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Methadone: Miracle or menace?

The opening of Lodi's first methadone clinic has ignited a passionate debate over a controversial drug. Many hail methadone as a blessing that allows addicts to regain a normal life. Critics say the clinic is too close to a middle school. And they contend that the growing availability of methadone only deepens America's dangerous and growing addiction to narcotics.

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Posted: Saturday, October 27, 2012 12:00 am | Updated: 8:55 am, Sat Oct 27, 2012.

When he found out there was a methadone clinic opening in Lodi, a 49-year-old man who says methadone helped him kick his decades-long heroin habit hoped he could start going there.

A local doctor openly questioned whether this clinic will actually help patients or if it is solely focused on making a profit.

Lodi Middle School, which is across the intersection from the clinic, sent out an automated phone message and letter home to parents informing them about the new clinic.

And Dr. Ernie Vasti, who started seeing patients on Oct. 15, said he is ready to bring a much-needed service to the Lodi community.

"There were so many people from Lodi coming to Stockton, and there was such an explosion of drug use. It just got harder and harder for parents and patients to travel to the clinics," Vasti said.

The debate around the use of methadone to treat drug addicts began to escalate in Lodi recently when Vasti opened Healthy Connections, a clinic at the corner of Ham Lane and Vine Street.

Supporters argue that the clinic will help more people stay off of opiates, because addicts won't have the additional burden of finding daily transportation out of town for treatment. They also contend it is a safe, legal way to make it through horrific heroin withdrawal symptoms, and that the opening of the clinic will likely reduce crime because there will be fewer opiate addicts stealing and committing other illegal activities to buy drugs.

Opponents worry it could bring drug addicts to a clinic across from the school. They are also concerned that the clinic is just swapping one addictive substance for another, and that it could lead to a rise of illegal methadone use among addicts. Moreover, they say the clinic is opening at a time when prescribed narcotic abuse is more pervasive and dangerous than ever.

Providing a local treatment center

The new clinic is located in the Lodi Memorial Hospital Urgent Care building, where Vasti is renting space from the hospital and operating the clinic in the morning before the Urgent Care clinic opens.

The new clinic is not affiliated with Lodi Memorial Hospital, according to Debbe Moreno, the hospital's chief nursing officer.

Vasti decided to expand his practice from his two clinics in Stockton to Lodi because of the increase in opiate use.

"Over the past several years, perhaps since the introduction of Oxycontin, there has been a shocking rise in the incidence of opioid prescription abuse and dependence," he said.

That dependence then flipped from pills to heroin, Vasti said.

The new generation of addicts tends to be young, white males from affluent neighborhoods, he said.

About a year ago, Vasti met with Lodi Memorial Hospital and did a needs assessment, which included examining Lodi Police Department data, to see if a clinic could benefit Lodi. Then, he met with hospital representatives and checked local ordinances.

While his goal was never to open near a school, Vasti said he wanted to be across from the hospital and within the medical complex. His south Stockton clinic, which has been open since 2005, is a block from St. George's Church and Grammar School.

"We have maintained good relations with our community and the two churches, and have not had any issues which would discredit me, my staff or my patients," he said.

According to county and state regulations, Vasti is allowed to see a maximum of 150 patients at the Lodi clinic, and he said at least 30 or 40 of them are from Lodi. He imagines that number will increase as people find out about the clinic, because he believes there are at least a couple hundred — and possibly as many as a couple thousand — people addicted to opiates in the Lodi area.

"It's much bigger than we think," he said.

This week, Lodi Middle School Principal Scott McGregor said administrators sent out an automated message and a note home to parents informing them of the clinic.

"We wanted parents to know we continue to monitor the safety of the children on an ongoing basis, like we always do," he said.

Lodi police also said they are aware the clinic opened. They are watching for any problems such as impaired driving, Sgt. Sierra Brucia said.

As a police officer, Brucia said he has encountered people on opiates, on methadone and on both drugs. While he has no medical background, he said it is concerning that people are substituting one controlled substance for another.

"I don't know the actual value of someone being on methadone instead of heroin, but if they are under the influence of a controlled substance, does it really matter which one?" Brucia said.

