Pubdate: Sun, 08 Jun 2014
Source: Tampa Tribune (FL)
Copyright: 2014 The Tribune Co.
Author: Jose Patino Girona
Page: 1
Bookmark: (Methadone)


Pain Pill Epidemic Doubled Number of Tampa Bay Patients on Methadone 
in Just 4 Years

TAMPA - 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."

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."

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 fiance 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 fiance'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 fiance, 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."

There's nothing glamorous about methadone treatment, where trust is 

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.

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."
- ---
MAP posted-by: Jay Bergstrom