Kicking heroin a long, hard road


David Messer was 11 when he started using drugs.

“I dabbled a little bit as early as 11, but sixth and seventh grade, I was using drugs almost every day,” he said.

He used whatever he could get his hands on.

“If I found a pill, I’d eat a pill. If I found a joint, I’d smoke a joint. If someone bought me a beer, that’s what I’d do that day.”

But Messer, now 30, is one of the lucky ones. The Fairborn resident found a way to treatment — he “crawled” into treatment “high as a kite” — and has found his way to recovery the past two years with the help of the staff at TCN Behavioral Health Services in Xenia.

Recovery doesn’t come easy for most and certainly didn’t for Messer, who tried to get clean multiple times on his own. But experts say getting more people the treatment they need is one of the keys to stemming the heroin epidemic and saving lives.

A national survey in 2012 by the National Institute on Drug Abuse reported that 669,000 Americans reported using heroin in the previous year.

The National Institute on Drug Abuse estimates illicit drug use costs the U.S. $181 billion in health care, lost productivity, crime, enforcement, and jail and prison costs.

Ten percent of American adults — 23.5 million people — consider themselves to be in recovery from drug or alcohol problems, according to a 2012 study by the Partnership for Drug-Free Kids and the New York State office of Alcoholism and Substance Abuse Services. In Ohio, more than $216 million was spent in fiscal year 2013 on alcohol, drug and addiction services, according to information from the state.

“It’s so devastating and it’s so common,” said Helen Jones-Kelley, executive director of Montgomery County Alcohol, Drug Addiction and Mental Health Services (ADAMHS).

“The high makes you feel so powerful. You’ll die to get high.”

‘We can’t keep pace’

There are many challenges to treatment and recovery, Jones-Kelley said, including a continuing stigma about being in recovery. There also aren’t enough resources, experts say, and there’s not enough knowledge about what resources are available.

“There’s a lot of progress out there, but we can’t keep pace,” she said.

Monica Sutter, psychiatric consultation liaison for Good Samaritan Hospital, said the costs of the heroin and opioid epidemic will continue to grow because of the spread of disease related to intraveneous drug use.

“I’m concerned about what follows an opioid epidemic — an HIV epidemic — and the costs are astronomical when you look at the price of anti-virals, the cost to the judicial systems, the developmental delays for the mothers who are delivering babies who are opioid dependent,” she said. “There’s not a system involved that doesn’t pay for substance use, whether you are touched by it or a family member is.”

Sutter said there will need to be more HIV and hepatitis screenings, as well as education and testing for mothers, pregnant women and school-age children.

“We want to watch for any bloodborne pathogens, because when individuals start shooting or using IVs, they don’t have the judgment, the rational decision-making that they had before they were using,” she said.”

Political issue

The heroin epidemic has become a political issue in Ohio. In recent months, Democrats Ed FitzGerald, a candidate for governor, and David Pepper, a candidate for attorney general, have accused Gov. John Kasich and Attorney General Mike DeWine of not doing enough to address the problem.

FitzGerald, Pepper and other officials have been critical of the Republican administration’s handling of a deferred federal government payment for addiction and recovery services, said Brian Hester, spokesman for the Ohio Democratic Party.

The administration, he said, took funding normally given during a 12-month period and extended the period to 18 months without state funding to smooth the transition. The move, the Democrats say, resulted in a $20 million cut.

“Heroin addiction is a problem that cuts across socioeconomic barriers, so leaning on Medicaid to fill the gap is not a real solution because so many simply aren’t eligible,” Hester said. “It is estimated that only 1 in 10 people who need treatment for addiction have access to it. But it is ironic that Republicans are citing funding that is only possible because of the president’s Affordable Care Act to cover their self-created shortfall.”

Republicans counter that the Kasich administration has taken many steps to increase funding for mental health and addiction services, including expanding Medicaid coverage.

“It’s tone deaf at best and ghoulish at worst that these Democrats are seeking political gain from the suffering of Ohioans with drug addictions and mental illness,” said Chris Schrimpf, spokesman for the Ohio Republican Party. “Few officials have done more to combat heroin than Governor Kasich.

