WIN Recovery, a certified opioid treatment facility operated by Hamilton Center Inc., saw evidence of a community need being met in the first month with the self-service “NaloxBox” added to the outside of its Terre Haute location (located at 86 Wabash Court, just west of the Vigo County Courthouse). This box distributes naloxone (also known as Narcan) for free to consumers, family members, or anyone from the public on a no questions asked basis. During April, dosages were distributed at a rate of more than one per day – with 31 in all.
Naloxone is a medication approved by the Food and Drug Administration that is effective in preventing death by rapidly reversing the effects of an overdose from opioids, and doses distributed through the WIN Recovery NaloxBox are administered via nasal spray.
Mark Collins, Chief Clinical Officer for Hamilton Center, admits he and his staff had no idea how much usage the NaloxBox would get in its first month.
“What we do know is that we want to give as many individuals the capability of having Naloxone at their disposal as humanly possible because Naloxone prevents overdose deaths,” he said. “What we’re trying to promote is harm reduction. Most importantly, we want to keep individuals alive, and Naloxone keeps individuals alive.”
Collins termed the volume of dosages distributed as “incredibly beneficial to our community” with hopes of that number increasing as more people are aware of the program.
“Having 31 doses in the first month shows that there’s a need within the community, and hopefully this will continue to decrease the overdose deaths in our communities, which is the ultimate goal” Collins said. “We will continue to advocate for the use of Naloxone within our communities.”
The box was provided by Overdose Lifeline, a non-profit organization which has fought the opioid addiction problem since 2014. Designated HCI/WIN Recovery staff will monitor the box, track its usage, and order free replacement kits as needed from Overdose Lifeline’s Indianapolis office.
State and federal funding has been utilized to cover the cost of the program, with support also coming from the Indiana Division of Mental Health and Addiction.
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Hamilton Center, Inc. is a regional health system in Central and West Central Indiana with corporate offices located in Terre Haute, IN. Services are provided to children, adults, and families, with specialized programs for expectant mothers, infants, and people who may be struggling with stress, life changes, or relationship issues, as well as more serious problems such as depression, anxiety disorders, and serious mental illnesses.
Hamilton Center, Inc., based in Terre Haute, IN, and serving multiple counties throughout central and west central Indiana, is committed to supporting the State of Indiana in responding to the opioid crisis which has been growing in recent years. As a community mental health center, Hamilton Center, Inc. has been treating individuals with substance use disorders and a variety of other behavioral health issues for over 49 years.
WIN Recovery is the first Opioid Treatment Program (OTP) of its kind certified by the State of Indiana in Knox County. The clinic will provide daily Methadone administration and behavioral health counseling and case management to provide comprehensive medication assisted substance abuse treatment
I. The problem:
Substance abuse costs our nation over $740 billion annually
Opioid overdose continues to be a major public health problem in the United States. There were 67,367 lethal drug overdoses in 2018 – most were opioid related.
Drug overdose is the leading cause of accidental death in the United States. Over the past several years, Indiana has seen a record number of heroin overdose deaths.
The rate of opioid-related emergency department visits to Indiana hospitals increased 32% between 2009 – 2014
Indiana suffered 1,211 deaths from drug overdoses in 2019 (18.7 per 100,000)
In Vigo County, 10 deaths were attributed to opioid overdose in 2019.
II. Who is at risk?
Individuals using heroin are not the only individuals at risk. Anyone who uses opioids for long-term management of chronic cancer or non-cancer pain is at risk for opioid overdose, as are persons who use heroin. Those who use prescription pain killers are 40x more likely to develop an addiction to heroin. Nearly all addicted individuals believe at the outset that they can stop using drugs on their own and most try to stop without treatment. Because of the drug-induced changes in brain functioning, many individuals have behavioral consequences, even long after they may have stopped using drugs, including continued impulsiveness to use drugs despite consequences.
III. Medication Assisted Treatment (MAT):
Medication-Assisted Treatment (MAT) is opioid addiction treatment that includes medication administration such as Methadone coupled with other behavioral health services such as individual and group counseling, case management and other support services as appropriate.
Medication is prescribed and administered under monitored, controlled conditions and is safe and effective for treatment for opioid addictions when used as directed.
Methadone treatment provides patients with medication, health, social and rehabilitation services that relieve withdrawal symptoms, reduce cravings and allow normalization of the body’s function.
Methadone has been used for over 50 years world-wide and is the gold standard of opioid treatment as it is most effective and least expensive.
Methadone represents a community return on investment as the average cost of treatment is $5,500 annually compared to $25,000 annually for incarceration.
