Is SLO County seeking to profit from heroin addicts?

September 3, 2016

749px-Money_and_pills_in_three_colorsBy JOSH FRIEDMAN and KAREN VELIE

Amid a growing opioid problem, San Luis Obispo County has announced plans to expand its substance abuse treatment programs. However, critics say the plans are inadequate in that they focus on providing replacement medication rather than full detoxification.

The county’s plans to promote drug replacement therapy as opposed to residential drug detox will result in a longer term revenue stream as addicts or their insurance provide monthly payments to the county.

In 2015, SLO County ranked fourth per capita in California in heroin overdoses leading to hospitalizations, according to state data analyzed by CalCoastNews. Likewise, 36 county residents died because of opioid overdoses last year, up from 15 in 2006, according to figures recently released by the SLO County Opioid Safety Coalition.

While SLO County is seriously lacking in treatment programs, it also ranks well above the state average for opioid prescriptions per capita. In 2013, there were 774 opioid prescriptions for every 1,000 residents in SLO County. There were 563 opioid prescriptions per 1,000 residents statewide.

California counties with the lowest opioid overdose rates tend to have at least one residential detox. For example, Fresno County residential detox programs offer a cumulative total of 122 beds. Fresno had one fourth the heroin-induced hospitalizations per capita in 2015 as SLO County.

In SLO County, there are no residential detox facilities, only one outpatient treatment center, a county-run drug replacement program with 40 slots and several doctors who will prescribe addicts legal opioids.

Aegis operates the county’s only outpatient treatment center, which is located off Highway 41 in Atascadero. Aegis provides detox programs and boasts an 80 percent success rate, generally through replacement therapy utilizing methadone or Suboxone, legal opioids.

Nevertheless, because of financial and time concerns, many local residents are unable to enter the Aegis program.

If the patient is not on Medi-Cal or several other insurance plans, the Atascadero clinic charges $698 a month for Suboxone replacement therapy and $260 to $490 per month for methadone replacement, clinic manager Anna Murray said.payment

County social services staff encourages the clinic to send uninsured clients their way. County staff then assists addicts in applying for Medi-Cal, Murray said.

Laws require methadone replacement clients to drive to the Atascadero clinic daily to receive their dose for the first 21 days. After three months, the clinic allows some methadone recipients to take two doses home, which reduces their clinic visits to every three days.

Mark, a machinist from San Luis Obispo, said he planned to remain in the Aegis program. But he had issues with the amount of time it required and the cost of driving to Atascadero and paying for his daily dose of medication. His car broke down after several months, and he stopped participating in the program and went back to using illegal opioids.

“I just couldn’t make it work,” Mark said. “I thought about applying for disability, but I like my job.”

San Luis Obispo County drug and alcohol services also offers Suboxone replacement therapy to a maximum of 40 clients at a time at a facility in San Luis Obispo. The county charges $583 for the first month of Suboxone, but most clients have Medi-Cal, said Star Graber, the division manager for SLO County’s drug rehabilitation services. “

SLO County officials plan to create a four-bed residential detox program as part of the upcoming expansion of services for substance abusers. However, the detox facility is not expected to open for a couple years, and it is not intended to treat opioid addicts, Graber said. Instead, the county intends to increase opioid replacement therapy options.

“Most opioid users do not need inpatient detox,” Graber said. “We are aware there is a shortfall, and we are looking to expand.”

Two administrators of residential detox centers in Lompoc dispute Graber’s claim that residential detox without replacement therapy is not needed. They contend less then 10 percent of opioid addicts are best served through drug replacement therapy.

Deb Keltz, the director of administration at Champion Center, a rehabilitation hospital in Lompoc, said detoxification from opioids is much more successful than maintenance. In addition, people are more likely to detox in a facility away from the people and places in which they were abusing drugs.

“You will not die from opioid withdrawal, but you may wish you did,” Keltz said. “Detox is better than maintenance programs.”

Keltz said 80 percent of patients who spend four to six weeks in a detox center and then continue with a year of follow-up therapy succeed in kicking their opioid addiction without replacement therapy.

Pat Brady, the administrator of Another Road Detox at the Good Samaritan Shelter in Lompoc, said having a detox available for opioid users is “absolutely important.”

“Some people are all for methadone; we don’t allow it in our recovery centers,” Brady said. “Detox works for most people, though sometimes it takes more than once.”

Last year, Santa Clara County had the fewest heroin-induced hospitalizations per capita, among counties with populations larger than 100,000.

In addition to having multiple residential detox programs, methadone and Suboxone replacement therapy in Santa Clara County costs $150 to $350 a month if the patient does not have insurance or is not on Medi-Cal, or about half what clients are charged in SLO County, according to Santa Clara health officials.

SLO County is planning an approximately $2 million expansion of its substance abuse treatment services. The county plans to add 26.5 full-time positions and to expand outpatient treatment and increase treatment for drug withdrawal, as well as case management and recovery support services.

