Heroin treatment can start, stop many times for struggling users
Click here to read more stories of the Gazette's series on heroin and its impact on Rock County.
JANESVILLE Melissa lost her future on heroin time.
She ignored the discarded needles at her feet.
She looked past the bloodstains on the wall from shooting heroin directly into her veins.
She lived all day, every day, for the intense and all consuming purpose of getting high.
Being an addict was a long way from being a straight-A student in a Catholic grade school. Melissa’s freefall began when the Janesville woman started drinking and doing drugs with her peers in high school. She snorted cocaine off the bathroom floor on prom night. She feared going to class Monday morning because she could not remember what she had done over the weekend.
After high school, Melissa bought opiate painkillers off the street with grant money she was supposed to use for college. She crushed the pills to bypass their time-release element and to get a rush. Later, she switched to heroin, which was cheaper than prescription pills and easier to get. She used heroin in combination with cocaine, spending $300 a day on illegal drugs.
By the time she was 23, drugs ruled Melissa’s life.
“I would rather die than live without them,” she explains. “I had no dreams, no goals. It was a revolving door. Every day, my only motivation was to get up and do drugs. I did not care if I overdosed because I was so in love with the feeling.”
Melissa wishes to remain anonymous, but her story is real.
She sought help last year for the third time at Janesville’s AlcoCare, a residential drug and alcohol rehabilitation center. A range of treatments exists for heroin addiction, including medications and behavior therapies.
Melissa’s mother threatened to put her on the street if she didn’t return to AlcoCare.
“I never would have done it myself,” Melissa says. “I was forced to go in.”
She had been through several kinds of programs, including one intensive residential treatment out of town.
But always she returned to using.
Once, her first act after getting out of treatment was to buy heroin, a highly addictive, dangerous and illegal drug.
The good news is 24-year-old Melissa appears to have turned a corner. She celebrated nine months of sobriety in March. She thanks intensive behavior therapy in combination with Suboxone, a medication that suppresses the opiate craving in her brain.
Opiates are a class of drugs that include heroin, morphine, codeine and prescription painkillers, including OxyContin and Percocet.
Melissa’s mother attended family programs at AlcoCare to understand how she was enabling her daughter’s behavior.
“I knew I needed help as much as she did,” the mother says.
“You know you are living in hell when you find stashes of needles in your daughter’s room and blood stains on your daughter’s jeans. I had to accept the fact that I might bury my child.”
Dr. Adedapo Oduwole hangs up the phone after talking with another doctor about how to treat a heroin-overdose victim at Mercy Hospital’s emergency room.
“The man is lucky,” Oduwole says. “His sister found him.”
Oduwole specializes in addiction psychiatry with Janesville’s Mercy Options. He sees two to three new opiate-addicted patients a week.
“Heroin is the fastest-growing addiction,” Oduwole says. “The newest users are as young as 15 and up to 25. This is a very big problem, but people are underplaying it. I think it is an epidemic in Rock County.”
Oduwole tries to stabilize patients and prevent them from using again.
He is one of a handful of Janesville doctors licensed to prescribe buprenorphine (BYOO-pre-NOR-feen), sold under the trade name of Suboxone. In the late 1990s, he helped pioneer use of the medicine, which takes away the craving for heroin and other opiates.
But before Oduwole prescribes it, he requires patients to go into treatment.
“They need to learn how to live life away from opiates,” he says. “I tell my patients they are on the road to death, and they will die if they continue on it.”
The goal is to eventually wean people off of Suboxone.
“But some are so messed up, they will be on it the rest of their lives to stay sober,” Oduwole says. “Others are not candidates for it because they will abuse it.”
He almost stopped prescribing buprenorphine to opiate-addicted people because some were selling it on the street. Then he looked at his list of patients who have successfully gotten off of heroin with the help of the drug and continued to prescribe it.
Oduwole first became interested in addictions while in his native Nigeria. He did a fellowship in addiction while in residency training in the Bronx. Ironically, he left New York to practice in Janesville because he wanted to raise his family in a city without a drug problem.