Methadone treatment programs are associated with a decrease in criminality, promotion of patient employability and education and connects patients with other medical and mental health care. In addition, the relationship between intravenous drug use, needle sharing, hepatitis and HIV/AIDS exposure is well documented. Methadone treatment is the most effective intervention for reducing the spread of HIV/AIDS and hepatitis – consistent with strong public health initiatives.
IV. WIN Recovery:
Hamilton Center, Inc., Vigo County, opened its first clinic in Terre Haute in May 2018. In November 2018 the organization received a second license from the State of Indiana to establish a clinic in Knox County.
WIN Recovery Knox County is currently open and accepting patients 18 years of age or older.
The program is certified by the State of Indiana, SAMHSA and accredited as appropriate.
In addition to medication assisted treatment, services will include individual and group counseling, case management and other behavioral support services as appropriate.
Hamilton Center, Inc. is partnering with Sagamore Medical Recovery Services, LLC which was formed in 2016 by Christian A. Shaw, MD, PhD and his partners. Dr. Shaw is a leader in the field and has worked to develop the most successful, innovative and respected methadone based opioid treatment program in New Mexico. Sagamore is providing the medical component of the clinic; Hamilton Center is providing the behavioral healthcare which will include individual therapy, group therapy and case management.
Hamilton Center is working with several community partners to integrate services within the Knox County community. This includes collaborating with the community mental health center, the hospital and physican practices, criminal justice, law enforcement amoung others.
The office is open from 6:00 am – 2:30 pm with new patients being seen from 6:00 am – 10:30 am. The clinic is open everyday including holidays and weekend.
For additional information call 833-232-0215 or 812-494-2215. Appointments can be made, however walk ins are welcome.
History and Effectiveness of Methadone Maintenance Treatment
Methadone treatment provides the patient who is opioid dependent with medication, health, social, and rehabilitation services that relieve withdrawal symptoms, reduce physiological cravings, and allow normalization of the body’s functions. Methadone treatment has been available for over 30 years and has been confirmed effective for opioid dependence in numerous scientific studies.
Moreover, in 1997, the U.S. Department of Health and Human Services’ National Institutes of Health (NIH) Consensus Panel found the following concerning methadone treatment: “Of the various treatments available, methadone maintenance treatment, combined with attention to medical, psychiatric and socioeconomic issues, as well as drug counseling, has the highest probability of being effective.”
Methadone treatment programs are staffed by professionals with medical, clinical, and administrative expertise. Patients receive medication from a health professional. Patients routinely meet with a primary counselor (social worker, caseworker, or certified substance abuse counselor), attend clinic groups, and access medical and social services.
Methadone’s effectiveness, and the absence of any serious, long-term side effects from using it, have been demonstrated in numerous studies conducted over the past 30 years. Among the most commonly cited outcomes are:
Consumption of all illicit drugs declines to less than 40 percent of pretreatment levels during the first year and eventually reaches 15 percent of pre-treatment levels for patients who remain in treatment 2 years or more.
Crime is reduced substantially: For example, in the most detailed study of treatment outcomes to date, during the first 4 months of treatment, crime decreased from 237 crime days per year per 100 addicted persons during an average year of their addiction to 69 crime days per year per 100 patients, a reduction of more than 70 percent. This number declined further to only 14.5 crime days per year for patients in treatment 6 years or more.
Fewer individuals become infected with HIV: A study by Metzger, et al, 1993, showed that over a 3-year period, 5 percent of patients in methadone treatment became HIV positive (over and above those already positive at admission), while among a cohort of out-of-treatment addicts in the same neighborhood, 26 percent became HIV-positive (over and above those already positive at baseline).
Individual functioning improves, as evidenced in improved family and other social relation ships, increased employment, improved parenting, etc., according to the Substance Abuse and Mental Health Services Administrations Center for Substance Abuse Treatment, 1994, and Lowinson, et al, 1992.
