ADDICTS FIND REFUGE AT CLINIC, SAY MMT TURNED THEIR LIVES AROUND

Great article supporting MMT for short term or long term treatment.
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http://www.fosters.com/apps/pbcs.dll/article?AID=/20100502/GJNEWS02/305029998

Addicts find refuge at clinic, say methadone treatments turned their lives around

Eddie was 18 when he took his first Percocet. He had torn cartilage in his knee from playing high school football and baseball and needed surgery. He had never taken an opioid analgesic before, but, said Eddie, "I think I was addicted the first time I took one."

Today he is 49, his knee still bothers him and so does the addiction that has plagued him for most of his life.

Scott was even younger. He was 13 when he took his first step toward addiction. Like many adolescents, he had friends old enough to buy alcohol. "And, uh, that got me started. Off we went." Alcohol led to prescription pain killers, and pain killers led to a self-destructive life spent avoiding withdrawal symptoms.

"It just blossomed and kind of steam rolled me from there," said the 47-year-old.

Tortured as they were, driven by a chemically altered brain that thought opiates were as essential to life as water, these men, whose last names are being withheld to protect their privacy, were able to find their pride again, their self esteem, their peace, security, love and healing. They checked into a methadone clinic.

Community Substance Abuse Centers, a privately owned company, has 13 clinics throughout New England, including one at 200 Route 108 in Somersworth and another at 177 Shattuck Way Newington.

The organization has been taking care of people suffering with opiate addiction since it opened its first clinic in Westfield, Mass., in 1989. Most of the 220 patients at the Somersworth branch come from the Tri-City region, but some drive daily from as far as Carroll County to receive treatment with methadone.

In 2002 it was estimated that 4.4 million Americans took pain killers for non-medical use. For those who became addicted, Methadone Maintenance Treatment, or MMT, is one of the many routes back to health.

Methadone, originally approved by the USDA as a painkiller in 1947, is used to eliminate the cravings for and withdrawal symptoms of illegal opiates such as heroin and prescription opiate pain killers like Percocet, Vicadin and OxyContin. It works because it is an opiate itself. It travels to the same receptors in the brain, alleviating the need for other opiates.

It has been argued the patient basically replaces one drug for another. However, proponents of methadone treatment argue the drug is not equivalent to the drugs causing addiction.

Plans to open methadone clinics in communities often run into opposition by residents concerned the facilities will attract unsavory addicts and lead to increased crime. Last year in Laconia, Colonial Management Group decided not to open a clinic after the city required it to pay for a police officer and cruiser to be onsite whenever it was open. In Sanford, Maine, in 2008, the same company's efforts to open a clinic there were stymied by an ordinance that severely restricted where it could be located.

Proponents of methadone argue that in the right dosage, it doesn't have many side effects like drowsiness or euphoria. In fact, it has the effect of blocking euphoria caused by other drugs, thereby discouraging illicit drug use. Additionally, because methadone stays in the system longer than other opiates, patients don't spend their whole day trying to alleviate cravings or withdrawal symptoms.

The literature handed out by the Somersworth clinic, which is named Merrimack River Medical Services, also states that, unlike other opiates, a person's tolerance to methadone doesn't change much. This means their dose doesn't have to increase to produce the same effect.

Methadone isn't a cure, though. When used in conjunction with counseling, patients can get away from self-destructive behavior and put their lives together again. Given time, they can start weaning off methadone and become free of dependency on opiates.

The medical community is open minded about addiction, viewing it as an illness rather than a social failing, said Maury Elsasser, senior counselor at the Somersworth clinic. Society as a whole can be very critical, labeling those dependent on drugs as hedonistic, immoral, weak minded and failures, he said.

"The world isn't so forgiving," he said. "The stigma in the world is what they're most concerned about."

Eddie, who lives in Rochester, sought treatment at the clinic five years ago.

"I'd probably be dead now if I hadn't gone," he said.

The brain develops a tolerance to opiates the more they're used. It takes larger and larger doses to satisfy cravings or produce a high. As a result, by the time Eddie was ready to make a change, he was taking 40 to 60 Vicadin or Percocet a day.

