Since Hurricane Maria pummeled the Caribbean in 2017, the island of Puerto Rico has been dealing with destroyed buildings, electrical outages and a lack of necessary resources like food and water. These are all problems brought on by a storm that killed anywhere between 64 and nearly 1,100 people on the island. Different media outlets have reported different numbers of deaths in part due to the widespread severity of the damage, making it difficult to get an accurate number.

Before Maria devastated the island, Puerto Rico dealt with challenges similar to the United States, including poverty, crime and addiction. Another major problem for the island — one that has persisted there for decades — is the drug addiction crisis and the unsuccessful efforts to help those suffering from substance use disorders.

Drug addiction and overdose issues are not isolated to Puerto Rico. Between 2014 and 2016, all but nine states in the U.S. saw an increase in their overdose death rates, which is determined by the number of overdose-caused deaths in a geographical area in a given year per 100,000 residents. With that said, the death rates of all 50 states have increased since 1999.

The United States as a whole is no different. From 2014 to 2015, the country’s overdose death rate increased from 14.7 to 16.3, and then up to 19.8 in 2016. The country’s battle against rising opioid addiction and prescription drug dependence is a growing concern for regular citizens and politicians.

In Puerto Rico, though, the drug addiction crisis is at a more critical state. According to an article by the Guardian, as of 2013, an estimated 60,000 people on the island misused drugs regularly by injecting substances such as heroin, fentanyl and other drugs into their veins. Puerto Rico has long been a popular transfer point for drug cartels due to its geographical location to the U.S. and its prominence as a major port for incoming and outgoing goods. This culture has led to the rise of heroin, fentanyl and horse tranquilizer misuse in recent years on the island. Due to the large number of people injecting drugs, Puerto Rico has one of the highest HIV/AIDS rates among all U.S. territories and states, as reported by by the Miami Herald. Around 40 percent of people infected with the disease are suspected of contracting the virus from intravenous drug use, according to the article.

Even with this growing problem, The Miami Herald states that the U.S. commonwealth only has a dozen detox centers and around 4,400 beds in residential treatment centers, “with few offering drugs such as methadone and buprenorphine to wean users off heroin.”

The lack of withdrawal-blocking medications is not the only thing missing from Puerto Rico’s treatment facilities. Many of the facilities struggle to provide adequate treatment to people in need in other aspects of healthcare, too.

What’s Missing From Puerto Rico’s Drug Treatment Services

Compared to mainland states, Puerto Rico has a much higher percentage of rehabilitation facilities that accept Medicaid, Medicare and private insurance plans, according to data from the Centers of Disease Control and Prevention. Around 85 percent of the facilities accept Medicaid and 86 percent accept Medicare.

Medicaid is a health insurance program funded together by the federal and state governments and is available to low-income and disabled people of all ages. Nearly 74 million people — around 1 in 5 Americans — were enrolled in Medicaid and CHIP (Children’s Health Insurance Program) as of February, 2018. Medicare, which is a government-funded health insurance program for residents ages 65 and older, covers 44 million people, or around 15 percent of the U.S. population.

However, these numbers don’t necessarily indicate a healthy system for dealing with drug and alcohol addiction. In Puerto Rico, only 50 percent of facilities offer intensive outpatient programs, 12 percent have adolescent programs, 66 percent provide transitional aftercare and 62 percent consistently use trauma counseling. These figures, which are lower than all mainland states’ percentages, are just a few examples of the lack of comprehensive rehabilitation treatment offered at many facilities in the commonwealth.

At a nearly 45-percent poverty rate, many in Puerto Rico rely on government-assistance programs like Medicaid and Medicare, which can limit access to treatment facilities. Because Medicare and Medicaid are government-provided insurances, the payments to the medical facility are often lower than out-of-pocket or private insurance payments. These smaller payments for medical costs — in some cases multi-billion-dollar shortfalls between the reimbursements and the actual hospital bills — can prevent facilities from spending on extra staffing and resources that are needed to provide all levels of care to clients.

Add in Puerto Rico’s $73 million debt crisis and there isn’t much government assistance to help these facilities. However, not accepting these types of coverages could significantly reduce access to treatment for a large chunk of the population.

On an island where rehabilitation resources are scarcer than in every mainland state, the people trying to fix the problem have no choice but to ask others for help.

Puerto Rico’s Addiction Dilemma

The limitations in the number of facilities, and the levels of care offered at many of them, has led to a grave problem in how officials in Puerto Rico help individuals suffering from addiction. There are so many people needing help and so few resources that the commonwealth’s government, at times, resorts to sending people to Chicago and Philadelphiafor treatment.

“For the past decade, Puerto Rican officials have sent nearly 800 heroin users to the mainland United States as part of a questionable response to an overwhelming drug problem occurring on the commonwealth,” an article on titled “Why So Many Puerto Rican Addicts Wind Up in Chicago” states.

The Puerto Rico government even acknowledges the struggle — and the fact that the people being sent to the mainland U.S. often don’t get the treatment they need. The island’s Administration of Mental Health and Addiction Services issued a press release in 2014 explaining the island’s handling of substance use disorders. It states, “Given the lack of treatment options Puerto Rico faces, some people, families or entities have opted to transfer people with substance abuse disorders to organizations located mainly in the eastern part of the United States, without getting the information about the qualifications of such centers.” Many of the people sent to the United States never receive the necessary help and are left to fend for themselves in major U.S. cities.

Help is needed for Puerto Rico in numerous capacities. Not only is the island struggling to provide basic utilities post-Maria while moving forward with an unstable infrastructure, Puerto Ricans are at a higher-than-normal risk of drug addiction, as evident by the 60,000 people who are addicted to injecting drugs and the nearly 100 criminal gangs tied to drug trafficking. Making matters worse, the people in need often do not receive adequate treatment to effectively begin long-term recovery.

Although Puerto Rico’s rehab facilities often accept more types of insurance than mainland American centers, options remain limited for many. While there is no quick fix or easy solution to Puerto Rico’s drug crisis, there are small steps that individuals can take. Whether it’s seeking treatment on the mainland or building community involvement to prevent addiction, there are paths for the government and people to improve the drug crisis. Moving toward a more stable economy, preventing gang involvement by integrating community events and groups, and providing more education for residents are just some preventative measures to help reduce substance addiction throughout the island.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.