'No magic pill' for addiction
Web Dateline: CHARLESTON, W.Va. --
Read related story: Some want to strengthen state's prescription drug monitoring program.
For more stories in the series, click here This is the final installment of a four-part series examining prescription drug abuse in West Virginia.
The young woman slips the orange tablet into her mouth, chin jutting out as she presses it under her tongue.
Ashley Stamper takes the pill twice a day, morning and night. In 10 to 15 minutes, the little hexagon will dissolve. She won't feel quite right until it kicks in.
Suboxone seeps into her system. Doctors prescribe it to help ease the cravings and kill withdrawal symptoms of opiate addicts who are hooked on painkillers like OxyContin, as well as heroin.
Alcohol remains the main reason people check into rehab, but West Virginians' demand for opiate addiction treatment has skyrocketed.
In 1999, about 5 percent of West Virginians seeking treatment needed help for opiate addiction, according to federal figures. Last year, that proportion was more than 26 percent.
Many are turning to Suboxone, the brand name for a medication whose primary ingredient is the drug buprenorphine.
Experts say the medication must be combined with counseling and other support to really help. Some users are selling it on the streets, which led the state to tighten controls on the drug.
Some people will say Stamper, 25, is just trading one addiction for another. In the past, though, the pull of OxyContin, fentanyl, Lortab and other painkillers was so strong she didn't care whether she lived or died.
"I'm not out there using and searching and partying," Stamper said.
Not just 'a handful of pills'
Stamper started going to the Prestera Addiction Recovery Center in Dunbar in August. On a frosty November morning, she waited with other customers at the CVS pharmacy a few blocks away from the center.
It wasn't yet 8:30 a.m. The six seats in the waiting area were filled. More customers lingered in the vitamin and nail care aisles. By the time they all left, they carried white paper bags with bottles of Suboxone inside.
In 2008, Prestera -- the state's largest mental health provider -- and three other providers got a $360,000 grant from the Robert Wood Johnson Foundation to increase access to Suboxone.
Prestera's program now has five doctors and more than 260 patients.
"We're not giving people a handful of pills and a kick in the butt," said Josh Parker, director of Prestera's Suboxone program. "They actually have to get treatment."
Stamper and others in the program attend mandatory one-on-one and group therapy, plus four 12-step meetings weekly.
"I'll be the first to tell you, there is no magic pill for addiction," Parker said. "Trying to battle addiction takes a lot of hard work, a lot of life changes, and a lot of support. And that's what we try to help them develop."
Doctors taper doses to wean patients off Suboxone. Some people get off it in six months, Parker said. Others take nearly two years.
Addicts get "dope sickness" when they quit using opiates. Withdrawal causes diarrhea, muscle cramps, fever, chills, depression.
"You feel like you're dying," said Kim Miller, manager of Women's Addiction Services for Prestera.
The physical symptoms aren't the only hard part of beating an addiction. Many women addicted to painkillers suffered sexual abuse and other trauma, Miller said. That's why therapy and other support are so important.
Stamper says she's "all about staying sober." She enjoys going to therapy, getting things off her chest. She likes listening to other addicts tell their stories at 12-step meetings.
Some people sign up just to get the pills.
"They usually weed themselves out real quickly," Parker said.
Pill counts and drug tests help ensure clients aren't selling their Suboxone or abusing other substances.
Not all opiate addicts need medication, he said.
"Prestera has tried to use it pretty much as your last chance of getting clean," he said.
Stamper tried methadone treatment before. She couldn't function on it. Cigarette burns cover her arms -- she used to "nod out" on methadone.
A few weeks before Christmas, Stamper waited with about 20 other Prestera clients in a bare room at the mental health center. At the front of the room, a doctor and nurse sat at a folding table with a stack of files. They called them by name to write their prescriptions.
The crowd had thinned out since the last time Stamper had picked up her prescription two weeks earlier, she said. A lot of people had been kicked out of the program.
"They're really strict," she said. "It's because they want to help everybody."
Doctors diagnosed Stamper with scoliosis at age 6. They put titanium rods in her back at age 12. Afterward, they hooked her up to a morphine pump. She remembers lying there thinking it was the best she'd ever felt.