On the other hand, the new clinic could help heroin addicts with withdrawal symptoms and would prevent sharing of needles, Brucia said.

"There are people who are getting legitimate prescriptions for methadone. As long as they are not breaking the law, they are free to use those services," he said.

The debate: Does methadone work?

Questioning whether addicts are replacing one drug — heroin — with another — methadone — is a common argument against clinics, but it is factually inaccurate, said J.R. Neuberger, a member of the board of directors for the National Alliance for Medication Assisted Recovery. The organization advocates for methadone treatment throughout the United States.

Methadone is a synthetic opiate that helps addicts get over the initial withdrawal period. In the long term, it helps regulate the brain's chemistry that in many cases has been altered by years of drug use, Neuberger said.

"Methadone patients are frequently pressured by families asking, 'How long are you going to stay on this stuff?' That's an insane question. If we had an aunt or an uncle, or a son or a daughter who has cancer, we wouldn't tell them to get off their chemotherapy," he said.

Lodi resident Pat Richardson is not a medical professional, but has talked with people in the community and researched methadone clinics because she was concerned about one opening locally.

From her research, Richardson said she believes for-profit clinics, like the one in Lodi, exist only to dispense drugs at the highest rate possible to keep turning a profit.

"The bottom line is this clinic is not set up to wean people from narcotics. It is a clinic to get them addicted and keep them addicted. They are a multibillion-dollar industry. Livable, loveable Lodi doesn't get that connection," she said.

Richardson worries the clinic could lead to people on methadone driving while impaired, users on both heroin and methadone going to the clinic and patients selling their take-home medicine on the street.

"It is likely that methadone will go into the street and that will result in more addiction and crime," Richardson said.

A 61-year-old Lodi woman said she also is concerned the methadone will be resold to addicts, based on her experiences getting treated for heroin more than 30 years ago in Mountain View. The woman requested her name not be used because she is a member of an anonymous 12-step program.

The woman was on methadone for seven years before going to college and becoming a vocational counselor. While she supports using methadone to detox, she said it should not be a long-term treatment.

In her experience, people on methadone no longer feel the effects of heroin, so then they would do two to three times the usual amount of heroin to get high.

When she went into the clinic, she would often pretend to swallow the liquid methadone but then sell it later for heroin. Addicts who were able to take doses home would sell them for drugs.

"I haven't really met anybody who really wanted to get off heroin when they were on methadone. Methadone helped you from getting sick and stopped withdrawals. It was a good tool, and an excuse to use for probation officers and parole," she said.

However, the woman said she is not concerned about addicts selling to nearby school children, because they only want to sell the methadone in exchange for heroin and other drugs.

But other former addicts credit methadone with saving their lives. Richard, a 51-year-old former addict, said he used methadone to get off of heroin, and now he has been substance-free for two years. He asked that his last name not be used.

"This clinic is one of the best things to happen for drug addicts in Lodi and Galt. It will clear out a lot of the crime. People will steal, lie and cheat when they are on heroin, but that will change if they can get on methadone," he said.

Dr. Gary Wisner, a Lodi orthopedic surgeon, has deep concerns about the new clinic, ranging from the possible leakage of methadone onto the streets of Lodi to the threat of patients imperiling Lodi Middle School students as they drive to and from the clinic.

The clinic serves only recovering addicts. But Wisner says it reflects a troubling trend toward methadone and other painkillers being widely prescribed and abused. In recent years, according to The New York Times, federal officials have seen a huge increase in methadone being prescribed as a painkiller — and a national surge in fatal overdoses.

To prevent the drug from being sold on the street, Vasti said the clinic has a variety of safeguards in place. Much of the methadone illegally on the street is in pill form, and he only uses liquid medication.

Patients have to remain off of opiates and attend appointments on time for a set period before they can earn the privilege of receiving take-home doses.

For patients who can take home medication, he usually only gives them a week or two-week supply, even though legally he can give a 30-day supply. He does not support giving a month-long supply because logistically it is difficult for a patient to keep track of that many vials at home, and the clinic cannot monitor the patient.