“Thanks to the governor, 60,000 Ohioans will receive care for addiction that weren’t receiving it before.”

Kasich’s first jobs budget increased state mental health spending 5.7 percent, according to the Ohio Department of Mental Health & Addiction Services. In addition to the expansion of Medicaid coverage, the governor freed up an additional $70 million available for county-funded clinical services, according to the department.

Treating the disease

Quitting heroin is a long, difficult process, said Jan Scaglione, clincial toxicologist at the Cincinnati Drug and Poison Information Center at Cincinnati Children’s.

“I think when people start on these things, they have no idea of the road they are going down,” she said. “They start, initally, voluntarily, taking the drug. The longer they use, the chemistry in their brain changes … once that switch gets turned on, they can’t stop.”

It’s critical that people understand drug addicition is a medical illness, experts say.

“Drug addiction is like a lot of issues that people don’t understand or comprehend,” said Virgil McDaniel, executive director of Project CURE in Dayton. “There’s a stigma attached to drug addiction — just like there is to mental health. It is a disease. And you have to treat it as such.”

It’s possible to get and stay clean, advocates say, but it takes a comprehensive approach. And it takes time.

Sutter, who spends time at the bedside of addicts who have come to the hospital in crisis — often after overdosing — said the process includes assessing patients and connecting them to community resources.

“A lot of our ability to truly make a difference in the hospital in such an acute time frame has to do with community partnerships, with agencies and our ability to refer directly from the hospital to the inpatient facilities,” she said.

“The substance-use population has been handed off from the judicial system to the pharmacy boards to the psychiatric services, to the medical boards. In actuality, we all need to play together to truly make a difference. Everyone kind of needs to unite.”

Drugs fighting drugs

One increasingly popular method is using medication to treat addictions. But it also is controversial.

Dr. Franklin Halley, chief medical officer at TCN, said helping patients by using medication — such as methadone, Suboxone and Vivitrol — seems contradictory to some. Still, he said, results can be effective.

“We know if people just try to stop without maintenance-assisted treatment, their success rate is maybe 5 to 10 percent, maybe at best,” Halley said. “And if you have methadone, you get up to 50 to 60 percent and you get up to 50 to 60 percent with Suboxone, too.”

The treatment is ongoing, like dealing with chronic issues such as high blood pressure or diabetes, Halley said.

“People that have a couple of decades of opiate dependency, maybe 20 to 25 percent of them are more likely to be dead by 20 to 25 years out,” he said. “It’s not just that they get sick — which they do with hepatitis and HIV and abscesses and infections and all the legal issues and chaos. But they also die — they overdose, not necessarily intentionally … They die because of everything that’s going on. It’s a very lethal illness.”

Halley said even staff members at TCN didn’t immediately comprehend the need for medication-assisted treatment, which work in different ways but generally help to reduce cravings and withdrawal symptoms and block the high users get from using opiates.

“People ask, ‘Why are we doing this? They don’t deserve that. They need to just be a better person,’” Halley said. “…It doesn’t work like that.”

William Roberts, a spokesperson for the Center for Alcoholism and Drug Addiction Services (CADAS), which is part of Public Health-Dayton & Montgomery County, said it’s important to have options for treatment, but equally important are coping skills for recovery. He thinks there should be treatment options that don’t include medication-assisted treatment.

“I’m not opposed to medication-assisted treatment but I believe we need an abstinence option for those who want to pursue it,” he said. “None of the medications are good if you’re not going to develop skills.”

Accessing care

Regardless of whether addicts use medications in treatment, experts agree the door needs to be open when they seek help. When addicts decide they want treatment, they want it now.

In Montgomery County, a change in process as of July 1 should make treatment more accessible, said Jones-Kelley.

“We don’t have a capacity issue,” she said. “There are ways for everybody to get assistance.”

Until July 1, those seeking treatment had to go through a centralized intake process through Samaritan Crisis Care. Now anyone seeking treatment can work directly with Montgomery County recovery facilities — which has cut the waiting time, Jones-Kelley said.

