Heroin Addicts Struggle to Get Medicine Treatment

Terry DeMio, tdemio@nky.com 1:51 p.m. EDT October 12, 2014

methadone treatment

(Photo: The Enquirer/Patrick Reddy )

Northern Kentucky’s only provider of methadone treatment for heroin addicts is losing patients who can’t afford to pay for their medicine.

For the 90-plus patients at the NKY Med Clinic who can’t pay the $450 per month, it means a high risk of relapse and heroin overdose.

Cathy Daines of Bellevue said her son is among those who will lose what she considers a life-saving treatment for him. He has asked to be weaned off methadone because of the expense. It was a treatment that was working.

“I am so afraid,” she said.

Unlike Ohio, Kentucky’s Medicaid program won’t pick up the cost. And, the state Cabinet for Health and Family Services did not expand Medicaid to include the drug this year. There is “opposition and fear” and need for education about methadone, said Jill Midkiff, spokeswoman for the Cabinet. Kentucky also did not have money budgeted for such a high-cost program, she said.

NKY Med Clinic, which has 900-plus patients, recently asked the state about getting Medicaid reimbursement for its 10- to 15 percent of patients who can’t afford it – but that’s not an option in Kentucky.

They’re exploring another option: The state’s Medicaid program will pay for the required counseling at treatment clinics if the clinic gets a special license, Midkiff said, noting the methadone itself is “relatively inexpensive” at about $50 per month.

Daines is worried a licensing process will take too long for her son to benefit from it, and Northern Kentucky doctors say there is no time to waste with a heroin epidemic raging.

NKY Med Clinic keeps expanding

NKY Med Clinic is the only medicine-assisted treatment group in Northern Kentucky that has expanded greatly during the heroin epidemic that grips Northern Kentucky.

The clinic opened in August of 2013 with about 600 patients, and now has about 900.

“Methadone treatment is not perfect, but it’s good enough for now, and it’s a lot better than heroin,” said Dr. Jeremy Engel, a St. Elizabeth family doctor at the forefront of the heroin epidemic in the region.

It stabilizes patients, giving them back the ability to function normally, working and caring for families without persistent cravings and withdrawal symptoms that propel addicts to seek more heroin.

Kentucky does cover other medicines, including Suboxone, which also can stabilize users. But the region has only a handful of doctors who can prescribe Suboxone and by law they can each only treat a limited number of patients. And Suboxone doesn’t work for everyone.

It’s a catch-22 that the region’s heroin-response leaders say could cost lives.

“When you have an epidemic, you triage,” Engel said, stabilizing people and then, as soon as possible, moving onto other treatments if necessary.

“This is a human disaster that is a medically based disaster,” Engel said. “Medicine-assisted treatment is the cornerstone addressing heroin.”

Methadone: fears and fact

The fear about methadone use to combat heroin addiction is unfounded, experts say.

“It is a matter of belief, not science,” said Dr. Adam Bisaga, professor of psychiatry with Columbia University. “Treatment with methadone or buprenorphine (the generic form of Suboxone) is approved by FDA as safe and effective treatment of opioid dependence.”

The questions surrounding the use of methadone as a treatment for opiate addiction is based on nothing medical and a belief that methadone treatment for heroin is simply “trading a drug for a drug,” said Dr. Mina “Mike” Kalfas, an addiction specialist and family doctor.

Daines’ son has been doing well with methadone, but she said other attempts he’s made to stay clean of heroin and prescription painkillers have failed.

Reducing the methadone dosage too soon into treatment leads to a high risk of relapsing to heroin use.

Kalfas said using methadone does not create another addiction. Instead, it helps the patient withdraw from drug use and relieve narcotic craving.

“Some people just don’t see it as a life-saving treatment,” Kalfas said. “They see it in a negative sense.”

Jim Thaxton, coordinator for the NKY Heroin Impact Response Work Group, said he’s perplexed by the Cabinet’s decision not to cover methadone.

“If I’m a physician and I treat someone with Suboxone, Medicaid will cover that cost and therapy,” Thaxton said. “Medicaid will cover the cost of opioids for pain management. Why not for treating people with methadone who’ve become an addict?”

Kentucky’s Cabinet for Health and Family Services consulted with the department for Behavioral Health, Developmental and Intellectual Disabilities and the Department for Medicaid Services before making its decision, Midkiff said.

Cabinet for Health and Family Services Secretary Audrey Haynes said she could not recommend that Medicaid cover methadone, Midkiff said, noting that methadone and costs associated with the treatment and delivery of it are “significant, and funds to cover these costs were not budgeted,” as well as the concerns about people being treated with the drug, another narcotic.

Midkiff said the cabinet is working to increase services and improve policies and regulations surrounding medicine-assisted treatment.

Seeking other kinds of coverage

NKY Med Clinic is also seeking other ways to help patients, said Holly Broce, regional director for Pinnacle Treatment Centers, which owns the clinic.

“Earlier this year we attempted to apply to become a Medicaid provider and there was not a mechanism in place to become a treatment provider,” Broce said.

So now, the clinic is trying to help patients cut down transportation costs – which also are covered under Medicaid for substance abuse – by opening treatment offices in Georgetown, Carrollton and Maysville.