The clinic also randomly asks patients to bring the vials in to check how much they have been using. They conduct urine drug tests regularly for all patients.

Studies have proven that illegal drugs on the street are not coming from methadone clinics, but instead pain management clinics, Neuberger said.

Many of the concerns people bring up about methadone use are red herrings, he said. Clinics help people regain control over their lives and beat their addiction, while using a legal and safe substance.

"There is more misinformation surrounding this treatment than in any other treatment in history. This is the treatment that works. This is the treatment that saves communities," Neuberger said.

Contact Maggie Creamer at maggiec@lodinews.com.

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  • Katie Horak posted at 12:33 am on Mon, Nov 5, 2012.

    SinfulDivinity Posts: 9

    If Methadone is such a miracle drug, why is it that when the patients come in they are not told that the withdrawals will be 10x harder and 10x longer than any opiate they've ever taken and thus forcing them to stay medicated to not get sick at a hefty price of $250 a month? Why do some Methadone clinics (such as Aegis) have "deals"? When I first was admitted, they had a deal of 25 days for $25. Just enough days to get you hooked. Once I tapered off, I had to be put on SEVEN medications from Kaiser to combat the withdrawal effects. Librium, Clonidine, Cyclobenzaprine, one for diarrhea, one for nausea, one for pains and aches, and one for fever and chills.... I wanted to die every single day. Tell me, if Methadone is such a good miracle drug, why would I have to be prescribed that many medications to combat the withdrawals afterwards? If I could go back in time, I would have just quit Oxy cold turkey and dealt with what seemed to be minor withdrawals compared to the methadone withdrawals. I'm 4 years clean since June 26th, 2008 and I have NEVER relapsed and NEVER will. I NEVER EVER want to feel those withdrawals ever again. I wouldn't wish it on my worst enemy

  • Katie Horak posted at 12:16 am on Mon, Nov 5, 2012.

    SinfulDivinity Posts: 9

    I will tell you as a former patient of a methadone clinic that it is a money making entity. They get you hooked by giving you a good deal and then it's soooo much harder to get off of than heroin or oxy... 3 and a half weeks of the worst withdrawals that you could ever imagine. I remember staying up every night with my fiance' thinking I was never going to get better and I was going to stay in that state permanently. It's not doom and gloom. It's a warning. It doesn't matter whether or not you have a nice experience, it's still 10x harder to get off of than opiates and you are forced to pay $250 a month for the rest of your life to be normal.

  • Katie Horak posted at 12:11 am on Mon, Nov 5, 2012.

    SinfulDivinity Posts: 9

    I will tell you as a former patient of a Methadone Clinic, Methadone is 10x worse than the herion/oxycontin and would actually harm patients more than help. My fiance' and I checked ourselves in to Aegis in stockton to get off an Oxy habit before it got completely out of hand. They had a "Deal"... $25 for 25 days. Funny thing really... a "deal" for rehab. First of all you have to wait. I mean WAIT. You HAVE to have codeine or something of the barbituates kind. I asked what if I peed clean and they told me that I would have to relapse to get into the program!!!! We waited for 6 1/2 hours to see anyone. Then you have to take a pee test and you see a doctor to evaluate your psyche. THEN they give you your dose. They start you off at around 25mg. If you are at the right dosage for your body, the stuff is like a miracle (most people will make up lies and say they need more and they'll get a high almost identical to heroin i.e. dozing, lathargic, falling asleep while talking, numb) . If you're at the right dosage, All of a sudden you have MOTIVATION to do GOOD in your life! It feels like the kind of natural energy you had as a kid. Well it's all smoke and mirrors... You still have to wake up every morning to "dose" at your clinic and even make appointments to see your therapist once a week for an hour and doc once a month. You have to do a pee test every week to make sure your not relapsing and they don't work around your schedule. They're open from 5am-1pm. Every day you have to wait to get your dose and then... they start to step you down and you start to FEEL it and DREAD it. 25 days turned into 6 months and every month it was $250. Good luck skipping a day because you will withdrawal. When we finally tapered off the methadone, IT WAS WORSE THAN THE WORST WITHDRAWALS/SICKNESS YOU HAVE EVER FELT IN YOUR LIFE. NOT FOR A FEW DAYS, BUT FOR 3 1/2 WEEKS!!!!!!!!!!!!!!!!!!! Three in a half weeks of chills, fever, diarrhea, anxiety, sleepless nights, wanting to kill yourself, worst depression of your life, antsy... any bad feeling you could ever have. If I had a choice now, I would have NEVER I mean EVER EVER EVER gone to a methadone clinic!!!! I would have toughed out those couple of days that I had withdrawals of heroin or oxy. Those withdrawals are a BREEZE compared to the EVIL that methadone does to you. Most people will tell you that if you start methadone, you're in for life. $250 a month, everyday, you can't go on vacation, can't leave the city, can't mess up in the system and if you complain to the doctor about something as little as an argument that made you sad he could bump you up all the way up to 150mg!!! It's a business that gets money from the weak and vulnerable. I'm 4 years clean now as of June 26th, 2008. I will never do oxy, heroin, methadone ever again, mainly because of the fear of that horrible withdrawal that methadone gave me and WISHING and PRAYING that my life would end or the withdrawals would. Worrying every single night that I was never going to be the same. I had to go to Kaiser to get seven medications to get me off the methadone withdrawals after I got out of the clinic. Please... If you're a user of Oxy, Heroin or Vicodin, Don't go to a methadone clinic... If there was anything that I wanted to get across and wanted to express in my life, it would be to never go to a methadone clinic to get off opiates. Just tough through those couple of days if you're serious about quitting. Otherwise, if you don't have strong will power and support from family or friends, you'll be on methadone for the rest of your life.

