Monday, May 30, 2016
Authorities in Va. debate how to treat addictions
By JOHN RAMSEY and K. BURNELL EVANS Richmond Times-Dispatch
Timothy Starr asked a Chesterfield County judge to send him to jail for 90 days. He could’ve been out in 10 days for driving with a suspended license, but Starr thought a extra few months behind bars might save his life.
Starr, 27, first used heroin as a teenager in jail. Now he’s among about 30 inmates in Chesterfield who attend daily counseling sessions as part of a program meant to help them kick their addictions.
Starr and fellow inmate Brian Coddington agree on what leads them to accept the jailhouse counseling: It comes from a former addict, and it doesn’t involve more drugs.
“If an instructor or someone that had a college degree in therapy came in, I don’t think the program would be what it is,” Starr said.
“I don’t care what they say; Suboxone or methadone is still a crutch. You don’t get that blasted high feeling, but it’s still hitting your brain.”
Their attitudes mirror a larger debate taking place across Virginia, where heroin and prescription painkillers have killed at least 5,500 people since 2007.
With the state overwhelmed by the years-long surge in painkiller and heroin overdoses, local law enforcement leaders are creating programs to treat people’s addiction instead of punishing them for it.
But more often than not, those local programs enroll the help of abstinence-based organizations such as The McShin Foundation, whose philosophy puts them at odds with the state.
The state prefers — and pays for — medication-assisted treatment that calls for opiate-based replacement drugs alongside counseling. The programs on which local leaders depend for help aren’t likely to see any of the additional $11 million in the state budget for addiction, because it will be used to try to expand the availability of the state’s preferred plan.
Bill Hazel, Virginia’s secretary of health and human resources, said counseling alongside medication is shown by scientific evidence to be the gold standard for helping recovering addicts.
Hazel said some local agencies may be turning to abstinence treatment because it’s all that’s readily available in Virginia. The additional $11 million is intended to help build up that network of doctors and counselors.
“If I can’t fly first class, I might fly coach. But I’d really like to have the option to do both,” Hazel said.
“I do not want to be disparaging of peer-assisted recovery, because it certainly works for some people. What we don’t know is how many people drop out and fail, and we don’t know what the long-term results are.
“This might be a discrepancy between what’s being studied, but we don’t necessarily want to be funding the ‘I don’t know.’”
Hazel said he hopes that leaders across the recovery spectrum can work together with the state to find a way to combine their approaches to battling addiction.
But the idea of using drugs to heal drug addiction is tough to reconcile with a philosophy of abstinence that goes back decades with 12-step models for drug and alcohol abuse.
John Shinholser, founder of the Henrico County-based McShin Foundation, filed a federal discrimination complaint this year against the state Department of Behavioral Health and Developmental Services.
The complaint accuses the state of excluding McShin from participating in groups that create the standards for treating substance abuse and freezing out the organization from state funding.
“It all goes back to bureaucracies. You’ve got all these leaders from all these agencies that know better. In the meantime, nothing’s happening, the epidemic’s out of control,” Shinholser said.
“You are doing the single worst thing you can do to an addict and that’s spit them back out in the community when they are there asking for help.”
Two main drugs are used to treat addiction to opiates, whether painkillers or heroin.
Methadone has been used for decades to help addicts avoid taking other opiates while preventing the debilitating withdrawal that comes with stopping cold turkey.
Buprenorphine was approved in 2002 for the same purpose. Most often, it’s sold as Suboxone, which includes the antidote drug naloxone as a countermeasure to prevent overdose. Teresa McBean, leader of a faith-based recovery organization in Chesterfield called Northstar Community, said the idea of taking drugs to beat drug addiction is at odds with the abstinence-based approach. The disagreement is so basic that there seems to be little ground for compromise. McBean said the epidemic is so big that no approach should be written off immediately. She compared her preferred method of trying everything to “throwing spaghetti against the wall and seeing what sticks.
