WIN Recovery: Regain Something Lost

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

Onset of actionA few seconds30 minutes30-40 minutes
Duration of action4-6 hours24-36 hoursAbout 24-48 hours
Route of administrationInjection, snorting, smokingOralSublingual
Frequency of administrationSeveral times a dayDaily or more frequently as neededEvery day or every other day
Effective doseEver increasingBlocking dose usually 80-120mg2-32mg
ToleranceIncreasing toleranceTolerance is stableTolerance is stable
Euphoric effectsEuphoria for up to 2 hoursNo euphoria when stabilizedNo euphoria when stabilized
Overdose potentialHigh and increasingRare (potential is mixed with other depressants)Very rare
Overall safetyPotentially lethalVery safeOverall good. Suboxone injection will cause serious withdrawal symptoms in dependent person. Not recommended for pregnancy and caution with liver disease
WithdrawalWithin 3-4 hours after last doseWithin 24-36 hours after last doseWithin 36-48 hours after last dose
CravingRecurringEliminated with adequate doseCraving may not be totally eliminated due to ceiling effect
Pregnancy/NursingGrave risk for mother and fetusSafe during pregnancyNot indicated/study underway
Experience of pain and emotionsBluntedNormal and full range of emotionsNormal pain but opioid analgesics may not be effective – may need to switch to methadone. Full range of emotions
MoodConstant mood swingsNormalNormal
Reaction time and intellectual functioningImpairedReaction time normal. Intellectual functioning unimpaired on stable doseReaction time presumed to be normal like methadone. FDA cautions driving/operating machinery in the beginning of treatment
HIV & Hepatitis C transmissionHigh rate with needle use and unprotected sexReduced/eliminatedReduced/eliminated
Immune system for HIV positive personsRapid progression to AIDSProgression slowedProgression presumed same as methadone – data not available
Immune/endocrine system functioningImpairedNormalized during treatmentPresumed normalized. Data not available
Stress ResponseSuppressedNormalized during treatmentNormalized during treatment
Criminal activityHigh levelReduced/eliminatedReduced/eliminated
Community impactDestructing impact. High crime, high death rate, transmission of diseaseContributed to public safety, low mortality, increased healthContributed 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”

Mental Health Month even More Meaningful this year

By: Melvin L Burks, CEO, Hamilton Center, Inc.

It is impossible to not talk about COVID-19 with my annual May message in recognition of National Mental Health Awareness month. Today’s unique environment gives us a very small glimpse of the isolation that people who have mental illnesses often experience.   Even for those of us who have never experienced a serious mental illness first hand, this health crisis can give us just a taste of the feelings of hopelessness, fear, isolation, sadness and anxiety that many people face – one in five people at some time in their lifetime. 

In addition, I’m also reflecting on what life will be like once this health crisis is behind us.   Although the physical health issues may be addressed, many of us will struggle with ways to cope with its mental health consequences. 

Hamilton Center’s theme this year is STIGMA, NOPE not today.  Stigma remains a significant reason why peopleavoid seeking treatment. It will take all of us working collectively to combat this fact.  If you or someone you know is struggling to cope, please reach out for help. It is the hardest, easiest thing to do.  Reach out to family, friends, your religious leader, a teacher or anyone that can provide support. And if the struggle is impacting your life significantly, reach out to a professional.  We are in this together and STIGMA, NOPE not today.