Mother says son can’t afford methadone

Daines said she’s frustrated that the state won’t cover methadone as a treatment. Her son has a job, goes to work every day and has stable while on the treatment.

He was prescribed Suboxone for a while, but “he said it made him sick,” she said.

A motorcycle accident five years ago left her son with nerve damage and dealing with chronic pain. He first became addicted to painkillers, then heroin.

Daines’ son did not want to talk to the Enquirer.

What about alternative medicines?

Nine physicians in Boone, Campbell and Kenton counties are certified to prescribe Suboxone, according to the Substance Abuse and Mental Health Treatment Services Administration; however, not all are actively prescribing the treatment.

Those who do so bemoan limitations they are given: In their first year they can’t treat more than 30 patients with Suboxone. After that, the cap is raised, to 100. Sen. Sherrod Brown, D-Ohio, is pushing legislation to lift the current cap and allow nurse practitioners and physician assistants to treat patients with the drug.

Kalfas has topped out on the number of patients he can treat with Suboxone. Engel has 15 in a St. Elizabeth Healthcare pilot program.

Midkiff said the state is working on best practices for medicines other than methadone, and working to recruit and retain substance abuse treatment providers.

“This is a huge step forward on the path to recovering for many Kentuckians,” Midkiff said.

She said the cabinet is monitoring outcomes in other states that are covering methadone and might revisit it in the future.

Ohio Medicaid has offered methadone to treat of opiate addiction since July 1, 1991. As of July 1, 2012, Medicaid coverage was expanded to include generic buprenorphine (Suboxone) and injectable naltrexone, more commonly known by its brand name Vivitrol, which blocks opiate receptors. The Ohio coverage includes transportation for methadone patients.

Ohio also expanded Medicaid eligibility as of Jan. 1, expanding access to alcohol and other drug treatment; including the three medications, said Eric Wandersleben, spokesman for the Ohio Department of Mental Health & Addiction Services.

More medicine options on the way in NKY

There are other ways Northern Kentucky is working to provide more access to medicine for heroin addiction – the biggest of which is St. Elizabeth Healthcare’s plans to open a Suboxone clinic.

So far, St. Elizabeth has attracted interest from six to eight physicians who’d be willing to prescribe Suboxone, said Guy Karrick, spokesman for the hospital system. But he said it takes time to prepare for and open a clinic, and St. Elizabeth hopes theirs will open at the beginning of 2015.

A Suboxone clinic will help, Kalfas said, but it’s not going to help everyone.

He’s worried about patients who fail with Suboxone or Vivitrol, a pharmaceutical that blocks opiate receptors in the brain and won’t allow people to get high.

“What do I do with them? I’ve got to have somewhere to send them,” Kalfas said. “The sad reality is that methadone is the backup.”

“I’m lucky with 60 percent success rates,” Kalfas said. “Methadone is my umbrella.”

Top five Kentucky counties for heroin detected in overdose deaths in 2013:

1) Jefferson County 105

2) Fayette County 35

3) Kenton County 34

4) Boone County 22

5) Campbell County 16

Of the 722 deaths autopsied by the Kentucky Medical Examiner last year that were determined to be from a drug overdose, 230, or 31.9 percent, were attributed to heroin, compared to 143, or 19.6 percent, in 2012.

Source: Kentucky Office of Drug Control Policy via Kentucky Medical Examiner and coroner reports.

Medicine assisted treatment drugs:

Methadone

• Methadone was discovered by the Germans toward the end of World War II and became used in the United States to cure what was then called “opioid abstinence syndrome.”

In the 1960s the U.S. Bureau of Narcotics accepted it as a drug that could be taken routinely to fight addiction.

An opioid itself, it replaces heroin, binding to the same receptors in the brain that yearn for the drug. Methadone can help addicts reclaim “normal” lives while warding off cravings and dope sickness that drives so many to relapse.

Also well-documented is its track record of being sold illegally, abused and contributing to overdoses. In addition, some methadone patients are on it for a lifetime. Proponents argue that they need it to function normally and not relapse into heroin.

Suboxone (brand name for buprenorphine)

• Suboxone or burprenorphine is also a narcotic, but it acts differently in the brain than methadone because it includes an opioid antagonist, which blocks the ability to get high from other opioids. Some addicts report euphoria when taking Suboxone, but it doesn’t have the properties of methadone that lead to dependence. One problem associated is that there is a black market for Suboxone, as addicts try to self-treat symptoms of heroin withdrawal.

Vivitrol (brand name for naltrexone)

• Vivitrol is which is neither opioid nor narcotic. Instead of binding to the receptors in the brain, Vivitrol blocks them. Even if the patient takes an opiate after Vivitrol, the second drug won’t take affect. It’s usually not prescribed to long-term heroin addicts who have been heavy users.

Original article can be found here.

Tips On Easing Drug Withdrawal Symptoms

by Michele

easing addiction withdrawalWithdrawal is a reality that most addicts refuse to deal with because it can be such an unpleasant experience and going through it can be very dangerous especially if you have been dependent on drugs for a long time. Unfortunately, in order to get clean, every drug addict has to go through withdrawal but there are some ways for you to ease the symptoms that you may go through during the withdrawal phase of your recovery.

