Methadone program helps curb heroin use, but medication can be a lifelong need for recovered addicts
Nurses dole out methadone doses in paper cups at the Community Clinic. After a morning of handing out the pink, cherry-flavored drug to patients, a fruity aroma hangs in the air near the nurse's station.
The methadone treatment program run by Janus of Santa Cruz treats about 290 patients who are trying to kick addictions to heroin or prescription drugs.
The treatment is considered "harm reduction," not a cure, for opiate addiction, according to Cecelia Krebs, Community Clinic program director.
"It is a very difficult addiction to beat," says Krebs, a registered nurse who has worked for Janus for 13 years. "It's hard for a lot of them to not use, unless they have a medication to help them."
Methadone reduces the body's craving for heroin and opium-based prescription drugs. It reduces withdrawal symptoms and keeps people from getting "dope sick," the nausea, headache, vomiting, insomnia and restlessness that addicts experience when they stop taking opiates.
The clinic, in the back of a low-slung white building tucked into a corner of the county's Emeline Avenue office park, bustles with activity every morning but Christmas.
Windows line one wall of the narrow, light blue room where recovering addicts wait in navy blue chairs for their daily dose of methadone.
About 60 percent of patients are recovering heroin addicts; the rest are prescription pill users. Counseling is required one to four times a month or patients to get methadone. Clinic staff members also provide support for addicts who are detoxifying.
The clinic can serve up to 330 patients, according to Bill Manov, administrator of the county Alcohol and Drug Program. Manov, whose agency contracts Janus to operate the methadone clinic, would like to see the program's capacity expand. In the past, it's had a wait list, but Krebs says the economic downturn has reduced the case load because people can't afford the medication.
Treatment costs $335 a month. Medi-Cal currently covers the cost for two-thirds of the clinic's patients, but that may change Oct. 1.
The governor's revised budget released earlier this month would eliminate Medi-Cal funding for methadone treatment for everyone but pregnant and post-partum addicts, according to Manov.
The cuts would affect 16,000 patients statewide, about 160 of whom live in Santa Cruz County.
"A lot of those people, most likely, will revert back to opiate use because they will have a hard time detoxing from methadone," Manov says. "It's got us really scared."
Neither the clinic nor the county has reserve funds to cover methadone treatment for Medi-Cal patients. The $1 million decrease in state funding would force a major restructuring of the clinic and staff layoffs.
If the proposed budget is approved, local Medi-Cal patients would either be weaned off their medication or join the 130 other recovering addicts who pay out of pocket for methadone treatment at the Community Clinic, Krebs said. There is one homeless couple that panhandles daily so each can earn the $15 they need for methadone maintenance. Krebs says they pay for their medication before they buy food.
"They do it to keep from using and to stay out of jail," Krebs says.
Patients aren't cut off from treatment if they relapse.
"At least they're doing less harm to themselves than if they're on the street," Krebs says.
Patients can slowly taper their methadone treatments, though it's recommended that patients continue methadone for at least two years while they handle court cases, find employment and stabilize their lives, Krebs says.
One Community Clinic patient will graduate law school this spring, and others are supervisors at their jobs. But Krebs acknowledged that some go back to shooting heroin or popping pills. It's difficult to track success rates.
"When people take medication daily they can definitely stop using heroin," she says. "There are good success rates with medication-assisted treatment."
The brain recognizes heroin as a natural substance, not a toxin, which makes it harder to quit. Opiate addiction can be compounded if the user has an endorphin deficiency; heroin fills that need in the person's body and alters the person's brain chemistry.
"I've heard numerous patients say when they use heroin, it's the first time they've felt good in their whole lives," Krebs says. "That's when it spirals down and gets out of control."
For those patients, methadone may be a lifelong medication to manage their illness.
"No matter how hard they try, they're going to return to opiate use," she says.
AVAILABILITY: At the Community Clinic, a treatment center the county contracts with Janus of Santa Cruz to operate on Emeline Avenue.
COST: $335 a month
NUMBER OF PATIENTS: About 290, but the clinic can serve up to 330 recovering addicts.
DURATION OF TREATMENT: Recommended for at least two years, but can be a lifelong medication for some.
WHAT METHADONE IS: A long-acting synthetic drug that makes cravings for heroin and other opium-derived drugs stop without creating the effects of euphoria or sedation. Methadone is ingested orally as tablets, powder that can be dissolved in water, or liquid.
HOW LONG IT LASTS: A single dose of methadone lasts 24-26 hours, much longer than heroin because the body metabolizes the drug differently.
SOURCE: Janus of Santa Cruz, the Drug Policy Alliance
By Jennifer Squires
Posted: 05/23/2010 01:30:08 AM PDT