Officials: Manatee methadone clinic by far most effective treatment for heroin addiction
MANATEE -- Addiction specialists in the Manatee County area have been lamenting lack of funding and lack of beds in long-term treatment facilities for more than a year as the heroin epidemic has exploded, but Jonathan Essenburg says there's already treatment available in the county, and its only barrier is a social stigma.
Essenburg, the regional administrator of Operation PAR, a nonprofit that is the sole methadone clinic in Manatee County, has been working with opioid and heroin addicts for years. Methadone is an opiate, commonly used in medication-assisted treatment for opioid addictions, which takes care of opioid cravings for addicts without getting them high. Addicts who use heroin or other opioids while on methadone are unable to get high because the receptors in the brain are blocked.
"We're freezing a problem. This problem that is overwhelming their entire life," Essenburg said. "They are constantly either in a state of withdrawal, seeking drugs or they're high, and they're not able to function normally. It's nearly impossible for someone like that to hold down a job and take care of the responsibilities that they have."
President Barack Obama's administration has embraced medication-assisted treatment options for addicts because it's widely regarded as the most successful treatment option for addicts. It's still a controversial practice, as some still see it as swapping one addiction for heroin and other opioids to methadone.
Drug Free Manatee, a local group that looks for solutions to substance abuse in the area, says they support medication-assisted treatment as long as it also includes counseling, which Operation PAR does.
"Operation PAR is a partner on our Addictions Crisis Taskforce and has been part of the discussion on comprehensive approaches to addressing the opioid/heroin epidemic," spokeswoman Merab Favorite said in an email. "The whole ACT team looks forward to reviewing outcomes of these medication-assisted treatment options."
Essenburg touts the program's high rate of success with dealing with addiction when used with behavioral treatment over just behavioral treatment alone. He said 90 percent of patients in methadone treatment stop using within two weeks, because there's no point to using if methadone takes away the high. And in places such as Manatee County, where there's a shortage of residential treatment facilities available compared with the large need, medication-assisted treatment can provide an effective solution to addicts looking to find whatever help is available.
There are 650 patients now receiving medication-assisted treatment from Operation PAR in Manatee, in addition to another 400 in Sarasota. Operation PAR has eight locations in Florida serving about 4,200 patients. Each patient has been designated by a physician as being dependent on opioids and has to meet certain requirements to qualify for methadone treatment, mainly that they have been addicted for a year or more and they are over 18.
Once they're accepted to the facility, the process is fairly simple. They're assigned to an addiction counselor, who will have counseling sessions about once per week to start and will decide the necessary prescription needed to address the patient's opioid addiction. The patient then has to come into the clinic every day, which opens at 5:30 a.m. weekdays and 6:30 a.m. weekends, to receive their medication for the day. They are also randomly drug tested to make sure they aren't taking other drugs while on methadone. Nurses assess them before giving methadone to ensure they aren't under the influence of drugs.
If patients meet certain requirements, such as successfully participating in the program for a year without failing a drug test, they can be prescribed medication for a certain amount of time so they don't have to come to the clinic daily. It is possible to overdose on methadone, so that option isn't available to addicts first starting on medication-assisted treatment.
Essenburg said the average amount of time patients spend on methadone is a year. That gives patients time to sort out the underlying factors of their addiction with counselors while not being tempted to use.
"Methadone is kind of like a bulletproof vest. That's how the patients sort of perceive it. They know while they're stable on methadone, they're not dealing with the cravings for opiates, they don't worry about relapse, things like that," Essenburg said. "If you were to take away the methadone and something goes wrong in their life, what's the likelihood of them relapsing?"
While Essenburg says all patients want to eventually get off methadone, a small percentage do stay on it long term. Essenburg said one of their locations has a patient who still takes methadone daily and has been coming since 1989. Even in those cases, Essenburg says methadone is preferable to the alternative. And some people, like those who been opioid addicts for 20 years or more, have permanently altered their brain so they can no longer function without opiates in their system. The only healthy alternative for those people is methadone, he said.
"In those cases, you think what can you really do?" he said. "They're always going to be experiencing this because their brains have been damaged."
Operation PAR also makes sure methadone is available for low-income populations. Essenburg said about half their patients are covered under Medicaid, while the other half pay out of pocket, which costs about $13 to $20 per day on a sliding scale. Anyone who says they can't afford the $13 can apply for temporary cost reduction, where they can even have the cost temporarily reduced to nothing for a three-month period.
"I know $13 a day sounds high, but then you compare it to what these people spent on their habit, which was $50 to $250 per day," Essenburg said.
While first-responders in Manatee say the problem with overdoses on opioids has decreased, the need for treatment in the area has not. Within the last few months, Essenburg said about 75 percent of their new admissions are heroin addicts.
The stigma persists against medication-assisted treatment. And while Essenburg said one of the worst things to do is pressure someone to get off methadone before they're ready -- a near guarantee they will turn to opioids again -- sometimes people in the county don't have the option either due to court requirements.
"So for some of our patients who might be struggling to regain custody of their children, you may have a judge who doesn't know a lot about methadone treatment, and says, 'You know what, I'd be more comfortable if you were off of methadone before we talk about giving you full custody of your child back,'" Essenburg said. "And when I hear stuff like that, I think that's so backwards because what you're doing is taking away this way for them to remain stable."
Essenburg said it became even more frustrating as he heard task forces push for more funding for more beds in residential facilities. While those can be effective, he said this is a proven, effective method that many can take advantage of right now.
"We don't need more beds. We have the capacity right here," Essenburg said. "If we get an influx of more patients, we'll just hire more counselors."
"Compared to abstinent-style treatment -- or just outpatient counseling -- it blows it away."
Kate Irby, Herald online/political reporter, can be reached at 941-745-7055. You can follow her on Twitter@KateIrby