Lodi clinic lays out road to recovery
Methadone clinic holds open house to educate guests on opioid addiction
Tamara Metcalf, Tammy to her staff and patients, welcomes guests to the Aegis/Healthy Connections Clinic in Lodi, giving brief tours of the small but cozy building where she and her team treat local patients for opioid abuse.
As part of Wednesday’s open house event, Metcalf directs guests to the dispensing room where a licensed vocational nurse named Rachel dispenses liquid methadone for patients, along with a small cup of water. Vitamin and fiber tablets are also available to patients, as opioid abuse can diminish appetite, leading to malnutrition, as well as inducing constipation. She then leads the tour down a short hallway containing examination rooms, each one decorated by a staff member to create a more welcoming atmosphere, as opposed to the cold, impersonal accommodations sometimes found in other medical centers.
As Metcalf continues the tour, she explains that the opioid-based medication methadone is one of two commonly used in Medication Assisted Treatment (MAT). The other medication, buprenorphine, is not dispensed at their facility.
The main purpose of methadone treatment is to enable patients to stop using illegal opioids such as heroin, as well as prescription medications such as oxycodone. Stopping opioid use, especially after years of using, is difficult for many patients due to the intense physical withdrawal symptoms.
Metcalf informs her audience that these symptoms closely mimic the flu, including cramps, nausea and insomnia among the most severe. In extreme cases, she continues, patients can even die from opioid withdrawals, similar to long-term alcoholics attempting to quit “cold turkey.”
Clinics such as Aegis/ Health Connections provide a carefully measured dose, taking into account any medications the patient may be taking along with their history of substance abuse, metabolism and opioid tolerance. This dose is large enough to stave off withdrawal symptoms, while still being low enough to prevent patients from experiencing a euphoric high that could lead to a relapse. As a result, the patients are able to stop using illicit opioids, allowing them to move on to the next phase of treatment.
After three months of MAT, the first leg of a journey that Metcalf says usually takes two years, patients then begin a personalized counseling and health care program, specially tailored to meet each patient’s needs. Patients, 51 percent of them younger than 40, receive coaching to improve their social and life skills, enter job training and continued education as well as repairing damaged relationships with loved ones. Patients also receive any medical or mental health care they may need, all part of Aegis/Healthy Connections’ goal of treating the causes of opioid abuse as well as its symptoms.
The clinic successfully graduated five patients in 2016, and 12 in 2017. Metcalf defines “graduation” as completing the final year of treatment in which the patient’s dose of methadone is gradually decreased, usually by one milligram per week, until finally reaching zero on the last week. The purpose of the gradual decrease is to slowly wean the patient off the medication while minimizing the risk of withdrawal or relapse.
According to founder Dr. Ernest Vasti, the risk of relapse is approximately 80 percent within the first year, but that risk can drop to as low as less than 20 percent after five years of remaining clean.
One patient, Tom Mitchell, age 40, is one month away from completing his two years at the clinic. He first came to Aegis/Healthy Connections in June of 2015, seeking treatment for his own opioid issues which began after falling 25 feet and sustaining multiple breaks and fractures in his arms, feat, nose and skull, with eight screws still in his right arm.
After being discharged from the hospital, where he had been on an IV morphine drip with only three weeks worth of medication, he realized that the clinic’s treatment would be his best chance at avoiding opioid addiction.
He says that methadone was able to relieve his pain without the “cloudy” feeling commonly experienced by users of illicit street drugs. Mitchell speaks highly of the clinic, saying he hopes that it is able to help more people in the future.
Vasti considers understanding the factors that lead people to begin using opioids, especially among youths, is just as important to recovery as treating withdrawal symptoms, comparing it to a diabetic taking insulin as well as practicing proper diet and exercise and understanding possible biological causes. He describes the primary risk factors for addiction as being 55 percent genetic and 45 percent psychosocial, with many young addicts suffering from either attachment or detachment issues, which can lead to engaging in risky behaviors including substance abuse.
He stresses the importance of examining environmental factors such as home life, when attempting to understand opioid use among youths, as well as providing patients with genuine care, compassion and encouragement, something at which, he says, Metcalf and her staff excel. He describes Metcalf as a “den mother,” treating all of the patients as her own children and making sure that her staff stays on top of the patients, ensuring that they stick to the program.
After Vasti and Metcalf address the guests, Vasti introduces County Supervisor Chuck Winn, who takes a moment to congratulate the clinic’s staff, presenting them with a County Supervisor’s Certificate of Recognition for their accomplishments in saving lives, also giving his personal thanks.
One of the main motivating factors behind Aegis’ mission is to decrease the number of deaths from opioid overdoses. According to the Center for Disease Control and Prevention (CDC), California had 4,659 deaths from drug overdoses in 2015, with opioids making up a large portion of them. Aegis/Healthy Connections currently treats 320 patients, with the majority making daily visits to the clinic for treatment. Some who have been in the program for longer are eligible to receive premeasured doses to take home, usually on a weekly or biweekly basis. In order to qualify, patients must demonstrate a history of adherence to the program’s rules, especially testing clean for illicit opioids and prescription pills.
Methadone treatment is only available to patients 18 or older, although Metcalf frequently advises parents of underage patients to consult a certified primary care doctor about beginning suboxone or buprenorphine treatment.
According to an Associated Press article by Carla Johnson, a review of 31 studies found MAT to be effective in keeping patients in treatment programs and preventing relapse. Conducted in 2014 by the Cochrane Collaboration, an international organization of scientists dedicated to evaluating research, the study also found that in addition to being more effective than placebo medications, methadone has the added benefit of preventing the spread of HIV by reducing needle sharing.
Despite the numerous benefits, MAT is not without its own risks.
Both methadone and buprenorphine can be abused and both can cause overdoses, especially methadone. However, researchers found that methadone treatment prevents more overdose deaths than it causes.
Regardless of the treatment methods used, recovery from opioid addiction can be a long journey, sometimes taking multiple tries over many years.