The politics of addiction

Jails are another story. In a study commissioned by the Drug Policy Alliance that’s not yet been made public, San Francisco attorney Jennifer Schwartz looked at what options are available to jail inmates in 16 California counties who are addicted to opiates or who are already enrolled in a methadone-treatment program at the time of their arrest.

For the latter group, San Diego County jail inmates must arrange for a family member to bring them their daily dose of methadone, which is then administered by a jail nurse. That arrangement is available to “short stay” inmates only, Schwartz said, though she was unable to find any jail official who could tell her what constituted a short stay.

Last year, new law made additional money available for counties to spend on Prop. 36-eligible offenders who were slipping through the cracks. Called the Offender Treatment Program, the money came with recommendations, among them that counties offer narcotic-replacement therapy to heroin addicts who were violating probation. But it’s only a recommendation, said Lisa Fisher, an ADP spokesperson.

“One of the hallmarks of Prop. 36 is local control,” she  said. “We would not tell [counties], ‘You have to do this,’ but we can certainly give them what our research has found to help improve outcomes.”  

Schwartz said that an impetus for the Drug Policy Alliance study was to examine whether jails should be mandated to provide methadone or a similar narcotic replacement to opiate-addicted inmates—both to stabilize them and start them on a treatment path.

“Our concern is what is happening to these people withdrawing if they’re not being constantly monitored,” she said.

“My overall impression was [the jails] are basically doing next to nothing, and the state department is really trying to get them more and more involved, as are the private providers, but they just don’t seem very interested.”

Jim Dunford, medical director for the city of San Diego, said inmates in downtown’s Central Jail who come in addicted to heroin are given medication to ease withdrawal, though methadone’s not one of them. “We make sure their withdrawal symptoms are being adequately managed,” he said.

Schwartz found only two county jail systems—Marin and Mendocino—that had medically assisted drug treatment programs for inmates.

According to the San Diego Association of Governments’ Substance Abuse Monitoring Program, while roughly two-thirds of county arrestees tested positive for drugs in 2006, only about 6 percent tested positive for heroin—a number that’s remained unchanged since 2004. But of that 6 percent, three-quarters said they preferred to inject heroin, as opposed to snorting or smoking it. The most recent CEWG report found, too, that more heroin addicts in San Diego County are opting to inject the drug—likely because it produces the fastest high. According to CEWG, 82 percent of heroin addicts who entered treatment in 2006 said they preferred to shoot the drug—a 10-percent increase from 2005. This put San Diego County fourth among large metropolitan areas when it comes to IV drug use among heroin addicts. Because of injection drug use’s attendant health issues—like hepatitis C, HIV and other infections that are spread through the use of dirty needles—studies have put the cost-benefit ratio for treating IV-drug users higher than for other drug users—between $7 and $12 saved for every $1 spent.


Jail is where Gretchen Burns Bergman's son, "Adam" (she requested that his real name not be used) learned how to shoot heroin. He had been smoking the drug and was convicted for drug possession when he was 19. With no access to syringes, inmates fashion makeshift shafts to inject drugs. It was from one of these shafts that Burns contracted hepatitis C.

After spending 11 years in and out of treatment programs and jail, Adam decided to give methadone a try. Bergman is the executive director of Parents for Addiction Treatment and Healing (PATH).

Bergman said she initially wasn’t in favor of methadone treatment. Like many critics of medically assisted treatment, she saw it as simply replacing one drug with another. She knew her son was already using methadone to tide him over until he could buy more heroin.

“They say [addicts] have an epiphany somewhere along the line, and I think here he was in his early 30s knowing he had overdosed several times, knowing he’d been tossed aside by society behind bars, but also, as he’s described to me, knowing that his family still loved him… so it was sort of like: Maybe I could try to use this methadone the right way. And just see if I could do it,” Bergman said.

Adam’s been clean for five years and works as a drug-treatment counselor in a medically assisted treatment program.

He’s applying to graduate school, Bergman said. He’s done well enough on methadone that he gets a 30-day take-home supply rather than having to show up daily for his dose. Bergman says Adam is able to function perfectly well on methadone but has talked about tapering off the drug or trying a newer form of narcotic-replacement drugs called Suboxone.