Know what to expect

Before starting the detox process, you have to take the time to learn what to expect during withdrawal so that you can prepare yourself, your home, and the people around you. Knowing the different withdrawal symptoms will help you arm yourself with procedures and strategies that will make the entire process as comfortable as possible.

NEVER go through it alone

It is always best to go through withdrawal under medical supervision in a rehab facility. But if you will be unable to check yourself into a detox facility, make sure that you have somebody that you can trust to be with you. As you go through withdrawal, you will not be well enough to look after yourself so it is best to have somebody there to take care of you to make sure that you are ok. Having someone there will also ensure that you are proceeding with the recovery as planned and that you don’t give in to drug cravings and relapse.

Prepare your environment

There’s no other way to go through withdrawal but to let it run its course. In order to make yourself comfortable, you should make sure that you prepare your environment and create a place that it conducive to relaxation.

Prepare some things that will help you relax and get your mind off the aches and pains that you will be feeling. Put together a collection of movies that you have been meaning to watch, or books that you want to read. Have them handy for days that you find it difficult to sleep or when you feel the overwhelming need for a drug fix.

Medication

Long term drug addicts will benefit from the use of medication to manage the extreme highs and lows of withdrawal which can be dangerous to their health. There are medications specifically prescribed for those going through withdrawal and these have been proven to reduce the drug cravings to increase the chances of recovery. However, there is much controversy as to the effectiveness of this type of treatment because some addicts can easily get hooked on these drugs when used for long periods. For example, two of the most common medications prescribed for managing opiate withdrawal symptoms are methadone and buprenorphine. These are synthetic opiates. To many, this type of therapy solution is simply exchanging one addiction for another addiction.

If you are not using any withdrawal medications for your recovery, using some over the counter analgesics can help ease the withdrawal symptoms during your detox. These can help reduce the severity of your muscle aches and pains. Sedating antihistamines are also recommended to help you get some sleep during withdrawal because it is expected that you will have a battle with insomnia. If you experience diarrhea, you can also take loperamide to help manage this. Take note that once you decide to detox, try to get a 2 week supply of these over the counter medicines so that you would have enough on hand when the symptoms start to kick in.

You also have the option of looking for supplements that are available to specifically target withdrawal symptoms. For example, Elimidrol and Withdrawal Ease were both designed to target common symptoms of opiate withdrawal and include a lot of the things mentioned above, but in one dose instead of shopping for multiple vitamins, supplements, and medications.

Many people and professionals, myself included, prefer the supplement route when it comes to detox. Options like methadone and buprenorphine simply prolong addictions and are highly dangerous without constant supervision and regulation. More people in the United States die from methadone overdoses than heroin overdoses.

Understanding PainKiller Addiction

by Michele

addiction to painkillersThe addiction to painkillers happens easier that you might think. It slowly creeps on you and you unknowingly get addicted to it. Many who are addicted to painkillers started with taking the medication as a prescription for a medical condition. When patients take painkillers, they have no intention of getting addicted to it.

These pain killers are very effective in numbing pain and almost every doctor’s go-to solution for managing pain is prescribing narcotic painkillers. Taking painkillers require no special training, it does not require too much effort or much skill. The fact that they are very effective in managing pain with very minimal effort eliminates the need of people to explore other pain management techniques.

Unfortunately, aside from effectively managing pain, these medications also produce the same euphoric effect that opiates give you, thus making it very addicting. While taking these prescriptions, some people enjoy the high that they get from painkillers and continue to take it long after they were supposed to. Painkillers can be legally obtained and can be accessed easily which makes it even more appealing to people who are addicted to it.

What are the usual symptoms of addiction to painkillers?

Long term use of painkillers result to dependency and tolerance for the medications. Over time your body will require the drug in order to feel normal and its absence will also signal the appearance of withdrawal symptoms that are very similar to those experienced by people going through opiate withdrawal. Some of the common symptoms of addiction to painkiller addiction are the following:

  • The need to increase the dosage of painkillers in order to achieve the same level of pleasure or euphoria.
  • Continued use of the painkiller medication long after they were prescribed by the physician.
  • Going to great lengths like travelling to another city or going to several doctors in order to obtain or replenish the prescription.
  • There is a sudden change in mood, energy levels, and focus as the person makes the addiction his priority and all responsibilities only comes second.
  • The person suddenly isolates himself and continuously gives excuses to get out of family activities that they usually love doing.
  • A noticeable decline in personal hygiene and overall health condition.

What are the treatment options for painkiller addiction?

Like opiate addiction, people who are addicted to painkillers would have to go through detox and experience withdrawal symptoms which may last for about 2-3 weeks. It is always safer to check yourself into a local detox or rehab facility during your withdrawal and have round the clock medical supervision to be able to monitor your health especially if you have been addicted to pain killers for a long time.

Detoxification should always be followed by individual counselling and group therapy. This will address the underlying factors which may have caused you to start with your addiction and this will give you the perfect opportunity to address those issues to prevent the possibility of being addicted again.