CLEVELAND - As the opiate crisis continues to kill a record number of people, a little-known federal rule has kept treatment centers so small that they turn away thousands of people a year who want help.
"When you use heroin, you can't wait a couple hours. When you need help, you have to be able to literally walk right in," says Christa Sirois of Massillon.
Sioris, 32, has now been clean for four months, after being addicted to heroin for two years.
When she decided to try to get clean, Sirois says she called fifteen treatment centers.
None of them could take her right away, and most told her to call back not in days, but in weeks.
"I don't have two weeks, I just don't," she remembers thinking, "or I'm going to die."
Fortunately, Sirois had family that stayed with her during what's known as the "window", the time when addicts realize they want help - if they can find it.
"The people who don't have family, and can't find help, those are the people who just give up," she says, "and those are the people who just keep dying." So what's the problem?
"Medicare or Medicaid will not pay if your institution has more then sixteen beds available for those suffering from mental illness or substance abuse," says Cuyahoga County Drug Court Judge David Matia.
The 16-bed limit was put in place decades ago, and for what was at the time a good reason.
It was designed to prevent people with some mental disabilities from being "warehoused" in large institutions when they really belonged in the community.
At the time, no one could foresee a huge heroin epidemic coming, fueled by the over-prescribing of opiates by doctors and dentists, where so much more treatment would be needed then is available.
Cathy Farrell is a nurse who knows Christa, and has driven another friend from rehab center to rehab center, looking for an empty bed they never found.
"You're sitting there watching someone go through withdrawal," she says, "throwing up, and being in pain, and not being able to eat, literally crying because they want to get help."
Now, a Presidential Commission has recommended sweeping changes that may help.
The first specific proposal is to waive the 16-bed limit to allow centers to treat more people, and still receive federal funds as payment for patients who don't have insurance. Another key recommendation is to encourage more "MAT" - medicated-assisted treatment.
Experts say that mounting evidence shows that using medication to help ween addicts off opiates does work.
But, to prescribe at least one of the medicines that helps with heroin withdrawal, doctors need a special waiver.
"There are thousands of doctors in Cuyahoga County," says Judge Matia, "and less than a hundred have this waiver."
President Donald Trump has now declared the opiate epidemic a national emergency, which should allow for his commission's proposals to be put into place.
It should also free up federal disaster funds to be used to help pay for treatment for addicts.
Back in Massillon, Christa Sirois now looks like a happy mom, as she plays with her four year-old daughter, Journey.
She is on medicated-assisted treatment, and sees a counselor on a regular basis. "I'm wonderful," she says, " I have my life back."
There is hope in the battle against addiction, but mostly, for those who are able to get help.