A fork in the road to recovery from opiate addiction

Since 1978, “Tony” has abused and been abused by his addiction to heroin. Now, more than five months into a residential treatment program in North County, the 53-year-old is working harder than ever to kick his addiction and stop the cycle of abuse.
“I have the gift of desperation; I don’t want to die,” Tony said. “I’m tired of hitting bottoms.”
For the past 30 years, Tony, who asked his last name be withheld, has lived in a revolving door of rehab and prison — burning bridges all the while. Facing a lengthy prison sentence on drug-related charges, Tony, a former inmate at some of California’s most notorious prisons — Folsom and San Quentin — chose Casa Raphael, a state-licensed residential treatment program under the Alpha Project in Vista, over an outpatient treatment program. “I told the judge I couldn’t do outpatient. I know myself, if I stay out there and just test random, before long I’d be strung out.”
What are the options?
For San Diegans looking to get off opiates who are not in a court-ordered program, treatment options — which range from $300 per month for methadone maintenance to thousands of dollars a month for residential treatment programs — are only limited by the size of their wallet. However, for participants under the Substance Abuse and Crime Prevention Act of 2000 (also known as Proposition 36) and San Diego County’s Drug Court the options are limited to the county-contracted drug-free treatment programs. These programs require participants to abstain from drugs, regardless of whether they are using a substance like methadone to help in their recovery.
Drug Court and the less intensive Proposition 36 give nonviolent drug offenders an opportunity to receive substance abuse treatment instead of being sent to jail or prison. The county receives approximately $6.3 million a year for Proposition 36; however, because San Diego doesn’t contract for or fund narcotic replacement programs — therapy used in conjunction with synthetic opiates, like methadone, to prevent withdraws and reduce cravings of opiates — no money is allocated to those services, Jose Alvarez, a spokesman for the San Diego County Health and Human Services Agency, said. Alvarez did say that San Diegans seeking narcotic replacement therapy can receive it through programs that contract directly with the state.
San Diego is the largest of a handful of counties that operate on the drug-free model, but public polices and a resistance to narcotic treatment programs in the criminal justice system, as well as limited access to such programs, have made it difficult for Proposition 36 participants to receive narcotic replacement therapy statewide, according to a 2008 yearly study conducted by UCLA researchers.
In 2006, the most recent year that data was available, the researchers found that 16.5 percent of criminal justice referrals who reported opiates as their drug of choice received narcotic replacement therapy; meanwhile 75.5 percent of opiate users seeking voluntary treatment chose a narcotic treatment program.
The UCLA researchers found that opiate users who were placed in narcotic treatment programs under Proposition 36 had a significantly greater chance of complying with the guidelines of their probation than those who weren’t. In addition, the participants receiving narcotic replacement therapy also had a lower arrest rate in the 30 months following their treatment. Their findings led the researchers to conclude that narcotic treatment programs are a valuable tool in fighting opiate dependence.
Falling through the cracks
Unfortunately, because of the stigma surrounding narcotic replacement therapy and the county’s use of a drug-free treatment model, Dr. Laura Rossi, director of the Capalina Clinic in San Marcos, said she sees many people fall through the cracks while waiting to get into long-term treatment, which is one reason she’d love to get Proposition 36 funding.
Right now, because there’s “no middle step,” Rossi said Drug Court and Proposition 36 clients are having a difficult time managing their addiction because of the gap between narcotic replacement therapy and the abstinence model. A study performed last year by the National Institute of Drug Abuse, an advocate of narcotic treatment programs, concluded that providing methadone to heroin addicts while they are wait-listed for a treatment program can increase the chance they will enroll when a space is available.
“The more treatment providers we can get that will agree with different options the better,” Rossi said. For example, the privately owned Capalina Clinic is a comprehensive drug facility designed to safely reintegrate recovering addicts into the community through harm-reduction therapy. The concept is based on the idea that some people are simply unable to stop using opiates, partly because of physiological changes in the brain, and that both the individual and society will benefit from the user being switched from illicit to legal drugs obtained from physicians and sanctioned treatment clinics.
While most of the clinic’s 365 clients are using methadone detox or maintenance program, it also offers Suboxone, a relatively new drug that like methadone blocks cravings and helps with withdrawal symptoms, along with mandatory counseling and random drug testing, Rossi said.
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Prior to CRC Health Group — the nation’s largest provider of addiction treatment services — taking over the clinic in 2002, Rossi said the methadone clinic had operated for more than 30 years, most of which was under the guise as a “juice bar.” A juice bar is a clinic where clients get methadone, a synthetic opiate used to treat narcotic addiction or chronic pain, to carry them until their next fix or to sell on the street. Rossi said unfortunately there are still clinics in the county, as well as around the nation, that operate that way.
The myths about the dangers of narcotic replacement therapy are further perpetuated because of the illegal street use of methadone and the Suboxone, Rossi explained. If not properly handled by medical personnel, combining the two drugs can invoke precipitated withdrawals, a more rapid and intense withdrawal. In addition, combining either drug with anti-anxiety medication, like Ambien or Xanax, could be fatal.
It was Suboxone that helped Tony break his $300-a-day habit before entering the Alpha Project. Between methadone and Suboxone, he said he preferred the latter. “Once you kick off Suboxone, you don’t need it anymore.”
Even with the Suboxone, Tony said because of his lifelong heroin use, this time around his body really felt the withdrawal symptoms. He suffered seizures, vomiting and diarreah all wrapped up in a month of sleepless nights. “As an old dope fiend who has a caring concern for the youths today, I don’t want them to go through what I’ve gone through.”
“The youths don’t have to hit rock bottom,” he added. “You don’t have to get old to be clean.”
Jason Rodriguez of San Marcos understands the importance of having treatment options, but he’s also a living example of the drug-free model. Ten years ago, Rodriguez kicked heroin cold turkey in county jail and then entered Alpha Project seizing every opportunity they gave him until finally he was appointed program director of the Casa treatment programs three years ago.
Alpha Project’s two residential treatment programs, Casa Base and Casa Raphael, are state-licensed, three-phase residential treatment programs designed to aid recovering addicts in the reintegration back into the community. Of the 50 percent of participants who complete the Proposition 36 funded program, 80 percent are clean for at least a year, Rodriguez said.
“What we try to do from day one is mix the work aspect with the treatment aspect,” Rodriguez explained. “(We) really believe having a job and working yourself back into the work force, along with drug and alcohol treatment, are keys to the Casa Raphael treatment center.”
In addition to “hawking” newspapers, a participant’s job in the program revolves around the community, whether it is graffiti removal in Vista or being a member of the Casa property crew. “We take and take and take as alcoholics and addicts so being able to give back is huge.”
By the time Tony finishes treatment at Casa Raphael, he should have more than a year of sobriety, and possibly even more importantly the knowledge that he finally surrendered to his addiction and embraced the help offered to him.
“Seek help before it gets bad,” Tony said. “The longer (you) stay on heroin, the harder it’s going to be to kick.”

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