The policy of doubling down on pharmacologically treating opioid addiction could prove financially beneficial to the county, which will receive increased revenue from the medication it will provide. The county is obtaining most of its funding for the treatment expansion through a new Medi-Cal program designed to deliver legal opioids to patients. California general funds are also expected to cover some costs, though there is risk the county will not receive the state money.

Even if the county receives additional funding, questions linger as to whether delivering more drugs will actually reduce opioid dependencies or help addicts become contributing members of the community.

Many experts cite prescription medication as the primary reason for a nationwide spike in heroin addiction.


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Resident

Hmmm.. Apparently our troops protecting the poppy fields in Afghanistan is somehow directly related to increase in Heroin flooding into the US and other countries:


https://www.youtube.com/watch?v=_Grli7aez0M


Who would have thunk it?


standup

Aegis is a legal addictive drug dealer. I have known several people that used/use their service. They don’t try and ween people off methadone. Instead, they look at every patient as a commodity that they don’t want to lose. They also don’t explain to patients that it is illegal to drive under the influence of methadone per the CHP. The funny thing is that people come and go from that place all day long driving their cars. Better to pay the popper and go through withdrawals for a week and tough it out. It won’t kill you.


Resident

The sad reality is, the government actually likes to have a certain amount of the population on drugs. They make a lot of money from heroin, cocaine etc… But not so much weed. Side-note.. how many CIA planes have crashed loaded with cocaine in the last 2 decades?


Other sad reality: A “drug” in South America completely cures Heroin and alcohol and other addictions, but is illegal here in the US: It’s called Ayahuasca:



JimF

Evidently, DMT/ayahuasca works wonders during the first year of recovery and is increasingly being used throughout the rest of the world. Also, kratom is great for initially weaning addicts off of opiates — but for some arbitrary reason the DEA just made that substance Schedule 1. It’s a shame because kratom does save a lot of lives. Paradoxically the alternative, buprenorphine and methadone (drugs prescribed in maintenance programs) are more addictive and have longer periods of withdrawal than the opioids the user is trying to kick in the first place. People on maintenance programs remain addicted, and a vast majority eventually fail.


As i’ve watched the war on drugs play out over the years i’ve become increasingly suspicious that it isn’t really designed to solve the problems at hand.


Resident

The whole “explosion” in Heroin is because of the low price and huge quantity coming into the country directly from Afghanistan.


Why did the production of Opium skyrocket shortly after the US invaded? Well, U.S. Soldiers now provide “security and resources” and guard over the poppy fields being grown by drug lords.


They pass this off as “the way it has always been, and part of the culture”.. But that was not the case before the US invasion.. Production is 40 Times what it was before the US invasion according to Russia (a nation with a serious heroin problem)


https://www.youtube.com/watch?v=ChIF6yvTL6k


It’s not a coincidence heroin use is exploding in the US and we have our soldiers guarding poppy fields in production land. It’s no “coincidence” that production is up 40X what it was the day before the first bombs started dropping.


SLO_Johnny

Another herbal “WONDER DRUG”. Give us a break with the holistic herbal nonsense. Opioids create permanent changes in brain structure and function and there is no going back. An addict is always an addict but they can learn to live with addiction without taking drugs.


JimF

One of the main components of addiction is escapism. Unfortunately otherwise committed individuals are prone to relapse when times get tough because of human nature and how they’ve learned to deal with problems. The psychoactive effects of dmt provide the user with a strong (and safe) psychological reset —they examine their priorities and refocus on their commitment to sobriety. It’s not a magic bullet, but it does offer addicts quite a bit of help until they learn better problem-solving skills and until the chemicals in their head stabilize.


As for your second point, i do know a number of former users who now describe themselves as feeling “normal/happy” and having little to no desire to use again — though getting there did take a lot of time/work (and of course there always is the potential for relapse).


Resident

Well, it’s a real wonder drug if you can call it that.


Most of the people administering the medicine in Peru and other areas of the Amazon Basin had been doing the practice for free for decades. Only recently, a larger influx of people with problems ranging from Arthritis to Psoriasis to Cancer to Drug/Alcohol addiction to issues from their childhoods have found solace in this “purging” ceremony.. and take all the prescribed, over priced “western” medications you want, you won’t find more success stories than those surrounding DMT/Ayahuasca-


Ayahuasca – like Psylocybin mushrooms has been shown to increase people’s outlooks on life, and self purpose, and reduce drinking, but moreso Ayahuasca has been shown time and time again to help with other physical problems unlike any other..


They’re totally natural, and non habit forming, not to mention produce apprarently life-altering experiences, so no wonder they’re illegal, right?


I highly recommend you, and everyone else reading this thread right now do a search for “Ayahuasca – here are a couple of interesting documentaries:


https://www.youtube.com/watch?v=P0ommNRJeMQ


This one was particularly interesting:



Rich in MB

Would a County that makes money from taking kids away from their Parents also look to make money elsewhere? Of course they would. We are not Taxpayers…we are Milk Cows, to be milked to feed the Government machine.


korie

Just a few thoughts after reading the article:

I would like to see the criteria for the claim of success reported by the facility above. 80% seems ridiculously high. As I understand it, often times the facilities don’t count the people who drop out before completing the program. A significant group of people. Not fair to skew numbers to the highly motivated subset. I would also question how long the patients are followed for relapse.