  • Tonya Roberts posted at 12:18 pm on Sun, Oct 28, 2012.

    tonya1968 Posts: 1

    The problem with these clinics are that MANY provide substandard care. Many patients are started on methadone based only on a positive drug screen for opiates. There are federal and state guidelines in place to try and prevent these clinics from just being a supplier of drugs but in many cases these are not being enforced. Many of the doctors working in these clinics do not understand the unique properties of methadone and this puts patients at an increased risk for death. Most deaths occur within the first two weeks of starting methadone. The risk of death during this time is up to 6.7 times higher than that of a heroin addict. Many of these clinics do not properly monitor and assess(vital signs, pupil checks ect) patients during this dangerous time . There are clinics that will continue to dose patients knowing that the patients are abusing other drugs that have lethal interactions with methadone.In fact SAMHSA (the federal agency that oversees these clinics) recommends this practice. Patients are not being assessed and monitored for signs of intoxication and sedation during their continued treatment with methadone. The federal guidelines do not require that a continued assessment (with vital signs, pupil checks ect.) be done after the first two weeks of induction. Many clinics are routinely starting all patients on a 30 mg dose even the SAMHSA has stated that this is NOT a safe dose for every patient. This has caused MANY deaths.Best Practices for methadone treatment needs to be updated to address these deaths.Should patients receive substandard care because they are being treated for a drug addiction? How many people have to die before we address these issues? www.stopmethadonedeaths.com

  • Doug Chaney posted at 11:48 am on Sun, Oct 28, 2012.

    advocate Posts: 499

    The so called research by Ms. Richardson, who , could well have been kept out of this article, admitting she is not a medical professional and comes to her conclusions just talking to people and researching methadone clinics. Her assumptions seem to be just a gloom and doom theory, accusing clinics of being money factories for huge prrofits and insinuating this clinic is going to be no different from the others she cited. The city of Lodi scrutinizes every business application and licensing approval and especially the dollars it puts into the general fund and could have done a better job of asking the newspaper to let the citizenry know that clinic was approved and ready to open. Again, just more gloom and doom and the sky's falling scare tactics by the Lodi-News Sentinel. I'm willing to bet there are many affluent, popular, wealthy and well connected families in the Lodi community that have a friend, family member or relative that is on this very mmethadone program, or or too embarrassed to admit they have an addiction problem to try methadone, especially those addicted to Lodi's favorite of choice, alcohol. The city leaders had to full well know this clinic was opening and when. I can imagine the ooutrage the day the detox center opens in Lodi, hopefully with a minimum of 6 beds, to detox those who are willing to go to a treatment program.

