Methadone clinic addresses opioid epidemic in Carson City, rurals

Deaths from opiate drugs have reached epidemic levels, according to data released by the U.S. Center for Disease Control and Prevention, with lethal overdoses quadrupling nationwide since 1999.

It's an alarming trend shared among urban and rural populations, the CDC said, reaching across both genders and all races.

More than three out of five drug overdose deaths today involve an opioid, the CDC said, while opiate-related overdoses accounted for more than 28,000 deaths in 2014. More than half of those resulted from prescription opioid medication.

Nevada is no stranger to the opioid crisis, either, said Eric Hare, CADC, site director of The Life Change Center in Carson City.

Hare cited the 2014 CDC report counting 14 opiate overdoses for every 100,000 people in Nevada, putting the Silver State into the top 15 out of 50 states, even though its population was in the bottom one-third.

"That's a pretty accurate representation of what the level of the problem is here," said Hare, noting that opioid abuse is as much a crisis in rural Nevada as it is elsewhere. "Just because you are in a rural area doesn't mean there's not access to drugs."

Hare said there appears to be a relationship between rural workers, poverty and prescription opioid use, because of the prevalence of injuries suffered in more physically demanding occupations and the number of people insured under Medicaid.

"A lot of people who live and work in the rurals do jobs that produce higher rates of injuries," he said. "The rurals are also more impoverished with a higher rate of people on Medicaid, whose patients have among the highest incidence of prescription pain medications."

Unfortunately for rural Nevada, Hare said heroin has become the drug of choice for many residents ages 20 to 40 years old.

"Heroin has taken over where 20 years ago it was methamphetamine in the rurals," he said. "Most of the people started off on pain killers. Then they switch over to smoking heroin or shooting up, because it's cheaper."

Another reason why opioids have become such an epidemic problem in rural Nevada is because of a lack of services to help those suffering from drug abuse and dependence, Hare said.

"To say that the need is only in the populated counties is not accurate," he said. "The rurals are being impacted greatly by this. There are no clinic services between Reno and Salt Lake City, or between Carson City and Las Vegas."

In addition to clients located in and around the Nevada state capital, The Life Change Center also serves the populations of Douglas, Lyon, and Storey counties, as well as Lake Tahoe communities.

Of the 175 patients currently enrolled in The Life Change Center program, about one-third come from Douglas County, Hare said, and 10 percent come down from Lake Tahoe to receive treatment services.

The Life Change Center is a Sparks-based methadone clinic that opened its doors in Carson City 20 months ago, intending to better serve clients in nearby rural Nevada communities.

Since opening in December 2015 at 1201 North Stewart Street on the corner of East John, The Life Change Center has seen its enrollment numbers grow steadily from only seven transfers to a number now approaching 200.

"When we first opened up in Carson City, most of the people who were coming in here were waiting for something like this," Hare said. "They were like, 'Finally, there's something here for us to get the help that we need.'"

Hare said there are two ways to look at the growth of the Carson City clinic. One is the unfortunate reality that so many people in rural Nevada are in need of help.

But, on the other hand, those people are now getting the help that they otherwise would not have gotten.

"It's too bad that there are that many people who need the help, and the problem is that big," he said. "But it's good that we're here."

Hare said before The Life Change Center opened in Carson City, rural clients had to commute to Sparks, a hardship for many especially in adverse weather or road conditions.

"I would do 10-12 telephone screenings a day from the Sparks clinic," he said. "Half of them were from Carson, Gardnerville and Dayton."

To have a rural client actually show up at the Sparks clinic for intake was remarkable, he said, because of the distance traveled and the time required to devote to treatment.

"Most of them I wouldn't hear from, and then wouldn't show up for intake after learning that they would have to come into Sparks six days a week to a clinic only open from 6 a.m. to noon," he said. "Those that did show up for intake, half of them weren't there anymore within 90 days. They're driving in bad weather trying to get up there."

Intake begins at 6 a.m., Hare said, but the clinic can't take anyone past 6:30 because of all the steps involved leading up to the doctor consult.

The total intake process can last more than four hours before a client can receive his or her first dose of methadone or similar medication that counteracts the opioids, Hare said.

Staff nurses dispense medication in a liquid form that discourages clients from attempting to resell the drugs, he said.

"It's harder to divert that way to a form that's easier to sell on the street," Hare said.

The first week or two of treatment can be the hardest on a client trying to quit an opioid habit, he said, because withdrawal symptoms are strongest in that time.

Hare said the clinic will assess each client's symptoms individually to determine if a dosage increase is appropriate.

Medication doses can be increased about every seven days as needed, he said.

"It takes people on average 7-10 days to get to a medication amount where they are not feeling any withdrawal symptoms for 24-36 hours and they are not overmedicated," Hare said. "We don't want them leaving here overmedicated or drug seeking."

The program takes a gradual approach to medication treatment for a reason, Hare said, because of the dangers posed by an opioid relapse and subsequent overdose in response to withdrawal symptoms.