I’m willing to bet, and say out loud, that the increase in number of overdoses in SLO County has some correlation to the dramatic increase in transients. (I see a difference between a homeless person and a transient.) And I’m not saying opiate addiction doesn’t cross a lot of socioeconomic boundaries. I’m just saying that in SLO County that issue needs to be considered in the numbers.

I’ve always been in contempt of the people who profit from Suboxone, drug maker and dealer. It’s ridiculous that it requires a MD with a special license to prescribe who is then not held to any standard in fees charged. It creates a supply and demand which results in massive gouging by addiction specialist opportunistic physicians. I work in health care and support physicians. But it’s a fact that this group tends to be runners of profit mills.

And I’ve always been rigid in my thinking about true detox vs Suboxone or methadone. Obviously it is the ideal. But I’m not so sure it’s close to the success rate given. And I wish I’d been more open to the idea of long term addiction to a noninjectable, predictably dosed substitute for heroin. After two bouts in “successful” inpatient detox and 6 week rehabs, someone close to me recently died of a heroin overdose. Injecting heroin, likely tainted with fentanyl, with two guys he met in the rehab facility.


Mike Byrd

Assuming many are fortunate enough that they know relatively little about these issues, here are some things you should know as you judge this article.


Replacement therapies using methadone and suboxine have only one purpose and, generally, one outcome – a lifetime addiction costing many thousands of dollars per year. It is dangerous and demeaning.


It is correct that one will not die from, say, heroin withdrawal (though it might feel like it). Methadone is much more addictive, much more difficult to kick, and death can be an outcome from withdrawal. In fact, it is so dangerous that many reputable detox facilities will not accept methadone cases.


It important to remember that methadone users are still addicts. They will not pass employer-required urine tests. They will find it difficult gaining good employment. If they ever seek mental health services from the county they will be turned away because they are drug addicts. They will not be welcomed into most 12-step programs because they are considered active drug users. If, like the fellow in the article, they are unable to make it for their daily dose appointment they must immediately seek illegal sources because they will quickly become dangerously ill.


That our local government is willing to doom people to a lifetime of misery and addiction and, usually, poverty is unconscionable. The poison they’re peddling is more addictive and more dangerous than the drug they’re replacing.


Residential detox is the only real solution for opioid addiction. Once the county introduces “replacement therapy” that solution virtually disappears. Our government should help people kick drug addiction, not promote lifetime addiction.


Resident

Actually, 90% of those people relapse supposedly.. without use of Ayahuasca, even detox isn’t that effective. Even a single use of Ayahuasca and people can break the addiction. The medical establishment and government really don’t like talking about it though.. Makes you wonder.


debbie peterson

Having researched this issue with regard to homelessness and addition, my understanding is that the most critical need in the county is residential detox centers, and the problem is finding someone to operate them. Apparently Good Samaritan in Santa Maria have an excellent program that would work here, but have not been interested in expanding to SLO County.


If this is the real need, then I would like to see the Board of Supervisors take the leadership to tackle this problem, rather than taking on some other convenient alternative.


tomsquawk

it’s all big business, from start to finish?


SLO_Johnny

Nothing is bigger than the $50 billion that goes to the heroin drug gangs or the $100 billion we spend on prisons.


SLO_Johnny

We should decriminalize drugs. We could take just a fraction of what we spend on cops, courts, and prison and we could build an excellent drug rehab program and finance early drug abuse education. We would defund the street gangs who sell and traffic drugs and put a stop to the gang wars and street violence. Drug addiction is a leading cause for people to engage in prostitution, burglary, robbery, assault, and a number of other crimes. They need to get their hands on a lot of money because illegal drugs are expensive. It makes addicts into very active and aggressive criminals.


We could provide an addict with all of the heroin or cocaine that they need for about $1 per day as the chemicals themselves are cheap.


Mike Byrd

I admit to libertarian leanings but there’s much more involved than just providing a safe means of taking addictive drugs. Addicts tend to be unemployable. Are we also going to support them throughout their lives? And their children? They will have many medical malodies. Will those be adequately treated at our expense also? Then there’s the persistent misery of the addict life. Do we really want to encourage and enable that.


Truth be told, as long as our county refuses adequate detox opportunities and related services, incarceration may be the best chance some of these folks have to kick their habits. If they have access to counseling, employment, housing and such support, a person who comes out clean has a reasonable chance at a successful outcome and a good life.


It’s impossible to overstate how difficult it is to overcome addiction but it can be done. Once these legal drugs are introduced the chance of that is virtually eliminated.


SLO_Johnny

Prison and punishment don’t stop drug addicts from taking drugs. It hasn’t work, just as Prohibition didn’t reduce alcohol consumption. People quit drugs when they get tired and want to quit. As I stated, we could have a place in a world class rehab center open for everyone needing on if we stopped building and operating prisons and built hospitals and clinics instead.


Treat it as a public health problem and not a crime.


Mike Byrd

Agreed.