But there’s a deep resentment among abstinence-only groups toward any treatment that uses other drugs, she said. “You get on methadone and you stay on methadone for a long time,” McBean said. “What some people would say is, ‘That’s the government response to making sure grandma’s flat-screen TV doesn’t get stolen — trying to address the problem of the crime associated with opiate epidemic without caring about the recovery of the individual.”
Attorney General Mark R. Herring has been a leading state advocate for addressing the painkiller and heroin epidemic, which now kills more people in Virginia than car crashes. He said both sides have merit in the treatment debate.
“I think we need more options all across the commonwealth in all of these areas,” Herring said.
“Certainly, you want to make sure when tax dollars are being invested, you want to be sure there is evidence to show it is effective and working. I think a lot of these groups, McShin and others, are demonstrating that they have a track record of success.”
Further complicating the debate is the sad reality that most people addicted to opiates will relapse no matter what form of treatment they receive.
Peer recovery organizations often have a makeshift memorial wall for those who came seeking help but eventually lost their lives to addiction.
And the therapy drugs don’t come without risk.
Since 2007, methadone has been linked to 1,120 overdose deaths in Virginia, or slightly more than cocaine. But while cocaine-related deaths continue to increase, the number of deaths from methadone continues to drop year over year, falling below 100 in 2015 for the first time since 2007.
Buprenorphine overdoses have been more rare. But they accounted for 10 deaths in Virginia in each of the past two years. And a national study found a 10-fold increase in emergency room visits related to buprenorphine from 2005 to 2010 as the drug became more available.
First approved for use in the U.S. in 2002, buprenorphine use in Virginia spiked more than 5,500 percent from 2004 to 2014, according to figures from the Drug Enforcement Administration. In the same time frame, methadone use in the state grew about 40 percent.
McShin, like many peer recovery organizations, follows up with those who graduated from the program every year and reports that about 60 percent manage their illness well, even if some of them suffer an occasional relapse.
Those phone calls don’t pass as evidence in scientific studies, which say it’s nearly impossible to measure the effectiveness of abstinence-based peer recovery programs.
Multiple reports, including from the National Institutes of Health and the Institute of Medicine, have concluded that using methadone or buprenorphine as part of addiction treatment keeps patients in treatment and off other opiates longer than abstinence.
Chuck Adcock is director of Family Counseling Center for Recovery, which treats addicts at its offices in Richmond, Chester and Fredericksburg using a mixture of abstinence, counseling and drug-replacement services for patients.
Adcock said methadone and Suboxone work well for certain patients, but it’s nearly impossible to determine which ones will benefit before they are given the drug. One of his patients on methadone recently graduated from law school.
“For some people, it’s a godsend. The reality for most people who are drug-addicted is they can no more handle a prescription for Suboxone than they could have handled their prescription for oxycodone,” the most deadly prescription painkiller since the epidemic began, Adcock said.
“It’s hard to get folks off of either drug. It’s like we’ve given up on the idea of abstinence and detox as soon as possible for these people. It’s really being marketed as the answer.”
Coddington, the inmate in recovery in Chesterfield, said he injected Suboxone once, but the feeling was so uncomfortable that he never tried it again.
He’s been enrolled at both a methadone clinic and at McShin. But he kept using heroin the entire time, because he thought he was clever enough to beat the system.
Chesterfield Sheriff Karl Leonard decided this year to use existing funds in the department’s budget to form an addiction recovery program, with Coddington one of the first enrolled.
Leonard also has a new form of home arrest program with The Healing Place that allows some inmates to wear an ankle bracelet while living and receiving treatment there.
“I get about five addicts a day at my jail. We’re good at getting you withdrawn, but I’m just sending you out of jail as a sober addict,” Leonard said.
“My philosophy is, we want to break all addiction and dependency on all drugs and alcohol. This is one perpetual cycle that either ends up with you being in prison for the rest of your life, or dead, and neither of those options are things we’re OK with.”
The Chesterfield jail has a doctor who is working to get a license to prescribe Suboxone, but Leonard said that will be used only to help reduce the intensity of the withdrawal symptoms that addicts experience when they first stop using.
