Sober N Clean

State's only public treatment system says 93% of patients aren't using other opiates

A client of the Charleston Center of Charleston County takes a dose of methadone.

When he tried to quit using OxyContin, heroin and other opiates cold turkey, Ken S. said the pain was so great he felt it in the marrow of his bones.

Ken, 40, who chose not to give his last name so he could remain anonymous, said that about a year ago he landed on the doorstep of the Charleston Center of Charleston County, a drug and alcohol treatment program that runs the state's only public methadone program.

He had been abusing opiates since he chugged a bottle of codeine cough syrup at 10 years old. And he was at the end of a two-year spree of heavy abuse of prescription opiates and heroin that left him in fear of losing his job and his family.

He was so out of control, Ken said, that he physically and verbally abused his wife as his child watched. "My 9-year-old son was scared of me," he said.

Ken was so ashamed of what he'd done that he tried to stop using the drugs, but the withdrawal symptoms were unbearable. He found himself doubled over and vomiting in the shower as nearly scalding water washed over him.

"It was disgusting," he said. He knew then that he desperately needed help.

He remembered hearing that a former girlfriend, who also was an opiate addict, had participated in a methadone program and was successful getting off the drugs.

So, Ken showed up at the Charleston Center. It was his last hope, he said, "the last house on the block."

Ken said he hasn't abused drugs in about a year. And he takes the methadone only as prescribed.

He's rebuilding his life with the help of the methadone program, which includes counseling and regular drug screening. He also is part of a 12-step recovery program. For the first time in many years, Ken said, he can think about doing things to help others instead of simply thinking about himself and planning to get more drugs.

He's aware of the stigma surrounding methadone programs, how they conjure images of homeless junkies injecting themselves with heroin.

Ken is employed, middle class, married and has never used a needle. He thinks the negative stereotype keeps other addicts from seeking the help they need.

Methadone, a long-acting synthetic opiate, has been used to treat heroin and other opiate addicts since the 1960s. Some addicts treated with methadone gradually decrease their dosage until they are drug-free while others stay on it for decades. They don't get high from methadone, and are able to function normally, including holding jobs.

According to the White House Office of National Drug Control Policy, methadone is a rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence.

Still, it remains controversial with the public and among some alcohol and drug treatment professionals who believe that only abstinence-based programs are effective.

Dr. Jack Emmel, medical director of the Charleston Center, winces when people ask him whether treating heroin and other opiate addicts with methadone is simply trading one drug for another.

When it comes to opiate addiction, he said, "you'll find no program that has the success rate of a good methadone program."

Addiction to shorter-acting opiates, which include heroin, OxyContin, Lortab and Vicodin, severely alters a person's brain chemistry, he said, while methadone stabilizes it.

Methadone, however, doesn't work quickly. It takes many months, even a year in some cases, for an addict's brain chemistry to return to normal, Emmel said.

Addicts who attempt to stop using opiates too quickly experience severe withdrawal symptoms and are likely to return to abusing the drugs, he said. Ninety percent of such addicts who stop cold turkey, even those whose withdrawal is medically supervised, relapse, he said.

Ed Johnson, program administrator for the center's opiate treatment program, said patients who use methadone fare better.

The center's random drug tests have found that 93 percent of patients who are using methadone aren't using any other opiates. And 65 percent aren't using any other drugs. Those rates indicate that the methadone program is more successful than most drug treatment programs, not just programs for opiate addiction, he said.

Johnson said the stigma surrounding methadone programs has worsened after some recent highly publicized drug overdose deaths involving methadone and other drugs.

Methadone also is used as a painkiller, he said, so it ends up on the street. But most addicts use it only when no other opiates are available. It doesn't give them a good high, but it holds off painful withdrawal symptoms, he said.

Johnson and Emmel said the center's staff thinks gradually decreasing the dosage of methadone and becoming drug-free or staying on the drug long-term are both viable options.

"A person whose methadone dose is adjusted properly is 100 percent functional," Emmel said. And some people can't get off it, just as some people with diabetes can't eliminate the need for insulin by changing their diets and exercising.

The center serves about 250 patients in the methadone program, Johnson said. They are all different ages and come from all walks of life. Fewer than half use needles. Most abuse prescription drugs.

The state has 10 private methadone programs, including one in Charleston.

The Center's program is self-supporting, and patients pay about $13 per day, Johnson said. That includes methadone and counseling. Without counseling, most patients would likely relapse, he said.

Ken says that's true for him. In the year he's been on methadone, he's been "working full-throttle on recovery," he said. He's been decreasing his dosage of methadone over the past several months, and expects to be off of it and completely drug-free by mid-August.
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source: Charleston Post and Courier, http://www.charleston.net