Opiates match alcohol in Ohio treatment centers

Opiate addiction in Ohio has grown to be on par with alcoholism.

At least that's what the picture shows when looking at diagnoses of people who received publicly funded treatment in fiscal year 2013, the most recent statewide data available.

Of more than 87,000 clients treated for addiction, 33 percent received alcohol addiction services and 32 percent received opiate addiction services; the latter figure is up from 28 percent in 2012 and more than twice as many as in 2008.

In addition, two county boards reported the majority of treatment partners served people for opiate addiction in 2013.

The Paint Valley Alcohol, Drug Addiction, and Mental Health Board, which serves five southern Ohio counties, reported more than 1,600 people — 77 percent of the total served — were diagnosed with opiate addiction. In Fairfield County, clients with opiate addiction represented 56 percent of the 229 people served.

While overall more people may be battling alcoholism, the awareness brought on by increasing numbers of opiate overdose deaths is prompting more opiate addicts to seek treatment, said Juni Johnson, executive director of Paint Valley ADAMH. More than 1,900 Ohioans died from drug overdoses in 2012, the most ­recent statewide data available.

"We've flooded the market over the last couple years with referrals and coordinated care for people with opiate addiction," she said.

It's an upward trend that could continue with the aid of Medicaid expansion.

"With the help of Medicaid expansion, we've really been able to throw open the doors and provide coordinated treatment," Johnson said.

The opiate client load at Johnson's office alone has gone from 120 in March to 400 as of last week.

While it's still too early to know the full effect of Medicaid expansion on addiction services, the Ohio Department of Mental Health and Addiction Services estimated 60,000 Ohioans with addiction or mental health needs can receive coverage through the expansion. The expansion increased the income cutoff and changed eligibility criteria that typically meant single, childless men and women weren't eligible in the past.

As of Sept. 30, 17,252 people accessed behavioral health services via the Medicaid expansion since January. Of the $21.8 million in services provided, $12.6 million worth of services were for addiction treatment, Tracy Plouck, director of the Ohio Department of Mental Health and Addiction Services, said.

Pickaway Area Recovery Services plans to use new revenue from Medicaid expansion clients to expand its residential treatment model for women to men. The plan is to open facilities in Pickaway and Fayette counties, Executive Director Barry Bennett said.

"I know we will be (able to fund it). There's no doubt in my mind," Bennett said.

The facilities will join Ed's Place as treatment centers for men. Ed's Place was opened this year by the Recovery Council in Pike County and currently serves 15 men with the ability to grow to 45. Although Medicaid doesn't cover inpatient drug treatment, both treatment providers take their clients to receive counseling via existing outpatient services, which they can then bill to Medicaid, Johnson said.

Some places haven't expanded facilities but have added staff. Catalyst Life Services in Mansfield and Marion Area Counseling Center have added staff because of double-digit increases in client volume.

However, not all treatment centers have seen immediate growth from expansion. Scioto Paint Valley Mental Health Center in Chillicothe treated 67 fewer people in fiscal year 2014.

Executive Director Matt Markley said it's difficult to pinpoint exactly why there was a decline, but said it's not uncommon for client numbers to "fluctuate pretty significantly from year to year."

Even with expansion, gaps in treatment services remain.

"The most difficult thing to fund is residential bed days," said Veronica Groff, Catalyst president. "People need to be in a safe environment without the influence of the drug for long periods of time, especially when it comes to opiate addiction."

In 2013, an estimated 22.7 million Americans older than age 12 needed treatment for a drug or alcohol problem, according the 2013 National Survey on Drug Use and Health. However, 89 percent didn't receive treatment. People who acknowledged they needed treatment most often reported they did not get it because they couldn't afford it.

Affordability for addicts is the reason why the treatment community pushed for expansion and will be rallying around it again in 2015. The legislature will be evaluating whether to continue expansion as budget talks begin this spring.

Self Help: Addicts buying Suboxone on street

All Chris Evers knew was he wanted to get clean.

By the time he embraced that thought, it was 2011, and the court already had sent Evers, a Chillicothe native who now lives in Wayne County, to treatment three times instead of prison.

"Old friends, old habits don't die so easily," he said.

Evers decided he wanted to try Suboxone, a drug used to aid treatment of opiate addiction, but couldn't afford it legally. So he began buying it illegally on the streets.

He's not the only one. In Scioto County, once the epicenter of prescription pain pill abuse in Ohio, Sheriff Marty Donini said the black market for Suboxone has exploded.

"I'm not so sure we've accomplished anything," Donini said earlier this year, noting pain clinics have been replaced by Suboxone clinics. "It seems like all the money and resources being pumped into drug addiction, they're fighting drugs with drugs. I don't think they're solving the issue. They're making people addicted to another drug."

Getting hooked

In 2005, Evers, now 25, was a junior at Zane Trace High School in Ross County when he got hooked on prescription painkillers. His dependency began with his wisdom teeth being pulled and ended with prison.

