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Physicians, Law Enforcement Differ On Heroin Treatments
By: Bianca Hillier
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**Editor’s note: The students of WOUB News’ Investigative Unit are looking into the heroin epidemic of Southeast Ohio. This article is the third in a series of stories chronicling the situation and what steps are being taken to combat it. Be sure to follow @WOUBNews on Twitter and “Like” our Facebook page to stay up-to-date with our stories.
With Ohio’s heroin epidemic has come increased attention on and accessibility to heroin addiction treatments.
Law enforcement and physicians, though, have different opinions on which treatments are the most effective. To understand the different types of treatments, experts say it’s important to understand their shared goal.
Dr. Melinda Ford, Addiction Medicine specialist at Ohio University’s Heritage College of Osteopathic Medicine, said drugs like heroin and methadone are “full-agonists.”
“That means the more you take, you get more and more and more stimulation. They fully stimulate those receptors in the brain,” Ford said.
All medically-assisted treatments (or MAT) turn off these receptors by attaching to them in your brain and blocking the pleasurable feelings that come from the drugs. In Southeast Ohio, the two most commonly offered treatment programs for heroin addicts are Suboxone and Vivitrol.
Suboxone is a “partial-agonist,” meaning the effects level off after taking a certain amount, so you can’t get high from it.
“That makes it much safer and is the reason they can get it to take home with them,” said Ford, who supports and administers Suboxone.
This controlled amount produces similar effects to those produced by opiate drugs. Since it is in a controlled amount, though, Ford says it allows for a much more stable lifestyle.
“You can live an absolutely normal life being on [Suboxone], as opposed to when you’re injecting heroin and you have to figure out where to get the money and how to get the money, and putting yourself in risky situations and potentially getting…blood-born diseases,” she says.
But, like heroin, Suboxone is an opiate, therefore critics argue sobriety is never truly achieved. Athens County Prosecutor Keller Blackburn called the idea of treating an opiate addiction with another opiate “flawed logic.”
“It’s like the nicotine patch,” Blackburn argues. “The nicotine patch is great to help someone quit smoking. But you can’t be on a nicotine patch your entire life… that’s not healed. Right? Taking Suboxone is better than taking heroin, but it’s not healed.”
Dr. Joseph Gay, Executive Director of Health Recovery Services in Athens, disagrees with the prosecutor’s assessment, as he supports using Suboxone.
Gay says the difference in opinion comes down to a difference in mindset. Law enforcement does not see addiction as a brain disease, he explains, which affects– and in his opinion flaws– their treatment plan.
“Most people understand that people with mental illness need to take their medication because they have a brain disease and it requires medicine to fix it,” he says. “People cannot seem to embrace that attitude about addiction.”
Blackburn, though, says there’s more than an attitude in play.
“There’s a lot of money to be made in Suboxone,” Blackburn says. “HRS has made a ton of money in Suboxone, and their doctors have made a ton of money in Suboxone. And their doctors have actively worked to stop people from getting on Vivitrol.”
Medical professionals do not benefit much from the drug, partly because the state does not fund Suboxone doses, according to Gay.
“If we write prescriptions we do a little better because we’re not absorbing the cost of the Suboxone. But it’s not like we make a huge profit. It’s a barely break-even proposition,” Gay said.
Only five of the HRS’ 165 Suboxone clients receive dosing on-site, though. The other 160 clients are given prescriptions, leading to that increased profit by HRS, according to figures provided by HRS. An additional 115 clients, HRS says, receive Vivitrol treatment.
Vivitrol is also Blackburn’s treatment of choice, as they switched from a Suboxone program to a Vivitrol program in October of 2015. Their 13-15 month program has 4 phases: phase one aims get the participants sober; phases two and three includes both MAT and counseling sessions; along with helping the participants find employment; and phase four is extended care after graduation of the program.
Blackburn says getting people through those two weeks is the most difficult part.
“Our logic is let’s make them go through 10 days, seven days, five days of pain, get them this thing that stops the cravings, and then they can go on and live their life. If you could get someone on Vivitrol and make them come to counseling and get them a shot, every 28 days, how is that not the ideal treatment?”
According to Blackburn, his program boasts an 82 percent success rate, with 183 individuals successfully entered phase 1 of our program and 23 set to graduate in the next month.
Reuben Kittle, Diversion Director and Felony Investigator at the Athens County Prosecutor’s Office, says the 18 percent who have not succeeded in the program have done so because of refusal to attend meetings, counseling sessions and other program requirements.
Jason Leach, a recovering heroin addict currently on Vivitrol, understands why some people relapse and can’t get past the first phase of the program.
“It was hell,” Leach says. “I had real bad headaches, vomiting… everything. I was in the bathroom more than I was working. But I got by that. I just did what I had to do [to avoid jail].”
Unlike Leach, recovering addict Megan Clark said she needed to go to jail to get clean, but then found Vivitrol to be the best option.
Now in her 12th month of Vivitrol treatment– including weekly meetings, monthly shots and avoiding people she knows who still uses– Clark says she no longer desires to use, crediting her sobriety, in large part, to Vivitrol.
“I feel like it’s a miracle drug, I honestly do. I never thought [sobriety] would be possible,” she says. “I’ve tried everything. I’ve done the methadone clinic, I’ve done the Suboxone. The Vivitrol is the only thing that has worked for me.”
Leach and Clark aren’t merely supporters of Vivitrol, but also avid opposers of Suboxone.
“They need to take Suboxone off the market,” Leach says, arguing that the effects don’t help recovering addicts shake the high.
“What’s the sense in taking something if you’re going to feel the same way as when you was using the heroin?” Leach argues. “I mean if you’re going to feel the same way you might as well just use the heroin. It’s the same thing.”
Ford and Gay stand by their Suboxone prescriptions, though, despite its problems.
“There’s a problem with diversion, there absolutely is,” Ford admits. “But in a program that’s run well, you try to watch for that.”
Gay says the way to watch for diversion is through regular drug screens and pill audits. Leach said the vision of a standard outpatient procedure just isn’t happening.
“The only reason [Suboxone works through HRS] is because they’re using it the way they’re supposed to. So it’s lasting the whole time,” he says. “If they take one extra dose, then the whole thing’s screwed up. And then they’re sick. And then, just, I don’t know. It’s pointless.
Regardless of the medicine prescribed, though, both law enforcement and physicians agree it’s a multi-part process.
“If you don’t go to counseling, it doesn’t work,” Blackburn says. “Regardless of what you’re doing.”
Gay says the counseling and behavioral therapy is crucial to breaking down the denial of addiction.
“You start looking at the specific factors that contribute to that addiction,” he said. “For example, we have many clients who’ve had trauma in their past. So that trauma may contribute to their desire to use drugs. They can also have other psychological conditions– depression, anxiety disorders, stuff like that.”
A March 2016 study by the New England Journal of Medicine did find that Vivitrol was “associated with a rate of opioid relapse that was lower than that with usual treatment.”
That usual treatment consisted solely of “brief counseling and referrals for community treatment programs,” though, sans any MAT requirement.
While Dr. Gay and Dr. Ford continue to administer Suboxone, Blackburn says the Prosecutor’s office is not open to reinforcing the old program.
“We do not see suboxone as being successful, he said. “And we are the ones who enforce the laws of the land.”
Kaitlyn Roman contributed to this report.
Read other articles from the Investigative Unit:
Addiction: How Choices Turn To Disease
Getting Help: Funding the Fight Against Heroin