When people think about a methadone clinic, many of them probably picture a long line of impoverished people waiting outside of a doctor’s office for their next fix.
There’s also an assumption that methadone and other medications are still allowing addicts to get high and that the treatment for opioid addiction isn’t the true definition of getting clean.
Dr. Matt Holmes, associate medical director for Meridian Behavioral Health, said it’s that kind of stigma mixed with state funding cuts making it difficult to make significant progress in fighting the opioid epidemic.
“The biggest thing is the stigma around the medicine, especially around methadone,” he said. “But those drugs facilitate healing of some of the dysfunction that happens with active addiction in your brain.”
Walking into Meridian’s office in Waynesville, which is where many patients go daily to receive methadone or suboxone treatments, it doesn’t feel like a doctor’s office and the people receiving services don’t fit that stereotypical drug addict mold.
The opioid epidemic touches every demographic regardless of age, race, education and socioeconomic status, which is why its so important to break through the stigma associated with seeking professional help for addiction.
Safe way to quit
By attaching to receptors in the brain, opioids block pain signals, slow breathing and can give people a calming feeling. Opioids target the brain’s reward system by flooding it with dopamine, a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation and feelings of pleasure. The overstimulation of this system produces the euphoric effects sought by people who misuse drugs and teaches them to repeat the behavior.
Medications like methadone and suboxone work to lessen the painful symptoms associated with opiate withdrawal while blocking the euphoric effects of opiate drugs.
Holmes said methadone and suboxone are both proven safe and effective in helping addicts reduce physical withdrawal symptoms while quickly enabling them to return to a normal way of life. Treatment through Meridian and other providers like Appalachian Community Services is more that just going in once a day to take the medicine — it’s also accompanied by counseling, regular drug testing and group therapy sessions.
Holmes said those who go through a medication-assisted treatment plan are also more likely to stay off drugs than those who attempt to quit cold turkey. While going through 12-step programs and having support are great tools to overcome addiction, he said it takes more than will power to safely quit opioids.
“These treatments are stigmatized but it decreases people’s risk of dying,” he said. “People go to detox and try to do meetings, but many of those people — up to 90 percent — will relapse because of the physical changes and the significant withdrawal symptoms.”
Relapsing after a detox can be even more dangerous than the continual use of opioids. As addicts build up a tolerance to opioids, they have to take higher doses to reach the same euphoric feeling. Once someone detoxes for a week or so, their body returns to that baseline level of tolerance, making them more likely to die from an overdose if they relapse and try to take the same amount of drugs they were taking before detox.
“After a detox you lose your tolerance, so if you go back to taking the same amount of painkillers or heroin you can easily overdose,” Holmes said.
Like opioids, Holmes admits that methadone can also be addicting and put people in a sedated state if abused, which is why it’s critical that patients prescribed methadone take it under close supervision every day at a clinic like Meridian.
How does it work?
If administered correctly, family members and co-workers shouldn’t even be able to tell if someone is currently undergoing methadone or suboxone treatment. However, treatment for opioids is not something you can put a specific timeline on, Holmes said.
There’s no short-term fix for opioid addiction, just like there’s no short-term fix for alcoholism. People who attend Alcoholics Anonymous never say ‘I used to be an alcoholic’ — they say ‘I am a recovering alcoholic.’ Recovering from opioid addiction should also be treated like a chronic disease with a more long-term approach to managing the problem.
“Some data shows it could be two years before you start to see healing in the brain,” Holmes said. “The hardest thing is people get to feeling so well they think they’re good and go off the treatment too soon.”
People react differently to different drugs — some people may respond better to methadone while suboxone may be a better option for others. Holmes said there have been plenty of studies where physicians attempted to take people off the treatment after two months, three months, etc., but the result was still the same and the chance of relapse was still high. But the bottom line is that the treatment helps people return to their normal life much sooner.
“We see people get back to their families and working and they have less involvement with the legal system and less instances of spreading HIV, hepatitis and other disease associated with addiction,” he said.
Holmes said he has seen some of the stigma surrounding methadone subside in recent years, but it’s still a major issue plaguing the system.
“I’ve started to feel it change some, but it’s still a major barrier for us turning the corner on the problem,” he said.
Cost of treatment
The cost of medication-assisted treatment is also a hurdle for people suffering from addiction.
Meridian and Appalachian Community Services receive state funding through Vaya Health to provide mental health and substance abuse services for the uninsured or people covered through Medicaid, but many people still fall through the cracks. Many private insurance companies still don’t cover the cost of substance abuse treatments or require pre-authorization and cover only a portion of the expense.
“At Meridian we have a sliding scale fee and the service includes everything — counseling, medicine, nursing — but at a private office it could be $300 a month for just the medicine — sometimes counseling can be included,” Holmes said.
That’s a hefty cost for a treatment that someone may have to undergo for several years.
If someone undergoes a suboxone treatment and is doing well — clean drug tests and responding to counseling — their physician can give them the medicine to take at home, but a methadone treatment program always has to be closely monitored in North Carolina.
“In North Carolina, our lack of Medicaid expansion money combined with the money the state has taken out of the mental health system and the stigma of people with addiction and treatment has led to less people being able to access treatment,” Holmes said.