At TCN in Xenia, Halley said asking addicts to wait or make appointments doesn’t work.

“In the old-fashioned model, people would make an appointment maybe one week, two week, three weeks, four weeks out, they wouldn’t come,” Halley said. “In substance abuse, when people are ready for treatment, that’s like an emergency. They need treatment now.”

TCN offers walk-in clinics at certain times during the week. No appointments are necessary.

The walk-in clinic was critical to Messer’s recovery, he said.

“I was ready right then and if you had made me wait a week, well hell, I would have done more drugs by then and I wouldn’t have been back.”

Long process

Not all people are are prepared to make a change when they seek treatment, said Roberts of CADAS.

CADAS assesses where people are in recovery by using the Stages of Change: precontemplation, contemplation, action, maintenance and relapse.

“We tailor the process to where people are and try to meet them where they are,” Roberts said. “This may not be the time for them, but it’s about getting seeds planted. That’s how most of us change.”

Messer hit rock bottom before seeking help. He was living in cars or sleeping on his sister’s couch — when she wasn’t mad at him for stealing from her.

“The thing is, I always tried to do it by myself and I couldn’t do it,” he said. “I ended up strung out again.”

Messer went to TCN in mid-July 2012 and started on the Suboxone maintenance program and intensive outpatient therapy. Two weeks later, he was living at Christopher House, a residential treatment facility. His first day at Christopher House was July 31, 2012.

During the assessment process, McDaniel said, a clinical person determines drug history. Often there’s a dual diagnosis and a patient is identified as having mental health issues and is referred to other agencies.

Janice Scherman, director of alcohol and drug services at TCN, said clients go through outpatient treatment as part of their program.

“All clients are required to actively participate in treatment because the two go hand-in-hand,” she said. “Medication-assisted treatment is just that. Medication-assisted treatment.

“Probably about 60 percent of the clients who come in are opiate addicted. Many of them have graduated to heroin, which, of course, takes a toll very, very rapidly.”

Relapses expected

At Project CURE, McDaniel said it’s critical for patients to stick to their treatment, particularly if they are taking methadone or other treatment drugs.

“You can only continue to get treatment as long as you stay compliant with your treatment program,” he said. “If a doctor is writing you a prescription for methadone, if you are mixing other drugs, it’s a prescription for an overdose. The doctor is not going to keep prescribing Methadone.”

Clients routinely take drug tests to make sure they aren’t using. If they relapse, staff reevaluates their status in the program, Halley said.

“We know there are going to be relapses,” Tom Otto, associate CEO of TCN said. “We know if we keep them engaged and in treatment, their chances for success go up greatly.”

Dr. Kent Youngman, CEO of the Mental Health & Recovery Board of Clark, Greene and Madison counties, likened treatment to having another disease.

“If a person had cancer and went into remission and then the disease came back, we wouldn’t say that was a waste of time,” he said. “We would say it was successful for a period of time and now we have to reengage in treatment. It’s the same thinking. If a person has an addiction issue, it may resurface and may need to be addressed again.

“The whole health care community thinks differently in terms of physical health addiction. We really, as a society, have to think about it differently.”

Scaglione said research has shown it takes about two years for brain chemistry of a recovering addict to revert back to normal. Many people, she said, don’t make it to two years because they end up overdosing.

Recovery community

One of the key pieces to being in long-term recovery, experts say, is creating the sober support network post-rehab.

Christopher House manager Nathan Crago said creating the network will “replace the old people, places and things in their lives.”

An alumni night at Christopher House shows people on the recovery path who have made it through and prospered.

Messer said he used every opportunity he could to develop his network. He was on the phone all the time talking to his sponsor and others who would help him.

“I built strong relationships with these people,” he said. “They gave me at least 230 percent more than I needed.”

Rehab, he said, “got me out of the mix and the madness so I could take a breather.”

The alumni group was inspiring, Messer said. “It was tangible evidence that it works,” he said. “They’re smiling. It’s really helpful to see someone happy.”

People entering rehab aren’t always glad to be in treatment, Crago said.

“But by the time they leave, they are grateful for their experience.”



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