New London — Heroin and prescription opiates have replaced alcohol as the primary drug of choice for uninsured and underinsured residents of Connecticut over the past five years, according to the commissioner of the state Department of Mental Health and Addiction Services, who said Thursday that, based on the number of overdoses being reported, there's more her agency, which she referred to as "the safety net provider," can do to prevent addiction and treat those who need help.

Miriam Delphin-Rittmon, appointed DMHAS commissioner in March 2015 by Gov. Dannel P. Malloy, addressed the opioid crisis during a meeting with The Day's editorial and reporting staffs. 

Nearly 20,000 people, or 45 pecent of those admitted to treatment by the agency in 2015, identified opioids as their primary substance of choice, she said.

Even Delphin-Rittmon, who has a doctorate in clinical psychology and served as a senior adviser to the federal Substance Abuse and Mental Health Services Administration, has a personal story to tell about the over-prescripton of pain medication, which she said is one of the factors driving the dramatic increase in addiction.

"My husband got in a snowmobile accident last winter, and he got 90 pills plus a refill," she said. "He took one and said, 'I can't think straight.'"

Limiting access to prescription pain medication is one of the state's prevention strategies.

The General Assembly passed a law this year that limits opioid prescriptions to seven days in many cases and requires pharmacies to submit information about all controlled substances to a state database, required communities to train and equip first responders with the overdose-reversal drug nalaxone and made it more widely available to the public.

Last year, she said, 23,451 pounds of medication — not all of it opiates — was collected through the state's prescription drug dropbox program.

Responding to reports by members of the community that detoxification and treatment beds often are unavailable to those who are ready for help, Delphin-Rittmon said that in those cases, the agency "more often than not" can connect its clients with other services, including outpatient counseling and medication-assisted therapies, such as methadone and Suboxone.

"We often can get a person linked up somewhere," she said.

In most cases, DMHAS does not work with people who have private insurance, she said.  

Delphin-Rittmon said DMHAS has been trying to share with the public the proven effectiveness of medication-assisted therapies and that, despite what she has heard from families at some 25 forums across the state, long-term inpatient treatment is not always the best path to recovery.

She said it disconnects people from their communities, families and everyday lives.

Instead, she suggested detoxification from the substance followed by three to six months of treatment.

"I think it's better for a person as soon as possible to be in their environment, to get linked up with a sponsor, linked up with counseling or therapy," she said. "I would argue that's going to be more valuable."

The agency has worked to develop a broad spectrum of services, including individual counseling, recovery centers and help lines. For those uninterested in formal, traditional treatment, there are alternatives such as meditation, yoga, drum circles and reiki, all of which recently were funded by the Substance Abuse and Mental Health Services Administration.

Delphin-Rittmon said her agency cannot regulate privately owned sober houses, where many in recovery live after completing inpatient treatment or receiving outpatient services.

New London has about 30 recovery houses, and city leaders are encouraging them to become certified by the Connecticut Community for Addiction Recovery, which is one of DMHAS's service providers.

The sober houses are subject to local zoning regulations, but also are protected by the Americans with Disabilities Act.

Delphin-Rittmon estimated there are 130 to 160 such homes across the state.

"The thing that makes it complicated is that they are not treatment facilities," Rittmon said. "Anyone could buy a house and decide they're going to call it a recovery house."

The DMHAS also does not have oversight over private treatment providers, such as Stonington Institute, a substance abuse treatment organization in southeastern Connecticut.

One thing the agency and the nation should not do, the commissioner said, is get "hyperfocused" on any one substance.

She said many people use multiple substances and noted the looming presence of new and even more deadly drugs.

Carfentanil, an elelphant tranquilizer that is 10,000 times stronger than morphine, has showed up in Ohio, Kentucky and Florida, but not Connecticut "as far as we know," Delphin-Rittmon said.

k.florin@theday.com