JANESVILLE, Wisconsin — People started shuffling through the doors before sunrise.
They walked in, took a number and found seats among peers. They anxiously waited for their numbers to be called so they could move on with their days — go to work, run errands, take children to school.
When their numbers were called — most within 30 minutes — they approached the counter, received what they’d come for and kept moving.
It wasn’t a supermarket deli or bakery. It’s the morning routine for hundreds of patients who every day receive treatment for opioid addiction at the Beloit Comprehensive Treatment Center.
When they approach the counter, a nurse evaluates them for signs of withdrawal or other substance use. If they look as though they are complying with treatment standards, they receive a small plastic cup of methadone, a syrupy liquid that allows them to keep on with their day.
Methadone is one of three medications used to help people with opioid addictions beat the disease. The other two are Suboxone and Vivitrol.
Each drug treats addiction differently, but one thing remains the same: Rock County doesn’t have enough treatment providers using the drugs to serve the demand, local law enforcement and medical professionals recently said.
“The amount of services that are available to people with addiction in Rock County are abysmal,” said Mike York, director of Beloit Comprehensive Treatment Center. “There’s a huge need for services here in Rock County, and we just don’t have them right now.”
York and Dr. Vernon Partello, methadone prescriber at the treatment center, agree the opioid epidemic will get worse before it gets better, meaning those who treat addiction have to adapt.
The staff at Beloit Comprehensive Treatment are in early stages of planning to expand their facility, York said.
Dr. William Ayetey, psychiatrist and Suboxone prescriber at Mercyhealth Behavioral Health-Janesville, recently was approved to increase the number of patients he can treat in a year from 100 to 275.
HOW DOES IT WORK?
The long-term purpose for each addiction treatment medication is to prevent withdrawals so patients do not crave more drugs, Partello said.
“Opiate withdrawals are pretty intense,” said Brenda Endtoff, drugs of abuse coordinator for Rock County Human Services. “It’s the sickest flu you’ve ever had. You’re miserable. You can’t function. You can’t go to work.”
For many people, opioid addiction starts with prescription pain medication, York said. Once they stop taking pain medications, withdrawals can become so painful they search for any drugs that can provide relief.
People rarely start their addiction with heroin, one of the most commonly talked about opioids, York said.
“Bad things happen to good people, and they adapt to their situation,” York said.
Opioids make chemical changes in the brain to suppress the nervous system and numb pain, Ayetey said. For some people, opioids can create a sense of euphoria, making them want more.
Each medication works to treat addiction at the brain sites differently, but similarly. None of them works without additional counseling, the professionals said.
“If we just had medication by itself, patients would never improve,” York said.
Regulations on Suboxone and methadone providers require them to provide counseling or refer their patients for counseling elsewhere.
The frequency of counseling is dependent on the patient’s needs, Ayetey, York and Partello agree.
Medication gives patients relief so they can go to counseling to learn how to return to normalcy, York said. Patients often have to learn how to repair relationships, solve financial struggles and develop other life skills that might have been lost during addiction.
The primary difference between the three drugs is in their composition.
Methadone is a full-agonist, Partello said. It is an opioid that can be prescribed for pain and can be abused like any other opioid.
For this reason, methadone patients are required to visit the clinic every day to receive their doses from a nurse. Sunday is the only day patients can receive a take-home dose because the clinic is closed, York said.
Methadone delivers an opioid in a manageable dose, Ayetey said.
Suboxone is a combination of buprenorphine and naloxone, Ayetey said. Buprenorphine causes the same brain-numbing effect as opioids but is half as strong.
Because buprenorphine is a partial agonist, it doesn’t produce the same effects as opioids, so people do not get high, Ayetey said. Buprenorphine binds to the brain sites more tightly than opioids, meaning if someone tries to take an opioid after taking Suboxone, they cannot get high. It also has a ceiling, so once Suboxone is taken, more doses at once will not produce a stronger effect.
The naloxone in Suboxone is commonly referred to by the brand name Narcan. It is used to reverse the effects of a drug overdose, Ayetey said. Naloxone blocks the brain site and prevents Suboxone from being injectable.
Suboxone is prescribed by a doctor and can be taken at home like other prescriptions, Ayetey said. Patients often start with one or two-day prescriptions, then eventually work up to 30-day prescriptions.
Vivitrol is an injectable shot of naltrexone, Ayetey said. Naltrexone prevents opioids from reaching the brain but may still cause some of the euphoric effect.
The shot is given once every four weeks, Ayetey said.
Methadone is best for people who have been taking opioids for a long time and have developed a higher tolerance to drugs, Partello said.
For many people with addiction, Suboxone might be a better option because it is less disruptive to everyday life, Ayetey said.
If a patient has taken methadone in the past, Suboxone might not be effective, Ayetey said.
Many in Rock County are referred to Suboxone treatment from the alcohol and substance abuse walk-in clinics through the Rock County Health and Human Services Department, Endtoff said.
The walk-in clinic has a contract to refer patients to Compass Behavioral Health Clinic in Janesville for Suboxone treatment, Endtoff said.
The Gazette was unable to contact Compass Behavioral Health Clinic for comment by press time.
The walk-in clinic has resources to help patients who may need financial help due to lack of or insufficient insurance, Endtoff said.
“The research shows that people need the medication along with the therapy,” Endtoff said.
The methadone clinic gets a lot of patients through word of mouth or through referrals from area hospitals, York said.
At Mercyhealth, patients have to go through a three-week addiction day treatment program before they are referred to Ayetey for Suboxone treatment.
Some private mental health providers have the capacity to treat more addicts but find it difficult to get the word out.
Dr. Sobia Kirmani-Moe, adult and child psychiatrist at Mercyhealth Behavioral Health Clinic-Janesville, runs a private practice in Madison where she prescribes Suboxone.
Kirmani-Moe has the ability to treat 100 patients a year with Suboxone but only sees about 10.
“It’s not technically ethical for me to put a big billboard in the middle of Janesville and say, ‘I have Suboxone, come get it.’ So it becomes difficult to reach out,” Kirmani-Moe said.
Ayetey thinks some doctors may be hesitant to administer medication-assisted treatment because of strict regulations from the federal Drug Enforcement Administration and the stigma around addiction patients.
“When you think of a patient with addiction, there all the kind of stereotypes or prejudices,” Ayetey said. “The truth is, when people are on Suboxone and are doing well, they don’t tend to (confirm the stereotype).”
York said he and his staff are working against the stereotypes that can prevent people from seeking treatment.
“People have this idea that there’s a whole long congo line of addicts waiting to come in and get their fix, but really that’s not how it works at all,” York said. “The biggest barrier to treatment is the stigma that surrounds it.”
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