Editor’s note: This is the fourth in a five-day series about opioids and heroin and the effect on Centre County. On Saturday, we conclude by looking at how the drugs hit families, communities and addicts themselves.
It’s easy to talk about the problem of opioids and heroin. It isn’t easy to understand it.
If you don’t have an addiction, you probably process the idea of drugs equaling bad because of a hundred public service announcements and after-school specials. You know drugs are illegal, so they are synonymous with danger.
But not all opioids are illegal. People can have an addiction to something they are legally allowed to have, something their doctors write them a prescription for like clockwork every 30 days. Yes, it might eventually end up illegal and ugly, but for many, that’s not how it starts.
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So why does it start? What makes taking a pill become a life-changing addiction?
“Basically, opioids change your brain,” said Scott Camazine, a doctor at MedCARE Family Health Services, a clinic specializing in addiction.
“Once you have taken opioids for a while, the neurophysiology is different,” he said. “There are receptors on the neurons for narcotics, and once you start taking them and stop taking them, your body reacts very badly to that. Essentially, you must do something about it, and to simply stop the narcotics usually is not an option.”
That’s withdrawal. It’s a physical process, painful and difficult. It’s the kind of thing that can scare an addict away from getting clean, even if he knows it’s what is best for him.
“Whether someone is addicted to nicotine or alcohol or opioids, addictions are just incredibly powerful,” Camazine said.
It’s the kind of thing that drives people to seek help, whether for themselves or someone they love. That is when people reach out to Cathy Arbogast’s office.
Arbogast is the assistant administrator for drug and alcohol in Centre County.
“Our office is finding that our role is becoming broader and broader with unique needs specific to addiction,” she said.
So what does Centre County have to do with addiction? Arbogast says her people are there to do whatever people need. Some call to get help for a friend or a family member, to see if the signs they are seeing point to addiction. Some want to get help themselves but don’t know where to start.
“It could be as basic as outreach and information,” she said. “We’re finding that more and more people are finding it difficult to navigate.”
Some people want to find a detox bed. Some want to get into rehab. Both of those can be hard to find as both state Rep. Kerry Benninghoff, R-Bellefonte, and Gov. Tom Wolf have noted the shortage of beds for treatment facilities in Pennsylvania. Then there is the challenge of puzzle-piecing the available beds together with the available insurance, or the financial resources, or if none of those are available, the county can still try to find a way to get someone the help they need.
“We want to be part of process before during and after,” Arbogast said.
That means helping with recovery, but it also means staying in touch during treatment, and helping with long-term goals.
“What’s going on? What’s your game plan? They need support when they return,” she said. “Again, it’s a very broad mission that they find themselves in. We don’t have all the answers. We’re willing to help them find the process.”
Camazine has a different way to tackle the disease. He doesn’t go with detox. The other school of treatment with heroin and opioids is about medication.
“The most practical way to deal with this epidemic is to simply to stay on,” he said. “People don’t want to hear this. But it’s basically a fact.”
That doesn’t mean using heroin. It means substituting a lethal drug for a management one. In this case, he is talking about suboxone.
Camazine compares it to insulin for a diabetic. It’s a drug that satisfies those neuroreceptors in the brain without the side effects of addiction.
His experience isn’t just with patients in his clinic who got hooked on Vicodin when a dentist prescribed it for the pain of teeth they couldn’t afford to have pulled. His own brother, a surgeon, faced opioid addiction. It really is a disease that can hit anyone.
“It’s a matter of treating the problem. It’s a disease. It’s that simple,” he said.
There are other drug treatments, too. Naloxone is an injectable drug that lasts for a month and costs about $1,000 a shot, but for 30 days, it negates the effect of any opiates. There is no point in taking heroin if you don’t feel the effects. It’s the same drug used in another format, Narcan, as an emergency overdose treatment.
Probuphine was also just approved. Instead of being a shot, it is an implant that is put in place by a doctor and gives six months of coverage.
Camazine says suboxone is a more affordable option. Treatment costs about $200, and the prescription costs about $2 per pill. Suboxone can be purchased on the street, but the markup is about $1,000 a month more than obtaining it through a legal clinic.
There is also a legal cost.
“Some people still consider it being on drugs,” he said. “(Illegally acquired) suboxone is the third most confiscated drug. It’s infuriating.”
So there are different options and different schools of thought when it comes to treating them. There are decisions to be made, and all of that needs direction and support. That’s where Arbogast’s office comes back with education and counseling.
“Addiction is not a casserole disease. When it hits your family, no one shows up with a casserole to help. We need to bring it out of the darkness,” she said. “We need this community to step up and be the community that we know them to be. Embrace individuals in recovery and give them the chance to be the people they can be.”