Doctors prescribed painkillers for Stamper on and off throughout her teens. She thinks she was physically dependent on them by 16.
At 18, she started abusing them, she said. She says she lived in an abusive household with her now ex-husband. Social workers took away their 1-year-old son.
One night, her friend brought over 45 Lortabs. They sat there and did them all. It was the first time she crushed and snorted a pill.
She could always find pills, she said over breakfast at McDonald's. She spots a few men at the cash register, in neon green shirts.
"I guarantee those miners have them," she said.
She used to send out mass text messages: "Hey, you got any painers?"
At one point, she used three fentanyl patches at a time. She stuck one on her head, another on her heart, and ate the gel from another. Fentanyl is 80 times stronger than morphine, and is prescribed for severe pain.
Took off like a rocket
Federal regulators approved Suboxone, manufactured by the drug maker Reckitt Benckiser, in 2002. Four years later, a federal law made it easier to get treatment.
In West Virginia, "it just took off like a rocket between 2007 and 2009," said Dr. James Becker, medical director for the state's Medicaid program. "Clinics were opening everywhere."
In 2006, West Virginia Medicaid paid about $360,000 for Suboxone claims. Last year, it was more than $4.7 million.
Today, 17 treatment programs and more than 90 private physicians in West Virginia offer the drug, according to the federal Substance Abuse and Mental Health Services Administration.
Unlike methadone, another drug used to treat opiate addicts, Suboxone doesn't have to be taken at a clinic. People can pick it up at a pharmacy just like any other medication.
Prestera developed its own support groups for people taking Suboxone because many traditional groups -- which are abstinence based -- do not believe in so-called Medication-Assisted Treatment.
Suboxone patients who attended traditional 12-step meetings "felt really unwelcome," Parker said. "And then they would have to try to get a sponsor and build a support system of people who don't trust them, who tell them they're not clean."
Although many recovery groups do not approve of Medication-Assisted Treatment, the medical community mostly does, said Dr. Louis Baxter, president of the American Society of Addiction Medicine.
Still, "We try to stress the point that medication is not used in lieu of the full treatment experience," he said -- detoxification, rehabilitation education and follow-up care, including ongoing counseling.
Addiction is like other chronic diseases, Baxter said. If someone has diabetes, their doctor should first encourage behavioral changes like a healthy diet. Some people need medication to stay healthy, he said.
When Suboxone came out, it was touted as a safer, better alternative to methadone. It contains Naloxone, a drug that hospitals use to treat people who have overdosed. If someone injects or snorts it, they'll feel unpleasant withdrawal symptoms.
Buprenorphine also has a "ceiling effect." Taking more of it doesn't increase its effects.
But people still sell it on the streets.
"Among drug addicts, it's seen as the miracle cure," Miller said, explaining that many addicts use the drug to bridge the gap between fixes.
A few years ago, Medicaid officials noticed something. Their data showed that West Virginians were routinely being prescribed 32 mg or more per day. The manufacturer's maximum recommended dose is 24 mg.
People were diverting the drug. Officials also discovered that some Medicaid patients were traveling out of state to get high doses of Suboxone -- paid for by West Virginia Medicaid. They were likely taking a few per day, and then selling the others, said Becker, the program's medical director.
Medicaid cracked down. Starting in August, only doctors enrolled in the Medicaid program could prescribe it to Medicaid patients. Patients now must have prior authorization. Medicaid also limited how much Suboxone it will cover per patient.
Medicaid endorses the use of Suboxone, when used with counseling and other support, Becker said.
"We just see it as a pathway to where [addicts] can recover their lives," Becker said. "Medication's not the ultimate answer."
Stamper says she looks forward to the day she won't need medication. Her main motivation is her son, now 7, and nearly 1-year-old daughter. Both live with family members because of her drug problem.
"I just want to be free of any type of drugs, have my family in my life, and make something of myself," she said. "I wasted a lot of time, and it's hard to fix it all at once."
To learn more about Prestera's program, call Josh Parker at 1-800-642-3434.
Reach Alison Knezevich at firstname.lastname@example.org or 304-348-1240.
This series was conceived and produced as a project for The California Endowment Health Journalism Fellowships, a program of the USC Annenberg School for Communication & Journalism.