According to Sheila Plourde, a pharmacist at Maine Medical Center in Portland, doses this high would put the average person in the hospital. But people who have built up a tolerance can endure higher doses. The primary danger to these individuals comes from the acetaminophen (an ingredient in many over-the-counter pain relievers) in Vicadin and Percocet, which causes severe liver damage in high doses.

Eddie was apparently aware of this.

"I was more worried about hurting my liver than not waking up," he said.

Nevertheless, he would drive all over the state, 200 miles a week, to get his drugs, visiting drug dealers, emergency rooms, family practitioners and conning pain clinics with his rusty knees. He even drove all the way to Vermont once for drugs.

Others, he said, have gone so far as to injure themselves so they'd have a legitimate reason to go to the emergency room and get a fix.

"You think of the worst flu you ever had (but) 10, 10 times worse than that," that is what withdrawal feels like, explained Eddie, who was desperate to feel normal.

He didn't always get away with drugs, though. Sometimes a doctor would reject him.

"It's like somebody telling you your kid died," said Eddie. "It's horrible."

Nevertheless, he got away with a lot. Even his personal doctor, despite suspicions, continued to write him prescriptions.

"He bitched all the time but he still gave it to me," he said. "Some doctors give them out like candy (and there are) some doctors who don't."

Dr. Michael O'Connell, the owner and CEO of PainCare, a statewide pain clinic that has a branch down the street from the Somersworth clinic, has been lobbying the state to help prevent "doctor shopping" by creating a password-protected, online database that would make available all of a patient's opioid analgesic prescriptions written in the state over the previous year.

But in the meantime, doctors continue to aid possible addicts or get hoodwinked by seemingly genuine patients. Opiate analgesics, as these drugs are officially classified, aren't cheap. For example, one 40 mg OxyContin pill can cost $20 on the street. Eddie would take as much as 800 milligrams in a day, and sometimes more. That's worth $400.

Drugs are less expensive at the pharmacy, but still can be a significant financial drain.

At the pharmacy, the lowest dose of a single generic Vicadin or Percocet costs $4.36, and a generic OxyContin costs $4.01. At the rate Eddie took these, he could spend at least $160.40 a day. That quickly adds up.

Despite being employed as an engineer, Eddie was forced to pawn things to help pay for his habit. He even pawned his grandmother's diamond wedding ring for $250, a ring he was going to give to his daughter when she grew up.

"I can't believe I did it," said Eddie, who couldn't say enough to describe how terrible he felt about it. "If I can take anything back, that's it right there."

On top of it all, he was also an alcoholic — something he shared with Scott.

Scott, also from Rochester, attributes the beginning of his problem to his crazy youth. It's almost a rite of passage in the United States for teenagers to rebel, drink, and try things that make their parents' hair turn gray a bit faster. Scott was no exception.

"I think most of us have experimented on some level," he said, "but for me it just took off."

Once hooked, he ended up searching out 80 to 200 milligrams of Vicadin, Percocet or OxyContin a day and had very much the same experience as Eddie: being sick, missing work, hunting for drugs, spending between $200 and $1,500 a week, missing out on time with his family. It wasn't until he was in his late 20s that he started to think there was something wrong.

"From 25 to 30 it started to hit me that I may have a problem with this stuff," he said.

The big clue for him was that he needed drugs to feel normal. It was another 20 years, though, before he did something about it.

"I reckoned, OK this is the very end of the road. You're in your 40s. You have to do this now," he said.

Two years ago, unable to quit on his own, despair brought him to his doctor. There he threatened, "if they didn't help me they may not see me again."

They referred him to the methadone clinic, and he made an appointment.

Eddie was brought to an epiphany by his wife, who discovered his habit when she found pills in his car. Until that point he had been able to hide his condition from his family. But when he got up one morning and found the pills on the front seat, placed there by his wife, it was all over. He described the reaction from his kids saying, "We didn't realize why you were the way you were, all **** up all the time."

