A knowledgeable participant in the treatment of heroin addicts in Lancaster County (and elsewhere) stopped by for lunch and a discussion of heroin addiction and treatment in Lancaster County.
The local methadone clinic, Addiction Recovery Systems located in East Hemphill, has approached full licensed capacity, treating approximately 400 patients with either methadone or Suboxone, the latter a form of Buprenorphine which inhibits abuse. Both methadone and Suboxone are opioids imbibed daily in a controlled fashion that avoids peaks and valleys so as to enable people to live normal and productive lives.
Perhaps another 600 addicts are being treated with Suboxone through certified local physicians and these patients receive their medication from pharmacies.
(Some patients respond better to methadone, some to Suboxone, and some do well with either. In general, Suboxone is more desirable for young people.)
The high cost of Suboxone has been an impediment to its prescription, but the Suboxone patent has now expired. It is anticipated that generic substitutes will soon enter the market and drive down the cost of up to $20 per daily dose. (In contrast, methadone is inexpensive; however it is only available through state licensed clinics which adds significant treatment costs.)
The Lancaster Drug and Alcohol Commission estimates there are from 5,000 to 10,000 heroin addicts in the community. Though reaching 10% to 20%, there is a need to provide facilities and to attract more addicts into treatment.
From time to time, a tragedy involves someone under treatment. In such cases, testing often shows that the party has imbibed a combination of drugs. For each such sad occurrence, perhaps a hundred others have been prevented through treatment. There is no news in what doesn’t happen! Unfortunately, when tragedies occur, poorly informed or headline seeking politicians will sometimes lash out against methadone and Suboxone treatment, the equivalent of blaming police for crimes.
Medicaid pays for treatment and transportation of most methadone patients. The program has been criticized for being wasteful because it does not require patients to attend the closest clinic and it pays for transportation without always detecting car pooling.
After two years of clinical treatment and urine testing without incidents, methadone patients are permitted to take home as much as a two week supply of medication. Over time, Suboxone patients’ prescriptions may be for as long as a month, although they are required to meet with a physician and have their urine tested periodically.
The Lancaster methadone clinic operates from 5:00 am until midday, and includes ongoing counseling service. The early hours enable clients to pick up medication and get to their jobs on time.
Some addicts do not respond to current opioid medication. There are programs in other parts of the world, including Vancouver, Canada, which supply heroin to them. Reducing crime rates and returning people to family and productive lives are considered more important than how these ends are achieved.
(WATCHDOG: Syringe exchanges are an important source of referrals for treatment. The small, privately funded syringe exchange operating out of the offices of the Bethel AME church in downtown Lancaster is too understaffed and underfunded to but begin to fulfill this important service, a virtual “drop in the bucket.” A request by the Urban League for funding to operate and greatly expand the syringe exchange was rejected by Lancaster General Hospital under the dubious pretense of legal obstacles. The federal government endorses syringe exchanges; Philadelphia and Pittsburgh sponsor their own extensive exchanges. Public charity LGH, one of the most profitable hospitals in the state, provides a small amount of Suboxone treatment to heroin addicts through a part time clinic, more of a ‘fig leaf’ than a whole hearted effort to address the county’s largest public health problem.)
