Methadone clinics not lacking in addicts
The recent death of a Butler County resident is believed to be linked to tainted heroin, but the dangers of the drug far exceed a single bad batch.
The county coroner's office attributed nine deaths to heroin in its 2013 annual report, the most of any single drug.
But not only is heroin deadly, it is addictive, making it hard for users to kick the habit without help.
Methadone clinics have been used to help treat opioid addiction, most commonly heroin, for decades.
The county has two methadone clinics, the Discovery House in Cranberry Township and Pyramid Healthcare's Foundations Medical Services clinic in Butler Township.Methadone-related deaths have skyrocketed nationally in the recent past, according to numerous studies, including a report from the Centers for Disease Control and Prevention.The increase in incidents has caused public concerns over the safety and effectiveness of treatment.But both of the privately run, for-profit clinics assert methadone is a safe and effective way to treat addiction.“Methadone treatment has a proven record of over 45 years as a treatment for harm reduction, reducing criminal activity and improving citizenship within the community,” said Jennifer McMurtrie, the program director at the Discovery House.The Discovery House, which has been in Cranberry Township since 1995, has nearly 20 employees treating about 340 patients. The vast majority of its patients are 25 to 45 years old. About 56 percent are men.The coroner's statistics do not reflect methadone related deaths, although its 2013 annual report lists 16 of 30 drug related deaths as being caused by “multiple drugs.” Coroner William Young III said methadone played a role in some of those 16 deaths, but he could not offer an exact number.Shelley Askew-Floyd, the director of narcotic treatment programs with Pyramid Healthcare's headquarters in Altoona, attributed the general rise in methadone-related deaths across the nation to an increase in use of the drug to treat pain.Askew-Floyd said most research shows methadone abuse comes from pain management due to the use of pills and the problems regulating them.“Abuse of pills are more prominent than oral medication and are more easily diverted,” she said.The Foundations Medical Services in Butler Township has been open for nearly nine years. Its 12 full-time employees can serve up to 245 patients, which have an average age of 32. About 54 percent of its patients are women.Methadone clinics administer the drug in liquid form rather than pills, which are more commonly used illegally.Research done by the CDC supported the likely cause of methadone-related deaths to its use as a prescription painkiller.The agency found that methadone accounts for just 2 percent of painkiller prescriptions but has accounted for more than 30 percent of painkiller overdose deaths.
However, overdosing through a methadone clinic is far less common because the clinics have strict governmental regulations.“Methadone maintenance treatment programs are highly regulated by federal and state agencies and also require a strict clinical component,” McMurtrie said.Both clinics are subject to inspections throughout the year.The state's Department of Drug and Alcohol Programs does on-site inspections multiple times per year.“Each facility that obtains a citation for non-compliance to a regulation is required to submit a plan of correction,” McMurtrie said. “During the next site visit, the drug and alcohol licensing specialist will review that the plan of correction was put into use.”These regulations require clinics to go through measures to prevent misuse of the drug that they administer through their treatment plans.These plans begin with an assessment of each patient by the clinic team.While patients do not need a doctor's referral to walk into the clinic, they must undergo evaluations at the clinic to be enrolled in the program.“The treatment plan is developed using information gathered during the assessment process and throughout the treatment stay,” McMurtrie said. “The treatment plan is approved and signed by the clinical supervisor and medical director.”For patients to be enrolled in a treatment program, they must meet different guidelines, which include a history of addiction.Prior addiction is needed because if a person already has a tolerance to opiates, then the methadone will not have as drastic an impact on the body. It's one of the reasons methadone from clinics is safer than when methadone is prescribed as a painkiller.
McMurtrie said patients are highly monitored during the initial dosing process to make sure they are set on an appropriate dose for their treatment.“The right dose of methadone is found when the person no longer experiences withdrawal symptoms and can no longer feel the effects of opiates, therefore taking away the incentive to abuse these drugs,” McMurtrie said.One of the main safety measures of the clinics is that the drug must be administered on-site until a person establishes a credible track record.Both clinics in the county follow federal regulations on take-home treatments.A patient must take each of the daily doses on site until the person has tested clean of other drugs for at least 90 days.Once patients have been clean for 90 days, they can apply for take home doses for over the weekend.After that, patients can go to three, two, and eventually one time per week visitation schedules, each separated by the same 90 day standard.Time is not the only factor in the eligibility either.Absence of recent abuse of drugs and alcohol, regular appointment attendance, and absence of serious behavioral issues outweighs the risk of the patients selling the drug on the streets, McMurtrie said.Clinics also make call backs to make sure patients have not tampered with the prescription.“Call backs are when we call a patient to return to our facility within 24 hours to have take-home medication inspected for tampering and to ensure all of the take home medication supplied is intact,” McMurtrie said.With a correct dosage, methadone has no impact on a person carrying out their daily lives, including driving a car and going to work.“They can drive if on a stable dose prescribed and monitored by a licensed physician.” Askew-Floyd said. “Patients do not experience highs and lows when on a stable dose coupled with psychotherapy.”Methadone isn't the only drug patients are kept from abusing in the clinics since they are regularly tested for other drugs.“If a person appears under the influence, his or her medication is withheld and our treatment team helps the person to find an alternative way for the person to get home,” McMurtrie said.The length of treatments can range from months to several years depending on a patient. While there are no long-term risks associated with treatment, the process can become costly.It costs about $100 per week for treatment at both clinics in the county.
While both clinics accept insurance, many of the people do not have insurance. That is where the county Drug and Alcohol Program steps in.“We're the single county authority for distributing federal and state funding to provide funding for treatment,” said Donna Jenereski, the program's director.“This treatment is designated for people in Butler County that do not have health insurance.”The county paid $35,970 for treatment from July through December 2013.The program acts much like the clinics in terms of their evaluations of patients.Patients must meet with the program's assessment team for an evaluation.“We look at every area of life,” Jenereski said.Once the assessment is completed, the patient is sent to the appropriate services.If the assessment team and that patient agree a methadone clinic is the best option, the program will refer the patient to one of the two clinics.In 2012, the program assessed nearly 1,000 patients and referred about 100 of them to methadone clinics, while others were referred to other drug or mental health programs.