“I think there’s that terrible fear—your life has balanced and it’s good—of ‘Oh my god, I don’t want to rock the boat’ type of mentality. Some people may want to be on [methadone] for the rest of their lives—that feeling of I never want to slip; I never want to go back and lose everything I’ve worked so long to regain in my life.”

Bergman said that at drug-treatment conferences and statewide meetings she attends, she hears complaints about San Diego County’s unwillingness to not only implement a methadone program, but also to be more progressive when it comes to treatment options.

“It’s conservative San Diego” Bergman said. “Our Board of Supervisors, we have to fight on every level, even in terms of things that have been proven to really save lives, like needle-exchange programs.

“Sometimes when I go to these conferences with other cities, I listen to what San Francisco’s doing, and I’m going, ‘You guys are so with it, so understanding.’”

A number of people CityBeat spoke to for this story pointed to the county Board of Supervisors as the reason why methadone isn’t part of any county programs. A spokesperson for Greg Cox, the board’s current chairperson, said the supervisors have never taken an official position on methadone (unlike needle exchange—a program where addicts can exchange dirty syringes for clean ones and get treatment referrals in the process. Supervisors passed a resolution against needle-exchange programs in 1997. The city of San Diego is the only city in the county that allows a needle-exchange program). The county used to fund methadone programs, but, like many other counties, cut funding in the late 1970s.

In a 2001 interview for a San Diego Magazine article on the rise in HIV infections in San Diego County, Supervisor Bill Horn, in response to questions about why the county doesn’t fund methadone or needle-exchange programs, said his cousin died from a heroin overdose after a failed attempt at methadone treatment. Horn did not respond to requests for an interview.

Both Whitmyer and Peloquin have tried to meet with supervisors to see if they could change their minds.

“Dennis and myself have approached the county to say, ‘Hey, why don’t we have any of this treatment here?’ Their response has been that the county Board of Supervisors disagrees with that treatment. Wonderful—let’s talk to them. Let me educate them,” Peloquin said.

“We have relationships with all the other counties within the state of California that [CRC is] in,” Peloquin added. “We have the exclusive Prop. 36 and methadone treatment contracts in Riverside. We participate at some level in L.A. We’re also participants in San Bernardino and Sacramento.”

If the county’s decision to not fund methadone treatment has been residents’ loss, it’s been CRC’s gain. Where government isn’t able to fill a need, the private sector picks up the slack. A 2005 study by the federal Substance Abuse and Mental Health Administration found that 54 percent of facilities that provide medically assisted drug treatment were run by private, for-profit entities while 35 percent were run by nonprofits and only 11 percent by federal, state or local governments.

Two years ago, CRC was purchased by Bain Capital (probably best known for its former CEO, Mitt Romney), and the infusion of cash has helped turn CRC into the largest drug-and-alcohol addiction treatment provider in the nation. Currently, CRC serves more clients than any other San Diego County drug-treatment provider.  

Peloquin said it’s not self-interest that’s pushing him to advocate for medically assisted treatment. “If the Board of Supervisors say that they’ll allow methadone treatment and CRC was not awarded the contract, I’m fine with that. As long as methadone treatment’s being provided, that’s fine.”

Whitmyer, who ran drug-free treatment programs before moving over to CRC three-and-a-half years ago, sees it a little differently. He doesn’t want to deal with county bureaucracy.

“What we want is acceptance of who we are and that we’re here and they refer people to us. I want Prop. 36 money, by the way, but as far as county funding, it’s too much to deal with them. But Prop. 36, we should be receiving funding for patients who qualify for Prop. 36.”

Roughly 65 percent of clients pay for treatment out-of-pocket, Peloquin said, and the rest receive Drug Medi-Cal.

“if you're on meth, if you have an alcohol problem or a cocaine problem, the county will pay for your treatment, but if you have a heroin problem or an opiate problem, unless you're willing to go cold turkey in their social model programs, they won't pay,” Whitmyer said.