Lawyers' Concerns: Getting help for kicking painkillers, without health insurance

Issue July 2005

Q: I am a 50 year-old solo practice lawyer, and I think I continue to turn out very good work. I am also a fairly conventional person. But the fact is I am addicted to opiates. I was introduced to them when, a decade ago, I had the first of a series of surgeries for back and joint problems and needed painkilling medication to recover. I’m not certain where the pain ended and the addiction began, but I have developed a very high tolerance and a true dependence. Whenever I try to walk away from these pills, I get very, very sick and simply cannot cope with my responsibilities. I am finally realizing that I need help to get unhooked, but I have run into some roadblocks because I have no health insurance. What options do I have?

A:Here we run into the problem of living in a land where health insurance is not universal, and where many cutbacks have been made in both private and government-supported services.
For detox, you have essentially three possibilities:
First is one of the public detox facilities supported by the Department of Public Health. They may not be particularly inviting places but can safely withdraw you from opiates. Generally you must call every morning to ascertain whether a bed is available. Another route into public detox can be through a hospital emergency room. Some of the Boston hospitals, like Massachusetts General and Boston Medical Center, have traditionally been accustomed to checking around for beds when they evaluate intoxicated patients.
Second is “free care” at a general hospital that has a detox unit. This requires a potentially time-consuming application process, including proof of income and assets, but offers a wide range of medical services at that hospital to those who qualify.
Third is an office-based detox (or maintenance) option now offered by a small number of specially certified physicians and clinics using either of two medications: Subutex or Suboxone. Office-based detox usually involves a fee for both physician and medicine, unless you find a free-care option through a hospital clinic.
Detox, however, is only the beginning, and relapse potential is significant enough to warrant further assistance.
For some people, a combination of self-help meetings (e.g. Narcotics Anonymous) and professional outpatient treatment (either self-pay or via hospital free care) may be sufficient. Others will find that they need a longer period of time away from home and their usual haunts.
Massachusetts has a number of halfway houses with no financial barriers, but gaining admission may take months and many will require that you come directly from a hospital. So-called “sober houses” are rented residences of various kinds that require abstinence as a condition of tenancy. Some have a staff and may provide house meetings or transportation to self-help meetings; others are essentially boarding houses.
A number of other facilities, typically in other states, offer a combination of residence and counseling at a price well below an insurance-oriented Massachusetts program.
That is only a general overview of the kinds of resources available to the uninsured person with an addiction.
As usual, we suggest that you arrange a face-to-face meeting with one of our staff, who can review the particulars and assist you in the search for appropriate resources. In some cases, LCL may be able to lend you funds to help cover treatment costs.

Questions quoted are either actual letters/e-mails or paraphrased and disguised concerns expressed by individuals seeking assistance from Lawyers Concerned for Lawyers.
Questions for LCL may be mailed to LCL, 31 Milk St., Suite 810, Boston MA 02109; e-mailed to [e-mail email] or called in to (617) 482-9600. LCL’s licensed clinicians will respond in confidence. Visit LCL online at
The June Q&A column contained misleading information because of an editing error. Although the medication Topamax (Topiramate) is not yet FDA-approved for alcoholism treatment, it is an FDA-approved drug for its original purpose of controlling seizures and also now for preventing migraines.