He has heard local young people describe heroin parties, where one person, known as “the lifesaver,” refrains from using. The lifesaver stands ready with a shot of Narcan, an antidote to heroin, if someone overdoses.
Oduwole says some drug users start by crushing and snorting prescription painkillers, then move on to heroin because it is cheaper and easier to use. Fear of infection with the virus that causes AIDS once kept people from shooting up with heroin.
“But people are not so afraid of it anymore,” he says. “AIDS is no longer a death sentence.”
Sharing of needles also can lead to infection with hepatitis B and C and a host of other blood-borne viruses.
Heroin is highly addictive because it rapidly enters the brain. As a person takes more and more of the drug, larger amounts are needed to get the same effects. Eventually, users need the drug just to keep from getting “dope sick” with withdrawal symptoms.
“No addict wants withdrawal symptoms,” Oduwole says. “You wish you were dead, but you will not die. Withdrawal will not kill you, but shooting heroin will.”
Overdose occurs when someone takes too much heroin, and it suppresses breathing. A tolerable dose for an addict can be fatal to a first-time user.
Oduwole says methadone is a treatment option for those who are not candidates for Suboxone.
“Methadone is a replacement program that makes your habit legal,” Oduwole says. “It is not good alone but can be beneficial with counseling.”
Janesville’s closest methadone clinic is Quality Addiction Management in Beloit. Methadone does not produce the same high as heroin, but it does prevent withdrawal and the craving to use opiates.
“The ideal thing is not to get hooked in the first place,” Oduwole says. “People need to be aware and to talk to their kids. This drug problem is going to sweep this community away. Young people are dying, and they are supposed to be this community’s future.”
Guy Onwiler is program director of AlcoCare, Janesville’s only licensed residential treatment center for alcohol and drug abuse. He has watched the number of clients seeking treatment for heroin addiction spike in recent years.
“Two to three years ago, we rarely saw it,” Onwiler says.
Now almost half of AlcoCare’s clients are addicted to heroin or other opiates.
“It starts innocently enough, taking a few pills,” Onwiler explains. “As the physical addiction builds, someone steps in and says heroin is the answer.”
The residential drug and alcohol treatment facility has two homes in Janesville for about 20 people. One is for intense treatment. The other offers reduced care, allowing clients to integrate back into society.
Treating the high volume of young heroin addicts is new.
“We’re getting better at it,” Onwiler says. “This is the most manipulative population we work with. We need them to change their whole lifestyle. Everything they do and were associated with fueled their addiction.”
Therapy helps them restructure their thinking and make lifestyle and behavioral changes.
“They absolutely can be successful,” Onwiler says. “It comes down to matching the client and family with the appropriate services.”
Becky McKillips is the administrative director, who says parents need to come to counseling as much as their children.
“Parents often want to hide a drug-use problem,” she says. “They need to learn how not to be enablers. As the family gets help, so does the client. Even if the client uses again, he or she gets help quicker if the family is involved.”
Onwiler is seeing more teenagers and people in their early 20s in recovery and 12-step programs in Janesville.
“We have wonderful programs to help them,” he says. “But this needs to be a comprehensive approach from the whole community. We need to be open and across the board.”
Bob Gibson is Rock County’s alcohol and drug abuse specialist who screens clients for referral and treatment. From 2007 to 2008, he saw a doubling in the number of heroin users—from 51 to 101.
At the end of February 2008, he had seen 12 heroin users. At the same time this year, he had already seen 28. He doesn’t know if the numbers will continue to grow of if they have peaked.
“Most of the new users are 19 to 20,” he says. “I rarely see someone in their upper 20s or 30s. In the 1960s and 1970s, the message was out that heroin is not a good thing. But the message has not passed on to the younger generation.”
Gibson says $230,000 in federal funding is available through Rock County to help people without insurance get into treatment programs for alcohol and other drugs. The amount is down slightly from last year.
“I’m hearing there could be more budget cuts,” he says. “We never have enough money to pay for everyone who needs it. So we help as many as possible.”