“What we’re not in favor of is transplanting one addiction for another addiction,” he said.
The Richmond Police Department is working to start helping addicts before they end up in jail with a program that soon will offer same-day treatment referrals to all overdose survivors.
Eventually, any addict will be able to bring his drugs and equipment into the city police department and ask for immediate help with no fear of being arrested.
Richmond police Capt. Michael Zohab, who is leading the efforts, said it’s time to admit the war on drugs was lost and try to salvage lives in the best way possible.
Zohab was initially surprised at the intensity of the debate around how to treat addicts.
“I had no idea there were so many varied opinions on the topic,” he said. “What I’ve learned is, recovery is not a one-fit fix for everybody. What’s going to work for me may not work for you.
“We like the fact that certain recovery programs are more holistic in the counseling, in the healing of the individual, to eventually not need an addictive substance to maintain their daily existence. ... But again, there’s no magic program.”
Monday, May 23, 2016
Tuesday, May 17, 2016
May 17, 2016
May 17, 2016
|By Sarah King|
Capital News Service
RICHMOND – Scraps of newspaper obituaries, photographs of the departed and handwritten notes in memory of loved ones collage the bottom third of a sectioned-off piece of the wall at the McShin Foundation’s intake office.
The delicate ensemble pays homage to lives lost to addiction – a tangible mnemonic indicative of a statewide epidemic. Inches to the right, the rest of the wall is covered with photos of smiling faces, separated from the deceased only by a faint line of demarcation.
“This is how we keep track of people when they leave housing,” said Michael Quinn, the intake specialist at the foundation, a local nonprofit recovery community organization. “If they’re doing well they’re above the line. People will come in all the time and kind of shift things around so we can keep better track of how people are doing.”
Unfortunately, not everyone’s face remains above the halfway mark – a reflection of a wave of deaths in Virginia due to fatal opiate overdoses.
Opioids – both prescription pain medications and heroin – account for most of the spike in fatalities. The number of fatal opioid overdoses increased 86 percent, from 475 deaths in 2010 to more than 880 last year, a CNS analysis of data from the Virginia Department of Health found. Opioids made up more than 90 percent of the state’s drug deaths in 2015.
Quinn attributes the sharp rise in drug abuse partially to the availability of more potent heroin.
“A lot of dealers are cutting the heroin with phenobarbital, which is a deadly combination,” he said. “And the other thing is, heroin’s become more of a popular drug in suburban and upper-class neighborhoods, so it’s becoming more acceptable.”
In Richmond, the number of heroin deaths jumped from five in 2010 to 38 last year. Over the same period in Henrico County, the number rose from four to 27. In Virginia Beach, it went from three to 18. And in Fairfax County, it increased from two to 32.
Nick, a Fairfax County native who asked that his last name not be used, knows firsthand about the addiction that drives those statistics.
“It was like when I was high, I could live in this fantasy all the time that was, ‘I’m gonna go to school tomorrow, and fold my laundry, and start working out, and cook dinner,’” he said. “But as soon as I came down, my only concern was getting back to that place of contemplative productivity by getting another hit.”
Now 22 and almost a year into a treatment program in Florida, Nick tried prescription painkillers for the first time at 16.
“It progressed from whenever I could get them, to raiding medicine cabinets, to finding my own dealers for the next three years,” Nick said. “I started using every day at 19, and that continued until about 20, and then I was injecting.”
Nick said his parents were unaware of his growing addiction until his father had to cover a $500 drug debt about nine months before he went to treatment.
“It was when I started using heroin in addition to the pills, and the unmanageability during the times when I had no drugs was too much to bear, that I decided to get help or I was going to die. So I checked into treatment,” Nick said. “My parents didn’t know I was IV’ing until we got to the ER the day I asked for help.”
Quinn said he hears stories like this all too often. The McShin Foundation works to erase the stigma associated with addiction and getting help.
