska Panhandle’s behavioral health region didn’t request a single toxicology test reimbursement in 2023 or 2024. Dundy and Loup counties haven’t even created accounts needed to access the program, according to state records.

The 22 counties in Region 3, which includes Hastings, used the program for 14 toxicology tests over two years.

Several county attorneys told Brittany Willmore, who studied the program with the University of Nebraska at Omaha, that they did fewer than 10 death investigations in a year, and none were drug involved.

“But I had kind of a hard time understanding how none of them could be drug involved if they weren’t necessarily doing the toxicology screening,” Willmore said.

As Revive cleared trash, tore out damaged carpets and drywall and filled in the Motel 6 pool to build a new treatment center in Hastings, legislators convened in Lincoln and approved a budget that cut $15 million in behavioral health funding.

That decision “dealt a huge blow” to Revive as it worked to open the new detox center, said Kasperbauer, its CEO.

The budget cut has trickled down to the people working to combat drug overdoses in every area of the state. Region 3 in central Nebraska lost almost $3 million, which impacted work “drastically,” Kasperbauer said.

The nonprofit operates with little support from the state’s Department of Health and Human Services. Revive has no contract with the Division of Behavioral Health for its new detox program, no funding for its long-term treatment programs and limited funding for short-term treatment.

When Kasperbauer joined in 2023, the organization’s top priority was adding detox and inpatient treatment. Revive raised $2 million by spring 2024, she said, mostly through the local community and funding from Region 3, to buy the hotel.

Revive was at full capacity for inpatient beds within the first month.

Often, the treatment center starts providing services to patients while enrolling them for Medicaid, with the hope that they will get reimbursed after the paperwork goes through.

If a patient is denied Medicaid coverage, Revive sends them a bill. But that’s not always possible — for example, if a patient is homeless.

“We’ve had to eat quite a lot of our bills,” Kasperbauer said.

When treatment programs aren’t available, Kasperbauer said, more people end up in emergency rooms, courts or jail — costing more in the long run.

Before Revive opened its own detox facility this summer, Kasperbauer said, many Hastings-area residents struggling with substance abuse landed in the ER at the local hospital and filled beds in the psychiatric department.

“It’s so frustrating for the state to not recognize the need for resources when people are working so diligently out here,” Kasperbauer said.

Meit’s Center for Rural Health and Research identified nine state-level policies that support substance use disorder prevention and treatment.

Nebraska, he said, has only two of those in place: a Good Samaritan law that protects people who call for help when someone is overdosing and a policy requiring certain substance use disorder providers to help patients access treatments like methadone.

But Nebraska doesn’t require private insurers to cover that medication, Meit’s study found. The state’s Medicaid plan also does not include behavioral health support for patients undergoing medication-assisted treatment.

Medicaid expansion enabled some states to reduce overdoses, Meit said. But recent federal cuts will slow that progress and make substance abuse treatment less available, he said.

Other incoming federal cuts worry local organizations like Revive, whose leaders say that COVID increased their communities’ needs tenfold. That need, they say, has not decreased.

But even as its budget is squeezed tighter, Revive keeps working toward expansion. The nonprofit is hoping to renovate more of the abandoned hotel and grow its capacity.

Because the patients keep coming — from every corner of the state. Patients from 19 to 72 years old, patients of every gender and race, from all walks of life.

The staff of Revive, many personally touched by addiction and overdose loss, know that for those patients, their work is a matter of living or dying.

“Addiction is not prejudiced. Addiction doesn’t care what you look like or what you believe,” Kasperbauer said. “There’s a lot of pain and shame that comes with it, but we’re all affected by it.”

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This story was originally published by Flatwater Free Press and distributed through a partnership with The Associated Press.