"(By graduation), it was to the point where I needed them to get through the day OK," Evers said.

Without Percocet or some other kind of opiate, Evers would become physically ill. The addiction led him to stealing his grandmother's oxycodone in 2008 and into the Ross County Common Pleas Court.

In a plea deal, Evers was sentenced to a secured treatment facility, STAR in Scioto County, instead of prison. He was sent for a second time in 2010, but was back before the judge within a year.

"When I was at STAR, I never treated my addiction. You do what you have to to get out. Fake it until you make it," he said.

Evers somehow got another chance, this time 120 days in jail and six months at a halfway house in Chillicothe. He still took pain pills but also began buying Suboxone, a drug used in addiction treatment, on the street. Suboxone was cheaper and helped him with withdrawal symptoms between getting prescription opiates.

He didn't get serious about getting clean until he collapsed and nearly died from an overdose on Chillicothe's Main Street.

"That was the day I said I'm going to change," Evers said.

He sought Suboxone treatment, but at that time, it wasn't covered by insurance. He couldn't afford a $200 upfront cash fee to see the doctor or a $600 prescription. However, Evers was able to find the money to get Suboxone on the street, buying a dose or two at a time and splitting each one to last longer.

"I really wanted to be clean. I was tired of disappointing my family," Evers said.

The change of heart wasn't enough; past deeds caught up with him in the form of two felony indictments on thefts related to supporting his opiate habit. In 2012, Evers was sent to prison.

Black market treatment

Illegal Suboxone use has been ongoing since at least 2005, when the Ohio Substance Abuse Monitoring Network came across a handful of reports while surveying for its annual Surveillance of Drug Abuse Trends report.

Since then, reports of Suboxone abuse have risen even though the medication predominantly prescribed and available is a dissolving film instead of a pill. The change in delivery method of the drug was an attempt to make the drug more difficult to abuse.

Even so, according to the network's 2014 report, officials across the state are reporting a high availability of Suboxone, and all areas but the Toledo region indicate they've seen an increase since 2013.

The typical person buying Suboxone on the street is like Evers had been — "self-medicating to wean off heroin or prescription opioids or to avoid withdrawal between highs," according to the network's report.

The challenge with treatment for opiate addiction is the severity of withdrawal symptoms, said Jennifer Turnes, senior vice president of Behavioral Healthcare Partners of Central Ohio in Newark.

"Too often, this can lead individuals to seek out other substances (like Suboxone) in an attempt to avoid the withdrawal symptoms or to replace the supposed high they get with opiates," Turnes said.

Evers said Suboxone made him feel normal.

"I didn't wake up and (crave) them. I actually felt alive. My judgment was not clouded whatsoever," he said.

Suboxone works by blocking opioid receptors in the brain and minimizing withdrawal symptoms.

While Donini's not alone in his views that medication-assisted treatment just replaces one drug with another, the National Institute on Drug Abuse at the National Institute of Health looks at it differently.

The institute views its use, and other addiction treatments, as ways of treating a chronic disease, not unlike approaches for diabetes and hypertension in which medication is used for ongoing treatment. However, Suboxone is designed to work hand in hand with counseling to address underlying issues.

"It is critical that these medications are provided in conjunction with treatment proven effective with this population," Turnes said. "We do understand the concerns regarding the availability of such medications for illegal use on the street. Unfortunately, this is a reality that further complicates an already sophisticated social problem."

And that lack of counseling is where the issue lies, said Juni Johnson, executive director of the Paint Valley Alcohol, Drug Addiction, and Mental Health Board.

"I've seen providers that look and smell like a pill mill. ... They're not certified by the state to provide counseling and they take cash only," Johnson said.

House Bill 378 aims to curb diversion of drugs containing buprenorphine, such as Suboxone, onto the street and require doctors prescribing it to provide counseling. The House unanimously passed the legislation earlier this month, and it is now before the Senate.

Moving on and up

Evers ultimately quit without Suboxone; there is no medically assisted addiction treatment in prison. He instead completed programming that focused on changing the way he thinks, and he became a mentor in a faith-based program called Kairos Torch.

About a month ago, Evers was released and has moved in with family in Creston, where he's working on their tilapia farm.

"This is my blessing," he said.

This time, Evers feels he has the proper support to remain in recovery. He's still regularly attending Narcotics Anonymous meetings and is set to begin classes at the University of Akron in January. His goal is to use his experience to help others struggling with addiction by becoming a counselor.

"It's always going to be a part of me, but I know how to handle it now," he said.

Treatment barriers reported 2010-13

Source: Substance Abuse and Mental Health Services Administration's 2013 National Survey on Drug Use and Health

Need assistance?

Call the Licking and Knox Counties Mental Health and Recovery Services Board, 740-522-1234, to be linked to a treatment provider.