Eddie quit cold turkey and managed to stay clean for six months. But he relapsed and started shopping pain clinics. It wasn't until after his wife found the drugs again that he made his first appointment at the methadone clinic in Somersworth. He missed it because he got cold feet, but rescheduled.

That first appointment is an important but sensitive one, according to Robert Potter, the vice president of planning and development at Merrimack River Medical Services. The people who come to them are driven there by desperation. Often they have burned all their bridges, alienated their friends and families, exhausted all other means of healing, and the clinic is their last hope for a normal, happy life.

"This is the end of the line, and they never thought they would be at the end of the line," said Potter.

"In my mind this was my last defense. This just had to work. It just had to," said Scott, who felt fortunate his daughters hadn't been affected by his illness and that his wife of 20 years supported him through it all. "I was very, very lucky. She's a wonderful person."

Not all their patients are junkies out on parole, explained Potter.

"I can't tell you the range of people who get addicted," he said. "It goes right up the economic ladder."

However, because these peoples' lives have gotten so out of control and because of the stigmas of society, they often have lost all respect for themselves and feel they have lost the respect of their community and family as well. As a result, an important part of the healing process is treating patients with the dignity and respect they thought they had lost.

"Some come in cuffs" and they treat them with just as much respect as someone in a three-piece suit, and "that's why I like them," said Eddie.

The first appointment involves being assigned a counselor. They will gather information and be their patient's guide throughout their recovery. The same day the patient will also get a physical, a blood screening, a urine screening, and their first dose of methadone.

The initial dose is only 30 milligrams. However, it is increased day by day over a seven- to 10-day period until the patient's vitals stabilize.

"The methadone just stops the madness," said Scott. "It gives you a time out from the addiction."

"Methadone makes me feel normal, like a normal person," said Eddie. "I don't get high. It just makes one feel normal."

It also costs a lot less. A week of treatment at the clinic is only $105. It's even covered by some private health insurance companies like Blue Cross Blue Shield, which covers 70 percent of Eddie's bill. As an added benefit, both Eddie and Scott discovered they didn't want to drink anymore after starting on methadone.

The methadone, however, is the easy part. The hard part, said Potter, is counseling. Methadone helps stabilize a patient biologically, but counseling helps emotionally, socially and spiritually. It gives people the tools to cope with whatever problems got them into addiction and held them there, and it helps them put their lives back together.

It helps them find a job or, if they haven't entered the workforce yet, it helps them complete their education. If they damaged their relationship with their kids, they can repair it. If they broke up with their wife or girlfriend, they can potentially get back together or, alternatively, explained Potter, if their partner is a negative influence, counseling can help them get out of the bad relationship. Taking your life back doesn't happen automatically, though.

"Like any type of counseling, you need to make an investment," said Scott. "It won't just happen. You have to apply yourself."

If a patient doesn't stick to their schedule, warned Potter, they probably won't succeed in breaking the habit and getting their lives back together. They have to drive to the clinic every morning when the clinic opens at 5:30 a.m. to get their methadone, and they have to keep up with counseling sessions.

For someone who has been addicted for five years, Potter says treatment can last 12 to 18 months. However, for those who have been addicted for almost a lifetime, like Eddie and Scott, their brain chemistry has changed so much they may not be able to get off methadone.

Both men would like to be free of it. But neither is ready to make the leap, a decision that belongs to them, not their doctor.

"A diabetic wouldn't stop taking insulin because they're sick of taking it," said Scott.

Whether free of methadone or not, the difference in these men's lives has been profound.

For Scott the biggest change has been stability. An average day for him was spent trying to find a dealer, staying loaded, and making sure he had enough money to pay for it. He described his life as a physical and emotional roller coaster, one he was extremely happy to put behind him.

In addition to the financial, social and emotional benefits, both men say they have a closer, more active relationship with their families as a side effect of being normal again.

Eddie, for instance, goes to all of his kids' hockey and baseball games now.

It's important "because I remember when I was a kid my dad went to every game that I played, I can't imagine him not being there," said Eddie. "I just thank God now that I'm healthy, have a wife and four loving kids and a steady job."