"We put them through the paces to take care of the physical symptoms of the withdrawals," he said. "We tell them to give themselves about 30 days to see if they are feeling okay. Then we can start talking about a titration program."

Titration is a medication tapering program in which clients gradually lower their dose of opioid counter-drugs over a period of time until they feel they no longer need them.

"If they taper correctly, once they start, it can take anywhere from six months to a year and a half to taper completely," Hare said. "This depends on how high their dose is when they stabilize and how slowly they want to go."

As a rule of thumb, Hare said the ideal taper amount is five percent a week, followed by a three percent decrease once a person reaches about one-third of their original dose amounts.

"It's a smaller, lower dose amount in their system, and we don't want them to get sick while they are tapering," he said. "That can be a trigger or relapse back into using."

Many clients are still working and functioning in society, Hare said, so the clinic takes extra care with drug doses to ensure physical withdrawal symptoms are closely monitored and kept under control.

"We don't want them to feel sick while going to work, taking care of their family and doing the things that they need to do," Hare said. "The good thing about the way we provide our medication is that we can go down to the smallest increments possible rather than doing big chunks at a time."

While medication treatment is a key part of becoming sober from opioids, counseling makes up another significant component to helping clients kick their habits for good.

The Life Change Center offers both individual and group counseling modalities, Hare said, and clinic staff encourage clients to actively engage in both throughout the course of their treatment.

"We can't drag them in and make them engage in counseling," Hare said. "But we provide every opportunity and motivate them to do that."

The Life Change Center offers fee-waiver incentives to clients who choose to engage in group therapy, which Hare said appears to be an effective coping method through the treatment process.

"There's almost a direct correlation between our increase in groups and the increase in our sobriety rates, which went from 50 percent since October to 73-74 percent," he said. "That extra increase goes right along with the increase in group attendance."

Hare said every client at the center is self-referred, most making the decision to get help on their own. The majority, he said, do not fit the slacker stigma generated by society.

"There are always those who perpetuate the negative stereotypes," he said. "But for every one of those there are five or six others busting their butts trying to get their lives back together, or have gotten their lives back to together."

Although every client who enters treatment seeks the help to get better, each must do their own program individually and at their pace.

There is no defined timeline or model for when clients should be off drugs and on their way to achieving sobriety goals, Hare said.

"Some people come in and want off in seven days, some in 30 days, and others who say they want to stay longer term and could take a year or two before they start to taper off," he said. "Some start immediately. We don't put that pressure on them to be in that process."

Hare said the methadone treatment approach, combined with individual and group counseling, appears to be effective.

He said a number of clients report being able to maintain sobriety because they followed the treatment regimen and tapered correctly off of drugs.

"I've seen a lot of people go through it, succeed and get their lives back," Hare said. "The best part is when they come in 30 days later after their final medication and tell us in their exit interviews that they haven't used; that this is the first time in years that they haven't been on medication or illegal opiates; and that they've got their lives back. That's a good feeling."

Abstinence, or quitting "cold turkey," may work for some drug problems, Hare said, but not so much with opioids, which attach to the nervous system and specific brain receptors that regulate pain.

And pain is a huge motivator for opioid drug use.

"They would get to some point where there were still very active withdrawal symptoms even after being clean for a while," Hare said.

But the tapering process of methadone treatment means a client steps down gradually from taking drugs, which, in turn, means their bodies get used to the idea more smoothly.

"They (clients) said they felt the medication, with its slow gradual taper, allowed their mind and body to recover and slowly adjust to the lifestyle of not having opioids in their system," Hare said.

Unfortunately, outside social pressures can throw a wrench into the sobriety plan of any recovering user. Those with opioid problems tend to face the harshest criticism from other former drug users, Hare said.

"A lot of people recovering from other substances look at the opioid epidemic in the same sense as what they recovered from," Hare said. "I would say keep an open mind that there are some differences."

The addictive qualities of opioids, he said, are very intense because of the way they work on and end up controlling the brain.

"This is a different animal. It's not the same," Hare said. "Somebody who's been on heroin or using pain killers, they don't just walk away from it that easy."

Opioid abuse is color and gender blind, Hare said, crossing into every education level and disregarding socio-economic status. Opioids can catch anyone in their grip at anytime.

"We've got everything in here from the shopping cart to the Mercedes Benz," he said. "A lot of people who come here are broken, and haven't had a good shake at life to start with. But they want to do better. A lot of them also have mental health problems and other things besides just this."

The Life Change Center in Carson City is holding an open house Friday, Sept. 8 from 12:30 to 2:30 p.m. at 1201 N. Stewart Street as a way of creating community awareness of the opioid epidemic occurring locally, and the clinic's efforts to combat the problem.

"The purpose of the open house is so community members can gain insight into the opiate epidemic and how we are doing our part to improve the outcomes of those suffering," the clinic said on its Facebook page. "We will have staff on hand to give tours of the facility and talk about the services we provide."

Lunch catered by L.A. Bakery will be served during the open house, the clinic said.