The politics of addiction

CRC’s largest facility is in Mission Valley, on Friars Road. From the building’s south-facing windows you can see Nordstrom and the Fashion Valley Mall just across the street.

Sue Garrett is the program director at the Friars Road facility. Garrett’s worked in the medically assisted treatment field for 20 years and has seen it evolve from so-called “juice bars,” where clients would come in, take their dose of methadone and be hit up by a drug dealer on their way out.

“We’ve cleaned up a lot of that; we don’t tolerate any drug activity on the property at all or you’re out of here. We’ve come a long way,” she said. “Back then, the services we provided, it was pretty basic. We didn’t have patient-appreciation day, we didn’t have [group therapy].”

Garrett and “Kathy” (she asked that her real name not be used) are sitting at a table in the conference room of the two-story building, which CRC bought from a previous methadone-provider five years ago and, according to Peloquin, spent half a million dollars to remodel. Kathy, an upbeat 36-year-old with shoulder-length blonde-brown hair, just had her second baby a few months ago. She’s been on methadone for nine years, during which time she’s had two kids (methadone has no adverse effects on a fetus), earned a master’s degree and bought a house.

When Kathy was 15, a boyfriend introduced her to heroin. When her parents found out she was using, they put her in a two-week detox program. She started using again in college, “here and there,” she says, until she got into a bad accident. “I started having pain-control problems, and [heroin] was a great solution.”

She tried 21-day medically assisted detox programs but kept going back to using. A well-paying job and friends who were willing to buy heroin for her in exchange for a share of the purchase meant she had a steady supply of the drug. She knew how much she needed to function, she said: “As long as I had it, I was fine. The only time there’s a problem is when you don’t have it, because then you start going through withdrawals and you’re in a really bad place.”

One evening, she arrived home to find cops in her house. A friend, also a heroin addict, who was staying with Kathy, had an outstanding warrant. The police found Kathy’s stash and arrested her, too. Her mom happened to be with her when it all went down.

“I saw there was a path—I could see it in my friends; I could see it in everybody around me—that that was not going to be my first encounter [with the police] if I continued on that road.”

Methadone, she said, helped her get her life in order—because she didn’t have to combat withdrawal, she was able to focus on what she needed to do to stay clean, like move out of San Diego and up to North County and cut ties with everyone she associated with as an addict.

“It’s not just about taking away drugs; it’s about taking away all the outside factors that influence why you’re using,” she said.

In addition to the CRC program, Kathy regularly attends AA meetings. It’s there that she finds the same kind of treatment philosophy that governs programs like drug court: A person on methadone or any other narcotic-replacement drug isn’t truly drug-free. The way some abstinence-only adherents see it, folks like Kathy are cheating. “There’s a faction that says, ‘You don’t get to take tokens; you’re not clean.’ Well, no, you’re taking Prozac; you’re taking this, that and whatever. How come you’re putting me off in a separate group? I’m abstaining just as much as anyone else.”

Mark Parrino, AATOD’s executive director, says medically assisted drug treatment needs to be thought about in the same way as any other illness for which medication is available.

“You have to strip away for a moment moral impediments and moral questions, and you have to say, ‘We’re treating in illness; this patient has a disease,’” Parrino said. “The disease is chronic in nature; it needs medication and ongoing treatment—the way you treat hypertension, the way you treat diabetes, which means that the patient stabilizes only as long as the patient takes medication.”

One analog that proponents of medically assisted treatment point to is depression: Some people recover from depression after a year or so on medication; others might relapse and could require medication indefinitely. Likewise, it’s not unusual to find folks who overcome depression simply through therapy, no prescription necessary.

“There’s a thousand roads up the mountain” is how John Richardson puts it. Richardson is the vice president of Mental Health Systems—an addiction and mental-health treatment provider the county contracts with for services—and he’s president of the county’s Alcohol and Drug Service Providers Association.

Richardson said ADSPA is in the process of drafting a letter to the county saying that the association, which comprises 34 agency members, is taking an official position in support of medically assisted treatment.

“There’s varying degrees of support” for medically assisted treatment among ADSPA members, Richardson said; “however, it’s a consensus of ADSPA to acknowledge medically assisted treatment as a viable treatment methodology.

“We’re not advocating for funding; we’re not advocating for the board to do something different,” he said.

 Mental Health Systems follows the drug-free, social-model of treatment and Richardson said he’s seen heroin addicts get clean and stay clean under that kind of program. According to the county, the success rate for heroin addicts in the programs it contracts with is 49.3 percent and for opiate addicts overall, 50.2 percent.

“It got a bad rap for many years because a lot of times the methadone clinics were considered juice bars,” Richardson said, “ and, quite frankly, they were. A lot of addicts abused the methadone system. However, a lot of people have gotten clean and sober and have recovered.”

“I can supply numerous accounts as to why methadone maintenance is the best form of treatment for opiate addiction,” Peloquin said. “Then it becomes a political issue and why that is I'm not sure.

“If I can get 15 or 20 minutes at the next county supervisors meeting to educate them on methadone treatment, then I will do that,” Peloquin added, because at the end of the day, there's a lot of people in San Diego who aren't being treated for opiate abuse.”   

 
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