Pathways to Recovery from Opioid Addiction
Thousands of people in Virginia are seeking help for opioid addiction. Many are using a combination of treatment, including peer support, counseling, healthy living and opioid replacement therapy. But the demand is outpacing available services. In part four of our series Facing Addition, Catherine Komp reports.
Stas Novitsky started using heroin when he was 19. First it was once a week, then it was twice.
Stas Novitsky: By the time I got to three or four times a week, I had developed a habit to the point where when I didn't have it I would go through withdrawals. And that began the next cycle of the next few years being consumed with this constant search for opiates or anything to make me feel good so that I wouldn't be sick physically.
The addiction got worse. Novitsky was using heroin several times a day.
Novitsky: I would get my first fix of the day and then I would go out and figure out what kind of jobs I could do to get high again later that evening. But at that point it wasn't even getting high, it was more so just maintaining my level of not getting sick.
Physically, he was deteriorating, losing weight, neglecting personal hygiene.
Novitsky: So the rock bottom was--a daily occurrence, every day. Every day I would be at rock bottom. My life had come to a point where I was working at the landfill and my job was to pick up the trash that rolled off the side of the hill and take it to the top of the hill. And then after that I would go and get high. So my life was literally trash all day, every day. I was either picking up trash or getting trashed.
He went to jail for larceny, got out and overdosed the next day.
Novitsky: After I overdosed, I took a little break for maybe a month and then got back into it because I didn't have any supports, I didn't have anything around me, no structure. I wasn't reaching out, I was just kind of floating by and hoping for the best. And then it got to the point where I committed some more crimes that were coming down on me, I was on probation. So I realized I'm either going to go to jail or die over this and I know that I can do better. And I got sick of the lifestyle, I knew that there was nothing in it for me anymore. There was no more fun, I was always chasing that first high that was never going to happen. All my friends were gone or in treatment or dead. So, it was me alone with all my problems and new problems coming every day and I realized that if I don't change now, this is the end. And I made that decision to seek help and I worked, I gave it my all.
Novitsky’s been clean for more than a year. He initially detoxed from heroin and then used a combination of recovery methods: 12 step, SMART, healthy living and eating, and being of service to others.
Novitsky: For me, in the beginning, the easiest way to be miserable in my day was to only think of myself. So by starting to give back to others it kind of took me out of my own head and showed me that there's other people that I can learn from and there's other people that have it worse than me that I can help along the way. So it's become this journey of realization that it's not just about me, I can help my friends, my family in the process and everyone else around me.
Novitsky is the Director of Youth and Family Development at the McShin Foundation, a 12 year old peer-led recovery organization. McShin offers same day detox, support groups, healthy living activities and has a residential program with about 75 beds. Located in the same building is their partner, Clean Life Medical, staffed by an addiction specialist and psychiatrist.
Francis Fletcher: McShin, the offices function as a Recovery Community Center.
Francis Fletcher is assistant director of Men’s programs. Like most staff here, he’s in recovery too. On a tour of the facility, we stop in a room where several participants are making photo collages. Intake coordinator Michael Quinn stops in. He says on a daily basis, he gets about 50 calls, 100 texts and about 30 emails. Twenty to twenty-five of those are from people who want to get into a recovery program.
Michael Quinn: We always have a bed open for someone who needs a detox and who is going into the intensive program, we always have a bed available.
McShin is not religiously affiliated, but it’s co-located in a church. The hallways are lined with photos from events, people having fun and smiling. And there’s always activity here, seven days a week. People have a place to go where others understand what they’re going through.
Novitsky: This is a community in that sense, that we're all in this together. We're all there hopefully for the right reasons, but the people that aren't weed themselves out on a consistent basis. So we just created a culture where recovery is openly talked about, there's no shame attached and people can be themselves without judgment. We're all here to help.
There are multiple pathways to recovery, including “medication-assisted treatment” often called MAT. These are opioids too like methadone and buprenorphine but they don’t create the same euphoric effects, cravings or withdrawal. Mellie Randall is with the Virginia Department of Behavioral Health and Developmental Services. She says medication-assisted treatment is growing in popularity because it’s effective.
Mellie Randall: This opiate replacement therapy, the methadone and the buprenorphine-naloxone combination, basically that provides enough opioid to the receptors so that the person can think clearly, they can function, they can work, they can make decisions and they are not driven by this deep craving nor do they have this extreme pain. So they are able to function, they're able to have normal relationships with people. Some people need the medication for just a little while, some of them need it for years and years and years but it's provided under physician supervision with good interaction, in the case of methadone, regular interaction with the nurse who is dispensing it and it can really make the difference between a person living a normal life or potentially overdosing.
Randall and others stress that medication-assisted treatment is not a silver bullet and carries its own risks, especially if the drugs are misused or diverted to the black market. She says MAT should be combined with therapy, peer support, exercise, nutrition and being around people who are supportive. And while counseling is required for methadone clinics, doctors only need to provide access to counseling after prescribing buprenorphine. And Randall says there’s no real monitoring of that.
Randall: People who are suffering from opioid addiction and seeking recovery often need a lot of support so there's some concern that this office-based medication that sometimes people are not getting enough of the social support and psychological support that they need. So we're actually working with the Board of Medicine to look at standards of care for the use of this medication in Virginia that would be in addition to what the federal requirements are.
Substance abuse treatment for opioid addiction is available through 40 community service boards across the state. Many have waiting lists, depending on the type of service a person needs. Even after someone receives an assessment, the cost of medication can be a barrier.
At the Richmond Behavioral Health Authority (RBHA) Dr. Jim May has seen drugs come and go during his 27 years here. When he first started there was a heroin epidemic. Two years ago, he says they had about 20 people on a waiting list. Today, it’s nearly quadrupled.
Dr. Jim May: Now we have 70-80 at any given time on our waiting list to get an assessment done.
RBHA currently serves about 400 people in opioid treatment programs, most using methadone. May and CEO John Linstrom say the cost of treatment can be an obstacle, especially for more expensive drugs like Suboxone or Subutex. But they’ve been working to increase Medicaid funding for substance abuse disorders.
John Linstrom: I think we're being proactive as an agency. Both Jim and I have been involved with some of the foundational work that we hope will be leading to some very fundamental changes, in at least Medicaid funding for substance use treatment in the Commonwealth. In fact, rates that have been severely low and pathetically below costs are going to jump April 1st and to the point where I think there will be some interest and interest certainly with us to increase some of our service capacity in that area.
Even with unlimited funds, health leaders including Mellie Randall point out that there’s a lack of specialists trained in addiction.
Randall: And even in the private sector we just don't how much network, we don't have very many places where you could go and for instance get detoxified or be put on the right kind of care. We don't have enough doctors who are trained to provide the right kind of treatment for addiction especially opioid addiction and we need to have more counselors trained.
Randall says her agency is working closely with the Department of Medical Assistance Services, the Department of Health Professions, and other organizations to find ways to get more counselors, social workers and physicians interested in this field. Lindstrom and May are hopeful they’ll be able to increase the quality of treatment programs and staff a 24/7 detox facility when they take over the operations of Rubicon facility this Fall. All three say it will take a significant commitment by many sectors in Virginia to fully address the opioid epidemic. Catherine Komp, WCVE News.