As Visalia prepares for a third methadone clinic location, Tulare County Mental Health discusses the benefits of the medically-assisted treatment
By Reggie Ellis @Reggie_SGN
VISALIA – As Tulare County’s largest city, Visalia deals with the brunt of many of the area’s most difficult problems. Visalia has most of the county’s violent crimes, homeless people and those dealing with drug addiction. As expected, the city is also home to most of the facilities, programs and organizations that deal with these issues.
This summer, methadone clinics, and the number of them in Visalia, became a topic in the broader discussions about homelessness, housing, blight quality of life at community meetings and city council meetings.
There are currently three methadone clinics in the entire county, two are located in Visalia and one is located in Tulare. The two in Visalia are operated by Aegis Treatment Centers and Bay Area Addiction Research and Treatment (BAART). The Tulare clinic is run by Kings View Substance Abuse Program. Residents began voicing their opposition to the clinics earlier this year when plans for a third methadone clinic in Visalia were submitted. Architect Larry Lewis submitted plans for a methadone maintenance treatment center at 109 NW 2nd Ave. adjacent to Oval Park. City staff said the applicant, Cornerstone Rehab Center LLC, will need a conditional use permit that will have to be approved by the Visalia Planning Commission, so there will be an opportunity for public comment.
The questions surrounding methadone date back to the FDA’s approval of the treatment for heroine addiction in 1972. Is using a drug to treat a drug socially responsible? Is it effective? Should we spend tax dollars on drug addiction?
The answer to all of those questions, according to the Tulare County Health and Human Services Agency (HHSA), is that we can’t afford not to use methadone maintenance treatment.
In Tulare County, 6% of people 12 and older misuse opioids. More than half of opioid-related deaths are attributed to painkillers purchased at a pharmacy and not drugs purchased on the street. In fact, three in four adults in Tulare County have a prescription for opioids, according to the California Department of Public Health. Many of those adults also have overlapping pain medicines.
“The human body needs three things to survive: food, water and the chemical motivation for life, which in our bodies is dopamine,” said Natalie Bolin, deputy director of clinic services with Tulare County Mental Health.
When someone takes a drug, such as meth, their dopamine levels rise too fast and too intensely for their brain to properly balance. Bolin said dopamine levels for someone on meth are 1,000 picograms per millilitre, 20 times higher than normal. That puts a lot of pressure on the brain and results in extreme chemical withdraws that can only be satisfied with the drug itself or a safely prescribed alternative.
“Methadone allows us to stabilize dopamine levels so that the patient can focus on counseling instead of cravings,” Bolin said. “You can’t do any real recovery until you get to a point where you are not thinking about the drug every second of every day.”
As of July 1, Tulare County HHSA became a mandated service provider of Drug Medi-Cal Organized Delivery System operated by the California Department of Health Care Services (DHCS). Bolin said the county made the decision in order to receive state funding to implement evidence-based treatment plans for substance abuse disorder, more commonly referred to as drug addiction. The federal government pays 69% of the cost as part its Medi-Cal funding, while the state covers about 18%, and counties pick up the remainder.
The state pilot program, the first of its kind in the country, is in response to the high cost of court-ordered residential treatment facilities which have a high rate of failure once the person completes the program. Under the pilot program, initial studies show that a intensive out-patient treatment, which combines methadone and behavior therapy, is more effective and cost effective. In other words, counties in the program treat drug addiction as a chronic disease, much like diabetes or heart disease.
According to DHCS, 8.5% (nearly 3 million) of Californians age 12 and older suffer from addiction but only 1 in 10 seek treatment. Barriers to access treatment include the lack of health insurance, out-of-pocket costs and the stigma of addiction. In order to qualify for the pilot project, residents must live in a participating county, be eligible for Medi-Cal and have been diagnosed with substance abuse disorder as defined in the Diagnostic and Statistical Manuel of Mental Disorders, the standard for mental health diagnoses in the United States.
From 2015-2017, the number of opioid deaths remained stagnant but the number of people prescribed buprenorphine, the most commonly used drug to treat opioid addiction, increased by 49% in Tulare County.
“That means more people are accessing treatment,” Bolin said. “And we have a 40-60% success rate treating it more like a disease than thinking of addiction in the traditional way.”
Methadone clinics are the most common place to administer a Medicated-Assisted Treatment (MAT), where the use of FDA-approved medications is combined with counseling and behavioral therapies to provide a “whole-patient” approach to the treatment of substance use disorders.
Three main types of opiate medications are used at methadone clinics throughout the nation. These include naltrexone, buprenorphine, and, of course, methadone. Bolin said all the drugs essential serve the same purpose, which is to trick the brain into thinking the patient is using the drug. Unlike buying opioids on the street, clinics control the dosage and do not “cut” or lace the drug with non-medical chemicals that can be extremely hazardous, such as bleach, bath salts, gasoline, and paint thinner.
“We are administering FDA approved medications that are safe and we are looking carefully at the amount we need to start, and then begin dwindling it down as we move toward recovery,” Bolin said.
Regardless of how people feel about methadone clinics and their effect on the area, Bolin said it has been proven that treating addiction both chemically and mentally is far less expensive than dealing with the effects of addiction through the courts and hospitals. The United States spends $78 billion on drug control policy but just $2.8 billion on treatment services. According to the Center on Addiction, 2 cents of every dollar spent on addiction and substance abuse goes toward treatment in California yet 98 cents is spent on the consequences of addiction.
“There are huge costs to not treating addiction,” Bolin said.
That’s not to say there aren’t challenges to MAT and methadone. According to American Addiction Centers, only a quarter of people prescribed methadone reach a point where they no longer need it and another 25% will never completely ween themselves off the replacement medication. About half are likely to be on and off users of the medication as they relapse and re-enter treatment. Like any medication, there are some mild side effects in short term use, such as slowed breathing, sexual dysfunction, nausea, vomiting, restlessness and itchy skin. Effects from long term use can include respiratory problems. Similar to prescribed opioids, there is also the possibility of replacing one addiction for the other. Abuse of methadone has the same side effect as most legal drugs including insomnia, swelling, loss of appetite, low blood pressure, irregular heartbeat and depression.
Bolin said there are risks associated with any medication, but, in the case of methadone, it would be far riskier for the patient, and the community, to remove methadone clinics from the equation.