“When somebody says they’re an addict, people think of them as this nasty junkie person you don’t want to be with,” Quinn said. “The media always portrays the problem – the arrests and drug dealers – but they never show the solution, which is people recovering and living regular lives.”
Quinn, like all other administrators at the foundation, went through McShin’s peer-to-peer program personally. He has been clean from opioids for more than a year. The foundation’s CEO has been sober for nine; the director of operations, five; and the founder, John Shinholser, more than 30.
“It’s an everyday battle still,” Quinn said. “I have a sponsor, I go to meetings – it’s working. And people can relate to us and can’t use the excuse of ‘Oh well, you haven’t been there, you don’t know what you’re talking about,’ because yeah, I have been there, and I do know.”
The McShin Foundation is now in its 12th year. About 60 percent of its clients are addicted to opioids. Quinn said the rate of recovery is higher than at most treatment centers.
He said traditional centers typically have an 18 to 20 percent success rate – which is determined by a year of sobriety – whereas success rates at McShin are closer to 50 percent.
Because the nonprofit McShin Foundation does not receive any government funding and insurance companies don’t recognize the program, Quinn said treatment must come out of pocket for individuals and families. But clients say it’s well worth the cost.
“You’re investing in someone’s life,” Quinn said. “My parents tell me all the time the best investment they ever made was getting their son back – and that’s priceless.”
For the past two years, the opioid epidemic has claimed, on average, more than two Virginians’ lives a day for the last two years. The toll has spurred state officials into action. Virginia Attorney General Mark Herring in particular is taking strides to address the rise in fatalities and opioid abuse.
Last month, Herring was awarded the Bronze Key, a national recognition presented for outstanding contributions, from the McShin Foundation at the organization’s 12th Annual Spring Awards Banquet.
“So many families across Virginia have been touched by addiction to heroin and prescription opioids, and too many have already lost a loved one to a fatal overdose,” Herring said. “In many cases, this is a problem that has its roots in the medicine cabinet, not in the streets, and that the medical community has to be part of the solution.”
Herring’s office created a documentary “Heroin: The Hardest Hit,” which features Virginians, including some from the McShin Foundation, sharing their personal stories of grappling with addiction and recovery, as well as the stories of people who died from overdoses.
Herring has also worked with local and federal authorities to prosecute more than 28 cases against dealers and traffickers involving more than 95 kilograms of heroin – which equates to 238,500 daily doses and a street value of more than $19 million.
“So often, shame, stigma or fear forces families and those with substance abuse disorders to suffer in silence,” Herring said. “But we cannot and will not let ourselves become hopeless or discouraged. We have to make sure that people who are struggling know you can beat addiction. There is life after addiction, and there is hope in recovery.”
Gov. Terry McAuliffe and state lawmakers across party lines agree have joined forces to address the problem. During the 2015 legislative session, the General Assembly made naloxone – a potentially life-saving opioid-antagonist administered in the event of an overdose – more widely accessible to law enforcement and health-care providers.
Last October, McAuliffe’s Task Force on Prescription Drug and Heroin Abuse released its recommendations, and state officials are implementing some of them. They include developing a website as an informational hub on prescription pill and heroin abuse, creating an opioid educational curriculum for law enforcement, reducing the stigma associated with addiction and increasing the availability of peer-support services.
According to a recent policy brief by the VCU School of Medicine, untreated substance abuse costs the state and local governments more than $600 million annually.
“Virginia’s opioid epidemic and untreated substance abuse are killing hundreds of Virginians and costing taxpayers more than half a billion dollars each year,” said Andrew Barnes, the brief’s lead author and an assistant professor at VCU.
For young adults like Nick and families across the state, there are emotional costs as well.
“A close friend of mine relapsed and overdosed on Dec. 18. It’s hard seeing someone give up on themselves and go back to their old ways,” Nick said. “I’m a fear-based person, but my fear of dying from this disease is the reason I keep doing what I need to in order to stay sober.”
