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Tuesday, Jun 19, 2018
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Pill epidemic floods drug treatment clinic

— The lobby starts filling up before dawn in the nondescript office building on Columbus Drive.

Young adults, middle-aged, men, women, some poor, some not, some employed, some not, they wait patiently in the dark and as the sun breaks over the horizon and the June day heats up.

Amidst their varying demographics, they share a few notable characteristics. They’re addicts. They want to break the habit.

And they all need a dose of methadone.

Methadone treatment has its roots in the heroin epidemic of the 1960s and ’70s. Heroin addicts had a hard time kicking their habit cold turkey. Methadone helped.

While methadone, like heroin, is an opiate, it affects the body differently, said Dr. Jason Fields, associate medical director at the Drug Abuse Comprehensive Coordinating Office in Tampa.

“The way the body processes it is much slower,” Fields said. “So you don’t get the highs and lows and you don’t get intoxicated with it when you’re on the right dose.”

Because the body processes heroin quickly, an addict might use heroin three to six times a day to keep reaching a peak high, Fields said. The effects of a prescribed dose of methadone peaks after three to four hours, and “the body slowly processes it over the remainder of the 24-hour period,” Fields said.

“They are neither high or sedated or experiencing withdrawal,” he said.

It can cost less than $100 a week for medication and counseling at DACCO. Some patients in its methadone program pay with cash; others use a private health insurance plan, Veterans Administration benefits or Medicaid.

Over the years, methadone became a standard in treatment of opiate addicts. DACCO has been using it for more than 25 years, Fields said.

“It’s one of the safest drugs around ... when it’s used properly,” Fields said. “Just like any drug, it can be misused and used for the wrong purpose.”

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At DACCO, the line for methadone began growing longer a few years ago as clients began coming in with a new addiction: Pain medication such as OxyContin, Vicodin and Percocet.

The country was in the midst of a pain pill epidemic, and Florida was leading the way. Illegal “pill mills” flourished, and the numbers of drug overdoses shot up. So, too, did drug-related deaths and the births of children addicted to pain medications.

As the epidemic took hold, the numbers of people coming in for methadone treatment began to skyrocket. Some were sent by the court; some just wanted to find a way to regain control of their life.

“People are in crisis,” said Liz Harden, DACCO’s chief operating officer.

Florida recently has made progress in battling prescription drug abuse, creating a drug database and updating laws. As the crackdown intensified, addicts lost their easy access to a fix, sending even more people to methadone clinics.

At DACCO, the number of patients receiving methadone has nearly doubled since 2010. Four years ago, the counseling center in Tampa was treating about 350 addicts with methadone. Now, the number is near 700.

“The pill mills have been shut down, and as their supply has gone away they’ve sought treatment,” Fields said. “It became much more difficult for them to get the pills. It became more expensive when the supply went down. So a lot of people said, ‘No, I can’t do this anymore.’ So they decided to get treatment.”

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One of those people is Samantha Dinaso. Now 22, she had been using OxyContin since she was a teenager. She would try to quit periodically, but when the insomnia, cramps and nausea kicked in, she gave up each time.

“You want to bang your head against the wall,” said Dinaso, of Thonotosassa.

Her fiancé encouraged her to seek treatment, and she voluntarily entered the methadone treatment program at DACCO.

That was 10 months ago. She said the treatment has made her a believer in methadone.

“I feel more like the person I’m supposed to be,” said Dinaso, who works in the office at her fiancé’s used car business in Tampa. “I don’t have the cravings. I don’t want to get high.”

Dinaso is expecting a baby boy in August. She started the methadone treatment a few months before she got pregnant. She can’t quit now because the physical changes associated with withdrawal could be dangerous to the fetus, but she says she wants to wean off methadone shortly after giving birth.

Besides the methadone treatment, she gets regular counseling, pregnancy classes and prenatal meetings through DACCO.

At home, she has support from her family, including her fiancé, her mother and others. She credits the program for getting her back on track.

“It has benefited me tremendously,” she said. “If I didn’t do this, I’d be in a ditch or in a jail.”

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There’s nothing glamorous about methadone treatment, where trust is hard-earned.

Addicts on methadone treatment take one dose each day, which is dispensed in person, meaning they have to go to the DACCO office. Dosing begins at 5:30 a.m. and ends by 10:30 a.m. The methadone is taken once a day, seven days a week.

Once they get inside, they give their assigned number to an office clerk, then get in another line.

When they each reach the window, a nurse asks for their identification number. Their face pops up on a computer screen to help verify their identity. The nurse reviews the patient’s chart and pours the methadone - it’s in the form of a red liquid - into a small plastic cup.

The patient drinks the contents of the cup. To make sure they’ve swallowed, the nurse usually makes the patient take a sip of water from a cooler next to the window.

On some days, the addict then visits a counselor or nurse. Other days, they leave the agency and go home or to work.

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Patients who demonstrate responsibility, see their counselors regularly and seem to be making progress eventually get one take-home dose, meaning one day a week they don’t have to get up early and wait in line.

If they continue to progress, they eventually get a second take-home dose. The patient brings the methadone home in a lockbox.

Treatment is not quick. A methadone regimen usually lasts a minimum of a year, often much longer — sometimes indefinitely.

Treatment also comes with regular visits with a counselor, nurse and physician — and frequent drug screenings.

Fields said one of the most common mistakes addicts make is trying too wean themselves off methadone too early. He says the methadone treatment when followed properly can dramatically improve the lives of addicts.

“Once they start on methadone (treatment), they no longer have to seek out drugs,” Fields said. “They get on a daily dose that works. They can participate in their family life. They can keep a job, seek employment. They can parent. It promotes health and helps them function.”

The medical establishment is convinced of the benefits of methadone treatment, but that doesn’t mean there isn’t still a stigma associated with it, said Dr. Stuart Gitlow, president of the board of directors for the American Society of Addiction Medicine.

Some people see an addiction as a moral failing instead of an illness, he said.

“They view it as if you just had a better character, believe in God and got a job, life would be well,” Harden said.

“The whole idea that you would go to a methadone clinic for assistance and counseling — it’s just hard for people, for whatever reason, to wrap their head around.”

Some also question the integrity of replacing one drug with another. Dinaso is not one of those people.

“You aren’t exchanging one drug for another drug because you aren’t getting high on this drug,” she said. “You’re prescribed that drug and you are taking it like you are supposed to. I don’t consider myself a drug addict anymore.”


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Twitter: @jpatinoTBO

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