A chance for salvation
Major push on to increase access to addiction medication
HARRISBURG » At a little before 9 a.m., Carissa Lehr stands on the porch of her mobile home. Her long brown hair is brushed and shining. Inside, her toddler son will soon wake, and Lehr will make him a waffle in her spotless kitchen.
Her life looks vastly different from a few years ago, when a decade-long addiction to painkillers and heroin controlled her every move. The 33-year-old credits the reversal to two things: The birth of her son. And methadone.
Methadone is one of three medications increasingly used to treat addiction to opioids and is now considered the “gold standard” for treatment. It amounts to the most promising solution, and one that is increasingly backed by evidence, to a confounding, soul-sapping aspect of opioid addiction: the tremendous craving that can persist even in people who are fully devoted to recovery, and the subsequent relapses and return to full-blown addiction.
Methadone prevents the excruciating withdrawal sickness that happens when people addicted to opioids try to quit. Although methadone is also an opioid, it doesn’t produce the high that comes from heroin and other illegal opioids. And while people using methadone must take it daily to avoid withdrawal, they don’t suffer the all-consuming craving and preoccupation that is part of heroin addiction. They can live normal lives and focus on things like their job or caring for their children.
Unfortunately, access to the medications can still depend on where someone lives. Pennsylvania is doing assorted things to fill the gaps. Still, in rural parts of the state, which have some of the nation’s highest fatal overdose rates, the medications are scarce. The shortages persist several years after rural county coroners and others began sounding an alarm, and the realization that medications are a crucial part of the solution. “We definitely still have a lot of work do. I think we’re taking the right steps,” says Jennifer Smith, Pennsylvania’s secretary of drug and alcohol programs.
Carissa Lehr gets her methadone at a clinic a few miles from her home near Mechanicsburg. In the beginning, she had to go every day. A nurse would pour the red liquid into a cup and watch her drink it.
Now that Lehr has a track record of embracing her treatment program, she goes a few times per week and is allowed to take home doses for the other days.
Medication alone isn’t considered effective treat-
ment. Lehr also attends recovery meetings and counseling.
“There are still days when I have a thought. But it doesn’t take me long to remember all of the negative and get out of it,” she says.
The other two medications commonly being used to treat opioid addiction are buprenorphine and naltrexone. Buprenorphine, often used in a form called Suboxone, is another opioid used to prevent withdrawal and cravings without making the user high.
Naltrexone isn’t an opioid and works differently, blocking the effects of opioids so that if the person were to use heroin, they wouldn’t get high. A popular form of naltrexone, called Vivitrol, requires only a monthly injection.
All three are approved
by the U.S. Food and Drug Administration. Combined with counseling, they comprise what’s known as “medication-assisted treatment.” Studies show that people trying to recover from opioid addiction using one of the medications are 50 percent less likely to die from an overdose than those who try to recover without it. They also stay in treatment longer, and are more likely to return to treatment if they relapse.
But that option isn’t available to many.
About 200 people come regularly to a clinic within the Pennsylvania Psychiatric Institute near midtown in Harrisburg. Open since November and with easy access to public transportation, the clinic has been attracting about 20 new patients per week.
Some receive methadone, which can only be dispensed at federally approved locations. Some get prescriptions for buprenorphine, which can only be prescribed by doctors and nurses who have special certification. Some receive injections of Vivitrol. Some, still in the early, shaky days of recovery, receive one-day doses of naloxone, which in larger quantities is sometimes used to get high or sold on the street.
Counseling and other forms of help are also available at the clinic, which is run by Penn State Health and made possible with a $1 million grant from the state.
It’s one of numerous places where people who live in Dauphin or Cumberland counties can go for medication-assisted treatment.
Barely 25 miles away, just over the mountain in Perry County, the situation is starkly different.
There, says county Commissioner Brenda Benner, access to medications to treat opioid addiction is “very, very limited.”
Perry, like other rural areas, has been hard hit by the opioid crisis. For example, Beaver and Armstrong counties each had nearly 60 fatal overdoses per 100,000 people, according to recent statistics compiled by Pennsylvania coroners. Many other rural counties have fatal overdoses rates far about the national average of about 20 per 100,000 people.
In Perry, the rate matches the national average. But because Perry has no hospitals, Benner suspects its overdose rate is undercounted for reasons such as overdose victims being transported to out-ofcounty facilities. The situation is serious enough that Perry has equipped its probation officers and ambulance crews with naloxone, the drug that can reverse an opioid overdose.
But when asked where people can get medications to treat opioid addiction near communities such Landisburg, Shermans Dale or Loysville, Benner says, “I am not aware of anywhere”
“I don’t think people really understand how great the need is,” she says.
The situation brightened somewhat with the planned opening of a medical clinic run by Harrisburg-based Hamilton Health near Newport. The clinic includes a state-funded treatment center where people can go for Vivitrol injections or prescriptions for buprenorphine.
But that still leaves many in Perry County to travel long distances to get medication and counseling. If they lost their driver’s license because of their opioid addiction, or lost their car to the financial ruin that often results from the addiction, that distance can be insurmountable.
Pennsylvania has spent tens of millions in state and federal money to make treatment more available, especially in rural areas. It has helped launch a handful of centers, like the one run by Penn State Health in Harrisburg, around the state.
The goal is for the centers, run by big health care systems including UPMC, Geisinger and WellSpan, to become regional hubs. The intent is for the hubs to run full-service treatment clinics, while also connecting with doctors and organizations in outlying areas, to help them provide medication-assisted treatment. For example, a rural doctor may be willing to provide Vivitrol injections, but feel unable to meet the person’s overall
treatment need.
The regional hubs would find a way to meet those needs. The state has further established 45 “Centers For Excellence” with a goal of expanding access to medication assisted treatment. Some but not all are in rural areas.
Also, Gov. Tom Wolf’s administration has changed
Medicaid rules and is working with hospitals so people who survive an overdose can immediately receive buprenorphine. Wolf has told private health insurers he expects them to provide undelayed access to the medications used to treat opioid addiction, and most have done so.