Methadone Clinic Changes Lives

By Ruth Heide Courier Editor          6.10.16 

ALAMOSA Heroin meets its match every morning at the methadone clinic in Alamosa.    Thanks to their daily methadone doses along with individual, family and group counseling 20 area residents are no longer using heroin.    “I am getting up every day, going to do stuff for myself, redo my life over again, get a second chance,” said Luis, a former heroin addict receiving daily methadone doses at the clinic, which is housed at the Crossroads Turning Points facility in south Alamosa .    Luis said the methadone treatment has helped him. He is not living in a fog anymore or just trying to get the next fix.    “Now that I am on methadone, I am clean, moving forward and actually better,” he said.    Luis was one of several members of a panel hosted by the SLV Behavioral Health Group recently to have a “Community Conversation” about methadone treatment and how the clinic is working several months into operation.    Amanda Gordon, director of Southern Region Services for Crossroads, said it made sense for Crossroads to be involved in the methadone clinic here because it has provided treatment in the area for 25 years, “so we already had an established location.”    She said Crossroads continued to see an increase in clients suffering from addiction to heroin and prescription pain pills and wanted to participate in a solution.    Dr. Barbara Troy, the physician involved in the methadone clinic, said a new neonatal task force was dealing with the problem of pregnant women who were addicts and whose addiction was affecting their unborn children. She was willing to meet with Crossroads staff to start a methadone clinic to help with this problem.    “It was obviously in the Valley. Heroin is everywhere,” Dr. Troy said. “How do we help the whole community get through this crisis?”    To provide an integrated treatment program, the SLV Behavioral Health Group also became involved.    “It’s been great working with Crossroads, making sure people can access the services,” said SLV Behavioral Health Group Chief Operating Officer Kristina Daniel.    Chio Ramirez, assistant director, Crossroads San Luis Valley Services, said participants attend counseling sessions including group, individual and family sessions.    “If there are co-occurring issues, we address those,” she said.    Daniel said a person might have mental health and substance abuse issues at the same time.    “We try to look at the whole person,” she said.    “It’s a team based approach,” added Victoria Romero, clinical director for Outpatient Services & Behavioral Health Integration for SLV Behavioral Health Group.    “I am excited about the integration of behavioral health, health care and substance abuse,” she said. “The more team based care, the stronger our services will be, the better our community will be.”    Luis said he has a much better relationship with his family now.    “My mom and dad are very supportive,” he said.    Ramirez said she could see the difference in people after only a few methadone doses.    “The first time they are not smiling. They don’t smile for a few days until they feel the medication working on them.” Angela Bonaguidi, director of Adult Outpatient Addiction, Addiction Research and Treatment Services, University of Colorado at Denver, School of Medicine, described how drugs like heroin work and how medication assisted treatment such as methadone works.    She said that over the last 10 years drug death rates have almost doubled and now exceed motor vehicle death rates. Most of these deaths were not intentional suicides, she added.    Bonaguidi said family members might ask why their loved one cannot just stop using an opioid like heroin.    “To really understand addiction, you have to recognize that it is a chronic disease,” she explained.    It would be like someone with diabetes just not taking their insulin, she said.    “It’s very difficult to manage chronic illness. It’s very difficult to stay medication compliant.”    She said when people relapse; the best place for them is where they have resources to help them. That is what the SLV Behavioral Health Group and Crossroads Turning Points are providing here in an integrated Opioid Treatment Program (OTP), licensed through the state, Bonaguidi explained.    She said medication assisted treatment has been widely received since the 1960’s and 1970’s and is recognized as an evidence based practice that is very effective. Only OTP’s are allowed to administer methadone, she said, clarifying “Any physician can prescribe methadone for pain, but no physician that is not connected to an OTP can prescribe methadone for addiction.”    The state licensure of OTP’s means the state can make sure patients are not going to more than one clinic at a time for multiple doses of methadone, Bonaguidi explained.    An OTP is highly regulated, and those receiving services must have at least one year history of opioid addiction, must voluntarily participate, and must participate in a robust treatment plan that combines medical and behavioral treatment. Participants receive counseling in addition to medication, Bonaguidi explained. The patient’s physician must also be on board with the treatment. Dr. Troy said she tells patients the methadone will help stabilize them so they can work on other issues in their lives.    “They have to do the counseling. That is what heals the brain,” she said. “It takes a while and persistence to heal that brain. That’s why we work as a team. It’s the whole body.”    “Patients in medication assisted treatment may be on it for their lifetime,” Bonaguidi said.    She said she has a patient who has taken methadone since 1982. He is stable and has not relapsed. He told her if he were to go off methadone he would relapse and die.    Bonaguidi addressed the idea that treating a heroin addict with methadone is just trading one drug for another.    “That’s not true at all,” she said.    She said methadone and heroin cause very different reactions in the body. Heroin gives euphoric highs and extreme lows, whereas methadone provides a steady state.    “It remains in the body for a longer time, helps people maintain evenness,” Bonaguidi said.    Another major difference is methadone is administered and supervised. At the Alamosa clinic, patients receive their doses in the morning in liquid form.    I n r e – s p o n s e t o an audience m e m b e r ‘ s question and concern about cups and bottles being taken out of the trash for their residue , Bonaguidi said methadone is a highly regulated intervention with specific rules on the disposal of cups, for example. Everything is accounted for, she said, and random “diversion” checks are made on patients. A diversion, which is a misuse of the medication, could be someone missing a dose or trying to give it to someone else.    “There are lots of different measures in place to help mitigate the risk of diversion ,” she said.    Romero affirmed there are many checks in place to keep the drug from being misused. She added that these clinics are better than the dangers heroin addicts are now creating in the community.    “Right now you can walk around and find used needles all over the ground. That’s an issue we have right now.”    Dr. Troy said needle use raises other medical concerns , such as Hepatitis C and HIV.    Alamosa City Councilman Charles Griego asked how patients were getting to the methadone clinic, since one of the public’s concerns before it opened was that people would be walking through their neighborhoods to get there. Dr. Troy said patients sometimes share rides, and Red Willow and SLV Transportation bring patients in.    Griego said when the special use expansion permit for the methadone clinic came to the council, he took the position that if it helped get someone off drugs, he was supportive of it. He recommended that those operating the clinic come back and give an update to the city council.    Griego also asked how many people the clinic could accommodate. Ramirez said currently there are 20 people utilizing the clinic, but it can accommodate up to 50 without adding another counselor.    “We are still new. Once we get to 50 then we get another counselor and we will be able to handle it,” she said.    SLV Behavioral Health Group Chief Executive Officer Fernando Martinez said this is a pilot project, a first in the San Luis Valley, which he hoped could expand to other residents in the Valley who need this service.    He added, “Across the state they are particularly interested in what we are doing here.”    Bonaguidi said 10 years ago there were only five Opioid Treatment Programs in the state, with three of those at her Denver facility. Now there are 17 throughout the state. She said in northern Colorado there are mobile vans, mobile OTP’s .    Dr. Troy said there will be more funding available for this type of treatment now that the Affordable Care Act has redefined addiction under substance abuse disorder. She said Medicaid will pay for methadone and Suboxone, another medication she prescribes for opioid treatment in her Valley Wide Health Systems practice. Suboxone is a newer medication . Methadone has been around since the 1960’s , Dr. Troy said.    Gordon said on average the cost for methadone treatments is $10-15 a day.    “That’s less expensive than incarcerating people,” she said, referring to the cost of approximately $40,000 a year to house someone in prison.    “Plus it avoids serious health issues such as HIV,” Gordon added.    “Methadone is a very inexpensive option for helping individuals stay alive.”    County commissioner candidate Steve Atencio asked if it would make sense to get an in-patient treatment facility in the Valley to add to the treatment options.    “That would be nice,” Dr. Troy said.    “The more tools you have to offer the better,” Gordon added. “Methadone doesn’t work for everybody. Lots of people have to try different things before something sticks for them.”    Martinez said the volume is not here to support an inpatient treatment facility. Because of funding, it is hard to find residential treatment facilities, he said.    Romero and Bonaguidi added that Medicaid will cover medication assisted treatment but not in-patient treatment.    “That’s why when we send them to rehab, they have to have cash,” Dr. Troy said. D r . T r o y said one of the biggest problems former addicts h a v e h e r e is pressure f r o m d r u g dealers.    “They are very forward here,” she said.    She said former addicts are accosted on the street by their former dealers.    Luis added, “Drug dealers don’t care about anybody but themselves and their money.”    Alamosa Police Chief Duane Oakes said it seems that when the police take one drug dealer out, three more pop up. Police conduct major drug operations a few times a year, a process that takes time and effort to put together, he explained.    “You can’t just go in and kick in doors.”    The police department under Chief Oakes’ leadership has worked the drug problem from different angles, with drug recognition experts and a drug task force in place, as well as two canine officers.    District Judge Martin Gonzales asked Oakes about his take on the methadone clinic. “I think law enforcement overall is supportive of it,” Chief Oakes said.    He said property crimes have increased over the last several years as people began stealing to get money for drugs, so law enforcement was supportive of efforts to reduce drugs and drug-related crimes. He said when he became chief, one of his goals was to deal with drug use.    “Anything that can help these people get off of their drugs or at least maintain their addiction is going to be helpful for us in the long run,” the chief said. “Anything we can do as a community and law enforcement is part of the community to help curb the problem ” If we can help people that are drug abusers, I think we affect crime rates.”    When efforts made it more difficult for people to get prescription drugs, they turned to heroin, Oakes said. Deaths due to drug use continue, he added.    Alamosa police are carrying Naloxone to use in emergency opiate overdose situations and have already saved one life as a result.    Oakes said the police had some concerns about increased crime with people coming in to go to the methadone clinic and with increased foot and vehicle traffic, but that has not happened. He said of the 20 clients at the clinic, he only knows of one who is walking there. Everyone else has rides.    “It hasn’t impacted us as far as crime rate. I am hoping it will help impact the crime rates on the positive side,” he said.    He said he personally knows how effective methadone can be because it has worked for members of his family.    Gordon said people in Trinidad , where she lives, would love to have a methadone clinic in their community.    “This is an amazing opportunity your community has,” she said.    Dr. Troy said she is pleased to see the community working together on this issue and moving forward, “and that means we will save lives.”    Bonaguidi said, “Being from Denver, I am really impressed with this community and the level of integration and number of representatives from different agencies and the community coming together for a common mission ” I am overwhelmed and very impressed with this community and how positive everyone is about wanting to treat this common issue.”    Those interested in the methadone clinic may contact Crossroads at 589-5176 or Dr. Troy at Valley Wide Health Systems at 589-2562 .