Ponder This: How should we handle addiction in the Finger Lakes?

Dale Cook Driscoll

Is New York State doing enough to address the heroin and opioid crisis?

One of the biggest changes I see in new legislation passed by New York Governor Andrew Cuomo is in the limitations placed on prescriptions that treat pain. These heavy duty opioids often lead to addiction, even if they are initially prescribed in a sterile, professional environment.

At one time not that long ago, patients were given a 30-day prescription without much investigation. Today, it has now been lowered to no more than a 7-day prescription at the doctor’s discretion. One major goal of this is to reduce the onset of addiction.

Rather than list each of the changes approved by Governor Cuomo, I am inserting a link for the reader that outlines these points very well. The new legislation leaves many unanswered questions, though.
It speaks to increasing beds for state run addiction treatment facilities and opening up additional program slots for substance abusers. However, the legislation doesn’t go into great detail about these changes.

How will they be appropriated geographically?

Undoubtedly, these changes are a good start. Are they sufficient, though, considering the extent of this opioid crisis?

To see the complete legislation recently passed click here.

As with any bureaucracy, State run facilities continue to have their downfalls. Generally, there are long waiting periods to get into the facilities, and detox staff is rarely on-site. This means the user must seek medical treatment at a medical facility for relief if they want to alleviate the discomfort of detoxing.

When considering relapsing, many fear withdrawals, which are a common part of the treatment process. These may include: strong cravings, cramps, upper body secretions such as sweating, running nose and crying jags, vomiting or nausea and muscle and joint aches.

While the officials I spoke with couldn’t give me an exact figure, the rate of relapse remains “very high,” according to most-officials from within the treatment space.

Two of the most commonly used medications in the detoxification process are Methadone and Suboxone.
Methadone can, in many cases, be more addictive than the original drug the abuser might have been relying on. The user can remain on Methadone for years and sometimes indefinitely. Oftentimes, the user will relapse back to the drug of choice.

This solution seems more like a replacement for one problem with another. Instead of being addicted to one drug, the user is addicted again to a new drug.

Methadone can also be used in conjunction with other opiates which can lead to overdose. Another downfall with Methadone is that it cannot be prescribed. One must physically return to a clinic on a daily basis to receive dosage of the medication.

How does this affect the user’s life? Will this way of detoxing get in the way of the user being able to hold a job? There are obvious transportation problems.

A couple of things need to be considered before choosing this method of detoxing.
Without a tight support system, the tapering period for Methadone can range from six months to a year. The relapse rate is high and the user is left alone in their struggle to remain addiction free.
Suboxone is not nearly as addictive as Methadone.

However, it is a much more difficult program to be placed. Once a doctor becomes state registered to administer this drug, they are allowed only one hundred patients at a time. This is a federal restriction under the Drug Addiction Treatment Act of 2000.

Initially, the limit was set at thirty patients, but was upgraded to 100 patients just ten years ago in 2006. The reason for the cap is understandable when considering many patients have medical and mental conditions that require treatment, as well as behavioral issues.

It’s not reasonable to expect one physician to be inundated with more patients. There are so few physicians licensed to prescribe Suboxone, which causes problems. Due to the shortage of eligible doctors — unless one is able to find a doctor with an open slot, Methadone treatment may be the only viable treatment option.

Based on a study conducted at Harvard Medical School and McLean Hospital, the rate of relapse once ceasing Suboxone is classified as ‘extremely high’ without a definitive percentage attached. Either method serves as a band-aid, which doesn’t adequately deal with the root cause of the problem; addiction.

I would like to start a dialog on jail sentencing, but first I want to remind everyone that substance abuse is a disease no different from alcoholism. The term Epidemic alone denotes disease for those who may be in doubt. People can, and may choose behaviors, but no one chooses to become an addict.

Doesn’t that mean the real problem is the supplier?

You might be asking why an individual would even want to tempt fate and use these harmful drugs in the first place. That is a question only the user can answer. A range of reasons exist, from self-medicating, environmental, to the careless mindset that they will only use socially.

Instead of passing judgment, perhaps we should start by showing some empathy.

Ask yourself:

Do you know someone who abuses drugs? Worse yet, have lost someone to an overdose?

Few are able to answer ‘no’ to those questions.

Let’s think about something for a moment: People with common lifestyles, hobbies, habits, and goals tend to connect. We don’t think twice about people who share an interest in tennis, associating with each other.

Therefore, users will likely connect with other users and dealers. Taking it a step further, what is commonly going to happen once they are released from jail? The obvious conclusion is that the user will leave jail with more connections… thus enabling the vicious cycle of drug use to continue.

I recently interviewed a young woman who spent several years in jail for stealing (mostly video games) to pay for her drug abuse. The drug she abused was heroin. To protect her identity, I will call her Alice.

Her last stint in jail; a six-month sentence served in Ontario County, she thought obsessively about how she was going to get her next fix once she was released. Unfortunately, that’s exactly what she did. Even after six months, the pull to use was great.

It took going to jail and then performing a six-month stretch at shock camp for her to become clean. I am happy to say that after three years she is still drug-free. Situations like this though, simply are not the ‘norm’.

I asked Alice what the withdrawal process was like. She said there were many symptoms, such as shaky legs, vomiting, and joint pains, but worst of all she said she just felt like she was dying. This lasted for two months. Under these circumstances, high rates of failure are not that surprising. This brings us back to questioning the effectiveness of a jail sentence.

If the state can afford to house an inmate for months at a time; would it be more cost-effective to mandate rehabilitation at the state-level? Whether it’s a jail sentence or treatment at a rehab facility, it hits the taxpayer in the pocket.

Wouldn’t it be better if we took the path to healing? The state can obviously afford to place individuals in jail for various violations associated with the use of narcotics. Wouldn’t a facility where there is “real” help available alleviate some of the burden put on the taxpayer? Wouldn’t it also be a better long-term investment for taxpayers, who ultimately would be seeing the benefit in their community?

In January of this year Governor Cuomo went on record saying “I am going to go down in history books as the Governor who closed the most prisons in the history of the State of New York and I am proud of it. I want to close more prisons with more alternatives to incarceration.”

May I suggest that a better alternative would be to convert some of these closed prisons into state run, low cost drug, and alcohol rehabilitation centers.

Dale Cook Driscoll’s ‘Ponder This’ is a bi-weekly column featured exclusively on FingerLakes1.com. She is constantly evaluating the political and social landscape around the state, and has been a long-time advocate for Brittany’s Law — legislation aimed at creating a violent offenders registry in New York State. She can be contacted via email at [email protected] and followed on Twitter here.

Also on FingerLakes1.com