(Photo by Spencer Platt/Getty Images)
It took Phil Fiuty more than 20 years from the first time he thought maybe he wanted to not use drugs anymore to become sober.
That’s not because of any moral failing or lack of character on his part, but illustrates his view that it can take a lot of practice to be abstinent. “It’s hard, and part of what makes it hard is not our internal strengths or our moral compass or any of that stuff,” Fiuty said. “There are physiological changes that occur in our brains and our bodies when substances get introduced.”
Part of the stigma around drug treatment comes from what Fiuty considers a nonsensical notion held by some that it’s possible to “solve” someone’s drug problem by only looking at the addiction and none of the other conditions of their life.
“You can’t untangle all of those things from everything else that’s going on for people,” he said.
That comes along with degrading language used to describe people who use drugs, he said, which then allows for the criminalization of entire communities.
“I think America loves bad guys,” Fiuty said. “We’ve always got a bad guy.”
Today, Fiuty is the harm reduction program director at the Mountain Center in Española, which runs a Suboxone clinic and a needle exchange, and provides psychiatric care and counseling.
Programs that promote abstinence work for only some people, he said. He’s heard the popular narrative about opioid treatment many times: Isn’t treating someone with methadone or Suboxone just trading one drug for another?
No, he said. It’s using a medication that alleviates the symptoms.
“Somehow singling out someone who’s found themselves dependent on opioids of some sort and then saying that the medication that is very effective in helping people manage that is just trading one drug for another is completely absurd in the context of everything,” he said.
Dr. Mark Stavros, chief medical officer at Maric Healthcare, said the same thing to a panel of New Mexico lawmakers earlier this month. A patient will still depend on the medication, but they will no longer have cravings or withdrawals, he told the legislative Health and Human Services Committee on Sept. 3.
So the addiction starts to go away. You start to see them get their jobs back, get their families back, go back to school. Their lives get back together. So if anything, we’re actually improving their lives more than anything else and keeping them from harm.
– Dr. Mark Stavros, Maric Healthcare
Stavros and Christina Juarez, executive director of New Mexico Treatment Services, are asking the Legislature to relax rules that prohibit nurses from dispensing “take-home” doses of methadone or buprenorphine, more commonly known as Suboxone. State law allows only pharmacists to dispense those monthlong doses.
Albuquerque Democratic Sen. Bill O’Neill, who sits on the judiciary committee, told proponents he supports the bill.
“Let’s get it through judiciary, OK?” O’Neill said.
New Mexico Treatment Services, which runs methadone clinics in Farmington, Española and Santa Fe, is part of a bigger network of providers across four states operated by Maric Healthcare.
Methadone is one of the most highly regulated substances in America. Fiuty said it is potentially a very valuable medication but can only be used in clinical contexts where a patient must show up to a physical location every day to receive it while following a series of other requirements until they earn their take-home medication, which is typically 27 days’ worth of the drug put into a lockbox specifically for that patient.
“The way that it works, unfortunately, 99% of the time is that there’s a huge waiting list to get on,” he said. “They might only do intakes one morning a week, and people have to be there at five in the morning, and they’ll only take a couple of people.”
With regard to the legislative proposal, Fiuty said anything that expands access and makes it easier to provide treatment on demand is positive. As things stand, people have to travel long distances to clinics that will dispense Suboxone, he said, and that plus criminalization makes access difficult. He said he doesn’t believe that drugs or alcohol cause addiction or alcoholism. Instead, he believes addiction is a set of symptoms that are generally present in people prior to any substance being introduced into their body.
“Nobody likes their first cigarette. Nobody does,” Fiuty said. But people will smoke again, again and again until they don’t have that initial reaction, he said, because they perceive some abstract benefit like making the user look cool or helping them talk to people.
The criminalization of chaotic or problematic substance use has created a lot of guilt and shame for people who end up with addictions or disorders, he said, or even casual users who get in trouble.
If someone gets caught up in the criminal legal system, Fiuty added, they not only stop treatment but they can get kicked out of the program or have to start all over again.
That starts to become untenable for people who are driving many miles from home each morning to a clinic, and he said he’s heard stories of people making the 107-mile drive between Tucumcari and Las Vegas every morning for methadone treatment.
Treating opioid addiction with medication has even more powerful social effects. Once someone is engaged in treatment, he said, they are interacting with medical professionals instead of police and jailers, which has an almost immediately stabilizing effect on their life. That can give someone a break and potentially an opportunity to learn some different ways of coping with things.
Methadone vs. Suboxone
Expanding access to methadone treatment — not just Suboxone — could also help deal with the rising presence of fentanyl in the New Mexico drug market, Fiuty pointed out. The body processes fentanyl differently than heroin, he said, and this has resulted in some complications with trying to transfer someone who is dependent on fentanyl onto Suboxone. Methadone doesn’t necessarily have those complications.
“It’s much easier to transition someone who is habituated to fentanyl onto methadone than it is to Suboxone,” he said.
Dr. Eric Ketcham is the medical director for New Mexico Treatment Services. He has been working at the company’s methadone clinic in Farmington for more than five years. In a Sept. 8 interview, he said that if a methadone clinic can’t hire a pharmacist, they can’t operate, and it’s ultimately people with opioid use disorder in that community who suffer.
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Lauren Reichelt is the director of the Rio Arriba County Health and Human Services Department headquartered in Española and is considered a leader in health equity in the state. She said she was a little suspicious of the lobbying effort around take-home doses of methadone or Suboxone, because she said around 2014 or 2015, New Mexico Treatment Services initially had “lousy management.”
Stavros from Maric Healthcare told lawmakers that when a patient comes into one of their clinics with any kind of opioid addiction, they start them on a low, safe dose of medication.
“It’s not going to be an overdose type of situation. It’s a very low dose,” he said. Later on during the discussion, he said the doses are measured either electronically or with hand pumps that are perfectly calculated to that particular patient’s dose.
“I don’t think it’s something a pharmacist has to do, personally,” Ketcham said. “I think a nurse could probably do it. I don’t really have a strong opinion about it one way or the other, but there’s so many barriers to access to treatment.”
So long as the pharmacist has adequately trained the nursing staff, and they have proven their competency in preparing take-home doses, Ketcham said he doesn’t see why they couldn’t do it.
“They prepare the doses that the patients take all day,” he said. “Every day the patient comes to the dosing window at a methadone clinic, it’s the nurse that measures out that dose. The pharmacist doesn’t do that. And that you have to do on the fly.”
Ketcham said it’s unfortunate that there are negative stereotypes about methadone, because it transforms and saves lives. Those stereotypes make it hard to hire nurses, counselors and pharmacists but also create shame between patients and their loved ones.
He said he has many meetings with family members at the clinic where he works and he has to try to get them to understand that methadone isn’t some horrible thing.
“Their child is in treatment with methadone and they go, ‘Can’t you just get off that? You need to get off that, quick. It’s so embarrassing. It’s a blight on the family name.’ ”
He said he’s seen too many people shamed into getting off of treatment with Suboxone or methadone because their family members find it too appalling.
“I try to sit down with family members and say, ‘This isn’t a quick fix. This isn’t a week detox,’ ” he said. “That’s another failed, deadly concept. The patients stigmatize themselves enough, they don’t need our help.”
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