Jun 29, 2016 | By Dannie Marden

Western NC Harm Reduction: A Look Inside a Methadone Clinic

Miscellaneous

Over the past few months, many news sources and online blogs related to recovery have spoken about the current opioid crisis in America. While President Obama has promised to pledge more resources to treatment and recovery efforts in the states, for years harm reduction facilities like methadone clinics have tried to bridge the gap between addiction and maintenance. While many of the programs seemingly are band aids in the bullet wounds addiction leaves, harm reduction centers are allowing many to receive another chance at life—but at a price.

What is Harm Reduction?

Harm reduction is essentially policies and strategies that, while not endorsing drug use, are aimed at reducing negative consequences of active drug use. The movement is built upon the idea that there is an absolute respect aimed at the rights of people who use drugs.

While drug use is still punishable by law, many law enforcement agencies around the nation practice harm reduction policies currently and endorse harm reduction in high drug areas. These places offer services, usually free of charge, and are funded through private grants and self-supporting donations.

5 AM Wake Up Call:

Clinics who serve doses of methadone watch patients line up as early as 5:45 AM to ensure that they receive their daily dose of hope in the bottom of a plastic cup. The withdrawals from opioids like Oxycontin and heroin are extremely painful, causing nausea, irritability, insomnia and muscle aches. In using drugs like methadone, patients can receive relief physical relief from substances related to withdrawal. While many are moving toward becoming productive members of society, others are merely existing—left to stay tethered to the program in some cases for up to 20 years.

Nicholas S., a counselor at a Western North Carolina methadone clinic, has seen just how far people are willing to go to get better. “They make it here every day, two times a day to get their dose if that’s what’s asked of them. The way that I see, it is there are different types of patients. Some of them show growth and others just show up not to be sick. It seems like it’s more effective in veterans and chronically relapsing older males.”

Abstinence Vs. Harm Reduction Based Maintenance

Nick is a recovering addict, who uses an abstinence based program of sobriety to help him remain clean and sober. “Harm reduction is successful.  I believe that it is successful at least, but I believe that abstinence based treatments are more effective. Harm reduction helps them to maintain a level of existence that mimics a normal life, but it inhibits emotional growth.” Nick intimated that in some cases, many are not able to receive proper detox protocols to get permanently off of methadone outside of the center. After a prolonged period, methadone becomes a new addiction, as withdrawal is extremely painful.

After meeting the necessary requirements to be placed on methadone, clients are mandated to receive bi-monthly counseling sessions for the first year, which shows how long this particular form of harm reduction can last. “It is a state regulation in methadone programs to see patients. In the first year, they must have two meetings monthly. After the first year, they have to meet once a month. If the patient misses an appointment, there are ways in which the counselor can stop their medication until they complete their session. Most times, counseling sessions are usually brought about by the patient. If they are interested in doing a detox or are still feeling sick or feel like they are still detoxing from opioids, we can talk about an increase in medication. The demographic is much different than what has been showing up in the rooms of 12-step programs. The trauma is deeply rooted, and often the patients are older. I see a lot of younger people in abstinence-based programs, who have the means financially to receive other forms of treatment that focus on abstinence.”

What Services Are Included at Clinics?

Patients are offered an array of services, from HIV and HCV testing to counseling services. The caseload for an active therapist or counselor is extremely high, around 50 patients. However, the success rate of appointments kept is very high.   While some are wary to taper off of methadone, many remain in the program as they have a better quality of life while on the medication.

“I hope to see some of them get off of methadone altogether, but I know that in some cases, it would be worse for them to stop. I’ve seen people get off of it, but they end up coming back, whether they relapse or not.”

Kristen B., who has been on methadone for three years, gave us an insight into her daily routine while in the methadone clinic. “I wake up every morning around 5:00 AM and make my way down here. At first, it seemed like I was doing something dirty, because of how everyone around here sees’s it. But I’m working toward getting my kids back, toward getting more of my life back. I tried to get off it once, but this stuff grows into your bones, man. But I got hope; I don’t think it’ll be like this forever.”

Other Forms of Harm Reduction:

Harm reduction programs in Western North Carolina are limited, and the waiting list for state-funded programs are long, as the opioid epidemic rages through most of the state. Buncombe County, home to Asheville, is one of the hardest hit areas in NC when it comes to opioid use, after Wilmington. Nonprofit harm reduction programs offer services such as needle exchanges and clinics for testing, but supplies are limited.

Aaron K., local harm reduction activist, stated in an interview “We serve more counties than we should. Our needle exchange is more like a cabinet, and if someone comes in and takes around 500 clean syringes, we cant stop them. Even if its supposed to be one per person, many people cant get to the exchange daily, and at least it means that there will be safe ‘works’ for people to have access to. We need more funding, and right now in the wake of HB2, we’re not able to pass any legislature about something that controversial.”

Asheville, NC has a growing recovery community that remains very involved in programs such as the harm reduction site. Meetings are held monthly in local coffee shops educating members of the community about heroin use, and how to properly administer Narcan. Those who attend can receive Narcan, the life-saving drug used in the event of opioid overdoses, for free or for a small donation.

According to the online methadone clinic database, there are currently over 1,400 methadone programs in operation.