Medicating heroin addicts: Is it a problem?

Ohio spent more than $71 million treating addictions with drugs like Suboxone, Vivitrol and Methadone through Medicaid in 2014

YOUNGSTOWN, Ohio (WKBN) – The state of Ohio is dealing with a heroin crisis right now.

According to data that Ohio Attorney General Mike DeWine presented in January, Ohio had the second-most overdose deaths of any state in the nation in 2014, and more than 1,000 of those overdoses were attributed to heroin alone.

A large part of the state’s response to the problem has been medication. In 2014, Ohio spent more than $71 million treating addictions with drugs like Suboxone, Vivitrol and Methadone through Medicaid, as well as other money through Ohio’s publicly-funded treatment services, although it is difficult to know exactly how much.

Ohio Department of Mental Health and Addiction Services Assistant Medical Director Justin Trevino said people who are opioid-dependent have a 90 percent chance of relapsing within their first year of treatment, if they don’t use any kind of medicine.

“When we talk about…opioid dependence… We’re talking about all the bad things that go along with that, other health problems and issues, you’re not attending to your family, you’re not working jobs,” Trevino said. “At some point…you’re not really in control of that in the sense that you’re not making good, rational choices.”

Treating drug addicts

Department of Mental Health and Addiction Services Media Relations Director Eric Wandersleben said patients who are treated with methadone, for instance, are usually on it for at least 12 to 18 months, and many individuals are on it for much longer.

Trevino said that it is generally a good idea to keep someone on medication for about that long in order to deal with the baggage of drug addiction. One government pamphlet on medical treatment for drug addiction states that recovering addicts can safely take medicine as long as needed, even for a lifetime.

Wandersleben said overall, keeping people on some form of treatment for 12 to 18 months is worth the side effects, since it saves the state money and helps recovering addicts live more responsible lives. Wandersleben said one year of treatment and counseling is cheaper than the $25,000 it costs, on average, to house an offender in a prison. He also said if medical treatment helps get rid of other societal costs of addiction, such as child welfare, homelessness, unemployment and visits to the ER, it is easily worth the cost.

“When you’re wrapped up in something, it’s hard to sort of see the mess that’s happening with you,” Trevino said. “The whole idea here is to get you really functional in your life, not to just keep you off the street drug, but you’re gonna lead this sort of low-quality life…The goal is to help you really lead as full a life as you can.”

But for some former addicts, the line between illegal drugs and legal ones is somewhat blurry. While doctors insist that medication is not simply switching one addiction for another, there are a number of people who believe that a medical solution to drug addiction is still not ideal.

“I would say this, methadone is not freedom, methadone is living the rest of your life dependent on a mood-altering substance,” said a former opiate addict who used methadone and has been clean for more than 25 years.

Switching one addiction to another?

A former Columbiana County drug addict who requested to be called “Edward” said that he thinks suboxone can be effective as a detoxifying agent, if used temporarily.

“But in today’s world, many folks are receiving it for extended periods of time,” Edward said. “That’s just trading the street dealer for the dealer with ‘Dr.’ after his name.”

Edward said he used speedball, a mix of heroin and cocaine, and he lost everything he valued because of drug use. While he sees the value of medicine in preventing some of the more serious effects of drug use, he believes that long-term treatment with medicine is not the answer, although he did not use methadone himself to get clean.

“Yes, it takes the street away, it takes the danger and some of the affiliated crime away. And if that’s their only goal, then I guess they’re successful in it,” Edward said. “If they want to treat addiction, only one thing works, and that’s complete abstinence from all mind and mood-affecting drugs, all of them. I know many people who have… gotten clean from methadone, and it may well be more difficult than getting clean from heroin itself.”

Cindy Woodford, chief operating officer of First Step Recovery in Warren, said while the organization encourages recovering addicts toward total abstinence, they are not closed off to the use of medicine, although they do not prescribe suboxone or methadone.

“While total abstinence is the goal, and change is the goal… people are dying in the meantime, and what do we do about that?” Woodford said. “We can’t apply a cookie-cutter approach, and if someone is resistant to total abstinence, we need to take a look at that patient and what are the reservations, what is the resistance.”

First Step’s model is based on 12-step programs, like Alcoholics Anonymous and Narcotics Anonymous, but Woodford said abstinence-based programs and the use of medicine need not be in conflict.

“The war, as we see it, is with disease and addiction, and it’s not about my treatment is better than your treatment,” Woodford. “As long as it’s done properly and the goal is to use that medication as a short-term vehicle towards total abstinence, we support that.”

Pairing medication with counseling

Mahoning County Mental Health and Recovery Board Associate Director Brenda Heidinger said methadone is a mood-altering drug and can be addictive, but can be used in good or bad ways.

“People who are in long-term recovery, who did it on an abstinence basis…may have personal views that abstinence is the only way to go,” Heidinger said. “There are others in the medical community that really look at opioid dependence a little bit different than alcoholism and some of the things we saw in the past and recognize that short-term medication-assisted treatment can really help with the counseling process.”

Heidinger added that doctors usually try to get patients off medication after short-term use. While there are people who take methadone for life, those cases are not the norm, she said.

 

Dr. Trevino and Dr. Joseph Lydon, who works with First Step in Warren, both said the side effects of methadone are relatively mild, as long as patients get the proper dose. Trevino said the side effects can include constipation and low sex drive.

According to Heidinger, medicine can be an initial boost to help fight off the worst symptoms while addicts try to get clean. While users initially need a drug to feel high, they eventually need the drug just to feel normal, she said.

“Methadone and suboxone…are most effective at the beginning of treatment,” Heidinger said. “They’re to help the person not have withdrawal, not have cravings, because you can’t very well sit down and talk to a therapist if you feel like you’ve got the worst case of the flu ever.”

She said the board looks at medication as an addition to other forms of treatment like 12-step programs, group counseling, professional counseling or other fellowship. Edward also noted that being in community can be helpful for those trying to get over addiction.

But the use of medicine does not mean that the addict’s responsibility is removed, Woodford said.

“The fact that a person has the disease of addiction doesn’t absolve them from responsibility,” Heidinger said. “The person is responsible to seek the help for the disease…we’re all accountable for our actions.”

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