Gibson suggests taking Suboxone or methadone as supplements to drug therapy because “it will increase chances of success.” However, some therapists question whether it is effective in the long-term and if supplements just prolong dependency on drugs.
Gibson says people cannot go into treatment while they still are on heroin. They need to go through detoxification or withdrawal. Symptoms include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting as well as severe cravings for the drug.
“I don’t recommend doing it on your own,” Gibson says. “Get help from a family doctor or a detox program. I always recommend some professional intervention to do it.”
In December 2006, Rock County closed its detoxification unit, located in the Human Services building. Human Services Director Charmian Klyve says the service cost the county $1,000 per day per client to operate and was too expensive to run.
Clients needing help now go to Tellurian UCAN Detoxification Program in Madison, which provided services at the Rock County detox unit before it closed. Last year, more than 400 Rock County clients used the facility for alcohol and drug detoxification. More than 70 have been there so far this year.
Advocates in the recovery community complain about lack of local services and say people are not getting into treatment as quickly as they should be after detoxing in Madison.
Klyve says few counties have detox facilities.
Rarely do you see an addict using just one drug.
“A lot of people are using a lot of chemicals, not just heroin,” says Tim Perry of Janesville’s Crossroads Counseling Center.
The clinic director is seeing an increase in the number of opiate-addicted people who come to Crossroads, an outpatient mental health, alcohol and drug treatment provider.
Heroin addicts spend all day, every day, thinking about seeking and using drugs. The drugs literally change their brains.
“When they are clean, you have to replace that with something that includes positive recreation or employment,” Perry says
He describes heroin as “the nastiest of all drugs” because addiction occurs fast, and the intense physical craving is powerful.
“It is right up there with nicotine,” Perry says. “The craving can be ongoing and lifelong. You can manage it by developing support and continued involvement in a 12-step recovery program.”
Heroin recovery is one day at a time.
“You have to always be aware who you are around and where you go,” Perry says. “To be clean from heroin, you have to be clean from all mood-altering chemicals. That means no beer after work. When I say clean, I mean clean. Other chemicals can work on the same pleasure-seeking parts of the brain, which say, ‘Give me more.’ The next thing you know, you are back on heroin.”
Perry prefers to get heroin addicts into inpatient treatment.
“They are very dangerous to treat as outpatients because they can overdose,” he says. “If I only see them in an outpatient program, I don’t know what they are doing the rest of the time.”
He treats teenagers as young as 14, 15 and 16, who are admitting to heroin use after progressing from prescription opiates such as OxyContin.
Prognosis for a heroin addict improves with the amount of treatment.
“The longer you are in treatment, the better your chances,” Perry says. “When people relapse, you want to re-engage them. The longer they can keep being re-engaged, the better their probability of recovery.”
Heroin takes money because of its extended treatment.
Cost for 30 days of residential drug treatment at Janesville’s AlcoCare is more than $3,000. But prices at different facilities vary greatly, depending on what type of rehab a person attends and length of time in treatment. Clients report some residential treatment centers charge as high as $30,000 per month.
“Lack of funding or insurance is a problem,” Perry says. “Insurance companies also put the clamps on the amount of treatment as well. They have a certain pot of money. Once a client goes above it, the client is either discharged or it has to come out of pocket.”
Melissa’s nine-month sobriety follows many relapses and a life-changing realization.
“I asked myself, ‘If I wasn’t in therapy, where would I be?’” she says. “I would be right back out there doing the same things and not having a life. I was just miserable.”
Heroin robbed her of a job, an education, her family, personal relationships and, most of all, hope.
Last year, she made up her mind to do things differently, one small struggling step at a time.
She wrote in a journal. She worked out. She began a relationship with God.
She found a mentor. She attended regular 12-step meetings in Janesville. She got a fulltime job.
“When I started seeing results, I got hopeful,” she says.
“Today, my chances (of recovery) are good. But that is all I can say. There are so many people who do not make it. I will have to fight this addiction every day for the rest of my life.”