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Wednesday, July 7,2010

Drugs of choice

The good news: Heroin abusers no longer dominate local rehab clinics. The bad news: They are being overtaken by prescription drug abusers. Methadone is the cheap new culprit.

by Andy Balaskovitz

A true opiate addict claims to "feel normal" the first time he does opiates. David Blankenship, program director for Victory Clinical Services, which operates an addiction recovery center on South Cedar Street in Lansing, calls these people “lifers.”


Some of the most popular opiates, both pharmaceutical and illicit, include oxycodone, methadone and heroin. Methadone is used to wean addicts off the other two drugs due to its longer-lasting effects on the body. However, records show that illicit methadone use has jumped significantly in the past few years.


According to a report by the state Department of Community Health, 267 people in Michigan admitted to using methadone illicitly in 2005. In 2009, that number jumped to 661 people. Officials are quick to mention that not all cases of abuse go reported and not all cases of addiction are treated.


How can it be that a drug used to cure addiction can lead to illicit use, further addiction and sometimes death? Local medical professionals point to the ease of obtaining opiate prescriptions for pain and also those drugs’ potency.


Blankenship’s center is one of the few in Michigan to offer adjunct therapy, which is a combination of medication to fight off physical withdrawals in opiate addicts and mental health therapy. He says all of his patients are opiate addicts. But what is troubling to him is that eight years ago, 70 percent to 90 percent of his patients were intravenous drug abusers, typically heroin. Today, about 40 percent of his patients are heroin users and about 60 percent are addicted to pharmaceuticals.


“Over time, pharmaceutical companies have gotten much better at making drugs,” said Blankenship, who was formerly the drug and alcohol liaison with the U.S. Navy in Guantanamo Bay. “Now they (prescription opiates) are at least as pure as street heroin and more consistent.”


Due to a nationwide “epidemic” of abuse, state Medicaid laws made it tougher — and more expensive — for physicians to prescribe oxycodone (such as OxyContin) to manage pain. Blankenship said methadone is a cheap and easy replacement for oxycodone. “Problem is, I think they got carried away with it,” he said.


At Victory’s Kalamazoo, Jackson and Saginaw clinics , Blankenship said he has noticed physicians prescribing methadone for pain — not its original purpose.


“It’s for addiction,” he said, adding that it is legal to prescribe it for pain but doctors who do so “are not following best practices.”


Oxycodone and methadone are both opiates but have very different effects on the body. Oxycodone is time-released and gradually dissipates over 24 hours. It is abused by snorting it or injecting it intravenously, he said. Methadone, on the other hand, has a longer half-life, giving it a lagging effect in the body that can last for days. “People abusing (methadone) don’t realize this and keep taking more, thinking it isn’t kicking in.


That’s where there is usually trouble,” he said.


Patricia Wheeler, executive director of the National Council on Alcoholism- Lansing Regional Area office, also has seen a rise in illicit methadone use among patients. Adding to physicians’ willingness to prescribe and the heightened potency of those drugs, Wheeler says funding for rehabilitation — or the lack thereof — contributes to further abuse.


“The dollars going into substance abuse treatment and prevention continues to dwindle,” she said. “We are not educating people as well as we’d like to.”


Wheeler said there is a misperception about the dangers of initially being prescribed drugs like oxycodone and methadone. “Our clients report that methadone is as addictive as heroin,” she said.


When taken with other drugs, it sets the stage for complicated physical and mental reactions in a person, unlike any we have seen before. “There are more drugs and prescriptions but less familiarity with their dangers,” she said. “We are all trying to do a lot more with more complicated patients and less money.”


Wheeler said with less money coming in for rehabilitation services, society pays more at the other end by dealing with criminal activity like drug dealing and drunk driving. And in the end, people are abusing something they know nothing about rather than being predisposed to addiction.


“This is not a behavior issue. It is a medical issue,” she said.


The National Council for Alcoholism in Lansing offers two residential outpatient programs at the Glass and Holden houses. A majority of its clients are from Ingham County, but are not given methadone to manage their addiction, as is done at Victory.


Of the 135 drug-related deaths in Ingham County in the past five years, 68 are specifically opiate-related. Twenty-three of those made specific mention of methadone, Dean Sienko, chief medical examiner for Ingham County, said in an e-mail. Due to the complexity of the database, he said his assistant was unable to compare those numbers with the previous five years.


Blankenship said he never expected the nature of his job to change so drastically over the past 10 years. He believes physicians today play a role that facilitates illicit prescription drug use. “I never saw it coming — not to this extent.”



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