  • Kerry Wolf posted at 8:36 am on Sat, Oct 27, 2012.

    Kerry Wolf Posts: 1

    Thanks, Joe, for your accurate and thoughtful comments, and Lodi News for bothering to get both sides of a story on methadone--something often neglected in such articles.

    As Joe mentioned, long term abuse of opiates can lead to permanent changes in the brain chemistry, specifically endorphin production. All the counseling and 12 step group meetings on earth cannot repair this biochemical, medical problem. It is similar to patients who abused anabolic steroids and then have to have life long testosterone replacement therapy because they no longer produce normal amounts of testosterone. The brain has opiate receptors specifically because the brain produces natural opiates (endorphins) that enable us to feel pleasure and happiness, and without those, a person will suffer from severe depression, inability to feel pleasure, irritability, physical exhaustion, extreme cravings, etc. Not all patients need long term replacement therapy--just as not all diabetics need injectable insulin--but some do. Methadone does not replace the drug of abuse as is commonly thought, but rather, the missing endorphins, enabling the patient to feel normal--not high, not euphoric--normal.

    To address some of the inaccurate comments--Officer Brucia said he knew people that had been on methadone, on opiates, and on both drugs. Methadone IS an opioid drug. Methadone is simply a subcategory of opioids, just as Snickers bars are a subcategory of candy. SO this comment shows a lack of understanding regarding drug categories.

    He also said it doesn't matter which "controlled substance" people are on. In fact, what DOES matter is not so much the particular opioid, but whether or not a patient has a tolerance to that drug. Patients taking opioid drugs short term, for acute pain, WILL be impaired by it's effects and should not drive. However, dozens of studies show that patients who are tolerant to the effects of methadone and are not taking any other mood altering substance are able to drive without cognitive impairment . The same is true for most chronic pain patients who are on a single opioid drug and are tolerant to the effects.

    Regarding school proximity to clinics--in my town, we have a methadone clinic directly across from a school and it has been there over ten years without a single instance of any problem involving any students. Nor are there any studies or records showing that methadone patients have harassed, coerced or sold drugs to schoolchildren in proximity to a clinic.

    What people don't seem to realize is that today, over 75% of methadone clinic patients are there for addiction to prescribed painkillers, not heroin. They come from ALL walks of life--we have patients who are attorneys, registered nurses, teachers, business owners, college students, soccer moms, etc. They have children, jobs, and lives just like most other people. Wherever clinics locate, stats show that crime DEcreases, it never increases.

    Abstinence based treatment is very ineffective when it comes to long term opioid use. This is due largely to the fact that it does not address the brain chemistry issue at the heart of most cases of relapse. Methadone treatment success is not based on how many people get off methadone, any more than diabetes treatment success is based on how many people get off insulin. It IS based on how many people cease abusing drugs and are able to live a productive, responsible, law abiding life--and by that measure, methadone is far and away the most successful method of treatment., with a rate of about 65%, as opposed to abstinence based rehabs with a rate of about 10% .

    Finally, it continually baffles me that people seem to feel that turning a profit is a terrible terrible thing, but ONLY for methadone clinics. It is fine for doctors to turn a profit and abstinence based rehabs--which count on repeat business--to turn HUGE profits on ineffective treatment, but if a methadone clinic dares to be in business to make money like every other business on earth, they are wrong and evil. It costs a great deal of money to run such a clinic--there are countless hoops to jump through, agency rules to meet and policies they must follow, staff to pay, etc. The false belief that they want to keep patients on methadone because they need their money is inaccurate--many clinics have long waiting lists and those that don't can usually replace a departing patient the same day with another coming in--they have no financial incentive to keep patients there that don't want to be there or who wish to taper off and leave.

    I encourage your readers to do a THOROUGH job of researching methadone treatment, from reliable sources such as the National Institute of Drug Abuse (NIDA), Substance Abuse and Mental Health Services Administration (SAMHSA), Faces and Voices of Recovery, etc for a non biased, evidence based picture.

    Kerry Wolf
    V.P., NAMA-Recovery



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