Richmond native William “Billy” Derr, 24, passed away from a fatal overdose last month. Derr’s mother, Jenny, wrote in her son’s obituary, “As those who struggle with addiction know, it is a daily fight, hour by hour, and is ever constant. Billy had some extended periods of sobriety; those were the times when his true genuine heart shined through.”
In the obituary, Deer stated:
“To the people who don't understand addiction, he may be just another kid who made a ‘bad choice.’ For those who do understand the disease, this was our oldest child, a brother, a friend and as his mother, my children are my everything. The disease of addiction is non-discriminatory and without mercy. It is up to us to open our minds and hearts to those suffering from the disease. We will continue to fight the fight.”
So will the McShin Foundation. It provides a rapid detox program, which tapers the individual off opioids over five to seven days. Quinn said what separates McShin from other treatment centers is that there’s no waiting list.
“If someone calls me, they can come in today, see the doctor and get put in a bed that day,” Quinn said. “If someone needs help, there’s always a bed available.”
Monday, May 2, 2016
I heard about Mcshin from a nurse in the emergency room while I was coming back from an almost fatal heroin overdose. I was the lowest I’ve ever been in my life, but it seemed as if my family was suffering more than I was. They had been watching me progressively spiral downward for years, but this was different. This was really happening. They realized that this was not a moral deficiency or a conscious choice that I had made. This was a disease, and it needed to be treated like any other serious medical issue. I was about to embark on a journey that would change my whole purpose in life.
I walked through the door of the Mcshin Foundation on December 26th, 2016. I was very nervous and shy, not knowing what I was getting myself into. I was quickly introduced to the “herd,” a group of like-minded addicts that wanted to stay clean. As I awkwardly went to shake hands with the first stranger, I was quickly trapped into a hug. “We hug around here,” he said. They were so nice to me! Almost too nice, but it gave me hope. I saw something in them that I wanted - happiness.
Within an hour I was in my first Narcotics Anonymous meeting. I was very uncomfortable, but could identify with everything that was being said. I heard my story. It was at that time that I realized something vital to recovery- I was not special, unique, or different. There were other people that felt the way I felt and had lived the way I lived. They talked about doing the same thing over and over again, expecting different results. They called it insanity. I believed I was an addict who needed help. Everything they were saying made so much sense. It wasn’t long before I was enlightened by a very important fact- drugs are only a symptom of the disease of addiction. It wasn’t enough for me to just stop using drugs. I had to change my way of life.
Living in a Mcshin recovery house has been so much fun for me. For the first time in my life, I have true peace of mind. I feel like I am part of a family for the first time. They hold me accountable and point out things that I need to improve on. They see things that I cant see. It’s comforting to know that we all have similar stories. Every staff member that works at Mcshin is a person in recovery. Even the house manager is a person in recovery. I went on to find out that the president of the foundation, John Shinholser, is an addict who has over thirty years clean. This gave me so much hope in the beginning. I thought to myself, “if they can recover, just maybe I can too.” They say that the therapeutic value of one addict helping another is without parallel.
I now have a full time job and am able to pay my own rent. I am learning responsibility, dealing with life on life’s terms. Depression, hopelessness, and anxiety are all feelings of the past and I owe it all to my higher power. The steps of Narcotics Anonymous are very important for me because they show me things about myself that I may have not seen before. I have a sponsor who works the steps with me and I call him every day. “A grateful addict doesn’t use,” he always tells me.
Mcshin showed me that I can have fun without drugs. I had tried other recovery options but they just didn’t seem to work. I think the reason Mcshin is so successful is because of its peer-to-peer approach to the disease of addiction. We have an army of recovering addicts who are on a mission to stay clean and spread the message of hope. It is not enough for me to go somewhere, stop using for a period of time, and then immediately go back to the street. This is my new life. I have to surround myself with like-minded people who are not using and have found a new way to live. This is an every day battle for me, and that is what Mcshin has taught me. Recovery is an action, not just a thought. Shinholser constantly reminds us about the reality of our disease. He says, “If you chase your recovery like you chase your drug, you’ll do just fine.”