Source: U.S. Department of Health and Human Services, Medication Assisted Treatment for the 21st Century
Heroine vs. Methadone vs. Suboxone
TOPIC
HEROIN
METHADONE
BUPRENORPHINE (Suboxone)
Onset of action
A few seconds
30 minutes
30-40 minutes
Duration of action
4-6 hours
24-36 hours
About 24-48 hours
Route of administration
Injection, snorting, smoking
Oral
Sublingual
Frequency of administration
Several times a day
Daily or more frequently as needed
Every day or every other day
Effective dose
Ever increasing
Blocking dose usually 80-120mg
2-32mg
Tolerance
Increasing tolerance
Tolerance is stable
Tolerance is stable
Euphoric effects
Euphoria for up to 2 hours
No euphoria when stabilized
No euphoria when stabilized
Overdose potential
High and increasing
Rare (potential is mixed with other depressants)
Very rare
Overall safety
Potentially lethal
Very safe
Overall good. Suboxone injection will cause serious withdrawal symptoms in dependent person. Not recommended for pregnancy and caution with liver disease
Withdrawal
Within 3-4 hours after last dose
Within 24-36 hours after last dose
Within 36-48 hours after last dose
Craving
Recurring
Eliminated with adequate dose
Craving may not be totally eliminated due to ceiling effect
Pregnancy/Nursing
Grave risk for mother and fetus
Safe during pregnancy
Not indicated/study underway
Experience of pain and emotions
Blunted
Normal and full range of emotions
Normal pain but opioid analgesics may not be effective – may need to switch to methadone. Full range of emotions
Mood
Constant mood swings
Normal
Normal
Reaction time and intellectual functioning
Impaired
Reaction time normal. Intellectual functioning unimpaired on stable dose
Reaction time presumed to be normal like methadone. FDA cautions driving/operating machinery in the beginning of treatment
HIV & Hepatitis C transmission
High rate with needle use and unprotected sex
Reduced/eliminated
Reduced/eliminated
Immune system for HIV positive persons
Rapid progression to AIDS
Progression slowed
Progression presumed same as methadone – data not available
Immune/endocrine system functioning
Impaired
Normalized during treatment
Presumed normalized. Data not available
Stress Response
Suppressed
Normalized during treatment
Normalized during treatment
Criminal activity
High level
Reduced/eliminated
Reduced/eliminated
Community impact
Destructing impact. High crime, high death rate, transmission of disease
Contributed to public safety, low mortality, increased health
Contributed to public safety, low mortality, increased health
Reproduced from 2003 Medication Assisted Treatment for the 21st Century: Community Education Kit, SAMHSA
Frequently Asked Questions
Does methadone treatment impair mental function?
Methadone treatment has no adverse effects on intelligence, mental capability or employability. Methadone treated patients are comparable to non-patients in reaction time, in ability to learn, focus and make complex judgements. Methadone treated patients do well in a wide array of vocational endeavors, including professional positions, service occupations and skilled, technical and support jobs.
How is success in methadone and other pharmacotherapy treatments defined?
The primary goals are to help addicts cease heroin use and lead more stable, productive lives. But, as knowledge about heroin addiction and effective treatment practices has grown, so too have the objectives of most methadone treatment programs, which also aim to:
Decrease criminality and reduce the numbers of substance abusers entering the criminal justice system.
Assist patients in addressing multiple substance abuse (including crack/cocaine addiction and alcoholism).
Assure treatment for general health matters, especially those related to drug use, such as HIV/ AIDS, tuberculosis and hepatitis
Promote patient employability and educational development.
Identify and treat mental health problems and alleviate homelessness, family substance abuse and child and family dysfunction.
Why do drug-addicted persons keep using drugs?
Nearly all addicted individuals believe at the outset that they can stop using drugs on their own and most try to stop without treatment. Although some people are successful, many attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug abuse results in changes in the brain that persist long after a person stops using drugs. These drug-induced changes in brain function can have many behavioral consequences including an inability to exert control over the impulse to use drugs despite adverse consequences – the defining characteristic of addiction.
How effective is drug addiction treatment?
In addition to stopping drug abuse, the goal of treatment is to return people to productive functioning in the family, workplace, and community. According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning. For example, methadone treatment has been shown to increase participation in behavioral therapy and decrease both drug use and criminal behavior. However, individual treatment outcomes depend on the extent and nature of the patient’s problems, the appropriateness of treatment, and related services used to address those problems and the quality of interaction between the patient and his or her treatment providers.
How long does drug addiction treatment usually last?
Individuals progress through drug addiction treatment at various rates, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes. For methadone maintenance, 12 months is considered the minimum and some opioid addicted individuals continue to benefit from methadone maintenance for many years.
How do other mental disorders coexisting with drug addiction affect drug addiction treatment?
Drug addiction is a disease of the brain that frequently occurs with other mental disorders. In fact, as many as 6 in 10 people with an illicit substance use disorder also suffer from another mental illness; and rates are similar for users of licit drugs-i.e., tobacco and alcohol. For these individuals, one condition becomes more difficult to treat successfully as an additional condition is intertwined.
Is the use of a medication like methadone simply replacing one drug addiction with another?
No – as used in maintenance treatment, methadone is not a heroin/opioid substitute. It is prescribed or administered under monitored, controlled conditions and is safe and effective for treating opioid addiction when used as directed.
Source: NIDA, “Principles of Drug Addiction Treatment”
