[Noozhawk’s note: This article is part of Day 9 in Noozhawk’s 12-day, six-week special investigative series, Prescription for Abuse. Related links are below.]
For someone who has been addicted to prescription drugs for years, a way out may seem impossible. That’s what Lisa W. thought before entering treatment at the Santa Barbara Rescue Mission’s Bethel House.
Lisa, who spoke with Noozhawk on the condition that her last name not be used, was addicted to opioid painkillers but recently graduated from the year-long treatment program. She has been sober since she started.
“I sit here right now with 11 months clean and sober, and last year at this point, I never would have been able to comprehend having this much time clean,” she told Noozhawk in August.
A host of treatment options exists locally, both of the inpatient and outpatient varieties, with addiction programs offered by Cottage Health System, the Santa Barbara Council on Alcoholism & Drug Abuse’s Project Recovery Treatment Center and the Santa Barbara Rescue Mission among them.
Many individuals are ordered into treatment by the courts after being arrested on drug charges. The Sheriff’s Treatment Program allows voluntary and court-mandated drug offenders to enter treatment while incarcerated. But first- and second-time drug possession defendants convicted of nonviolent offenses must receive a probationary sentence in lieu of incarceration. The voter-approved law, known as the Substance Abuse and Crime Prevention Act, says that the defendants are required to participate in and complete a licensed and/or certified community drug treatment program under the terms of their probation.
By 2006, however, initial funding for the program had run out, while the mandate remained. Now, Santa Barbara County and other jurisdictions are struggling to keep up with more and more people seeking treatment.
Pat O’Connor, assistant director of Project Recovery at 133 E. Haley St. in Santa Barbara, knows all about that demand.
“If we had the funding, we could offer more treatment,” he said.
Since the reduction in funds “it’s been tough and everybody’s lost, but we’re still here and we’re not going anywhere.”
Project Recovery works in conjunction with the court system. If an offender qualifies, a judge will require that treatment be pursued and, in some cases, will even dismiss the charges if the participant does well.
“There’s jail and then there’s us, and we’re just a little bit better,” O’Connor laughed. “When we start out, we have quite a few resistant clients.”
Nevertheless, O’Connor says that between 55 percent and 65 percent of people finish the Project Recovery program. Adults seeking outpatient treatment on their own are also welcome at the facility. Day and evening classes are offered, and the evening session includes a Spanish-only option. Click here for more information on Project Recovery, or call 805.564.6057.
People with private insurance may have more options available for addiction treatment, but they also may be challenged by insurance companies on what will actually be covered. The concept of “parity” becomes an important issue, and a 2008 law requires that benefits coverage for mental health and substance use treatments must be at least equal to coverage provided for physical health services. The law, known as the 2008 Mental Health Parity and Addiction Equity Act, only applies to insurance groups with more than 50 employees,
Detoxing from a drug is just the start of the treatment journey, according to Dr. Sherif El-Asyouty, co-founder of Recovery Road Medical Center. Once in a program, treatment approaches will vary by individual.
“The best programs provide a combination of therapies and other services to meet an individual patient’s needs,” according to the National Institute on Drug Abuse. “Specific needs may relate to age, race, culture, sexual orientation, gender, pregnancy, other drug use, comorbid conditions (e.g., depression, HIV), parenting, housing and employment, as well as physical and sexual abuse history.”
Each individual will vary in treatment needs. Ironically, drugs exist to help people become less dependent on opioids. This may seem counter-intuitive to the goal of being “clean” and drug-free in treatment.
“That’s a good goal,” said Dr. Joe Frawley, Recovery Road’s co-founder. “But you’re not going to get any rewards by being clean by itself. You’re going to get your rewards by being able to be there with your kids, being able to have a job, not being arrested, not being sick.”
Frawley said he’s seen success with drugs like Suboxone, a drug that binds the brain’s opiate receptors to control cravings. That allows the patient an opportunity to learn some coping skills. (Noozhawk’s note: Suboxone is manufactured by Reckitt Benckiser Pharmaceuticals, a sponsor of Noozhawk’s Prescription for Abuse series.)
“When you’re on a short-acting opiate, you’re never really sure what your feelings are and what are the feelings of drug withdrawal,” he said. “It’s very hard to learn emotional control when you’re on a drug that, every four hours, you’re going up and down with withdrawals.”
Other drugs are used to help opioid-dependent people. Methadone is one such medication, and when used to treat addiction, it must come from a federally authorized clinic. Doctors can also prescribe the drug for pain; it has the same pain-killing power as OxyContin but is much cheaper.
Frawley said methadone has a long half-life, and remains in the body for about 30 hours.
“In one person it could last 25 hours, in other it could last 90 hours,” he said. “This creates some of the problems when you’re dosing methadone. Its pain-relieving properties last about four or five hours, but it stays in the system a long time.
“If you’re using it to manage pain, you can overdose because you are taking it for pain but you don’t realize that you’re building up. You’re not metabolizing everything that you’re taking.”
El-Asyouty said that while drugs like methadone have been life-savers for many patients, they often end up on the street and are used addictively. Because drugs like Suboxone are cheaper than heroin and OxyContin, “now people on the street have experience with it so they use it to avoid withdrawal,” he said.
“This is another medicine that is not used as a medicine,” he said. “It’s used as a drug to carry them until their next fix.”