When Zac Talbott went to methadone treatment for the first time, he said he didn’t go for all the right reasons.
“I wasn’t originally seeking recovery,” Talbott said. “I was just trying to not be sick, and I thought, ‘Well at least they’ll give me some methadone and I won’t be sick,’ but I wasn’t really into treatment.”
But he ended up getting a lot more help than he originally expected.
“Even as an addict I had the same perceptions as everyone else, ‘Well I’m just gonna go and get in line and get my dose,’ ” Talbott said. “Little did I know, I went through a full bio/psycho/social assessment, a full physical examination, I had to meet with a clinician.
“I ended up being in an environment where not only was I given a medication that allowed me to normalize, but also gave me the support and the individual counseling and the case management and the medical treatment that I needed to get back to who I was before painkillers and heroin had robbed my freedom,” Talbott said.
Now the program director at Counseling Solutions in Chatsworth, Georgia, Talbott spends a lot of time combating negative stigmas associated with methadone treatment.
Methadone is a treatment option available for people who are addicted to prescription opioids or heroin.
There aren’t any methadone clinics in Johnson City, but Suboxone, another controlled substance that contains an opioid blocker called buprenorphine, has a presence in the surrounding area.
Talbott said both Suboxone and methadone are intended to help normalize a substance abuser’s brain activity so they can begin engaging in other therapeutic treatment methods.
For residents of Johnson City, the closest methadone clinic is in Knoxville, a trek Talbott said can be difficult for methadone users who might have to take daily trips to the clinic to refill their dosage.
“People don’t see methadone and buprenorphine as medications, which is what they are,” Talbott said.
“These are medications that restore function. They’re no different than if someone takes a Lipitor for cholesterol.”
Talbott said Suboxone and methadone can have different levels of efficacy depending on the patient.
“We tend to see people do better on (buprenorphine) if they have shorter addiction histories and lower tolerances,” Talbott said. “If an adolescent comes in or someone who hasn’t used very long, buprenorphine tends to be very effective, whereas folks who have used for long periods of time and have longer tolerances often do better with methadone.”
This differentiation isn’t applicable across the board, but Talbott said it offers a good standard of treatment.
According to a report published by the National Center for Biotechnology Information, Tennessee has the second highest opioid prescription rate per capita in the nation. The Centers for Disease Control and Prevention also reported there has been a 250 percent increase in opioid-related overdose deaths from 2001 to 2010 in Tennessee.
Deanna Irick is the executive director of High Point Clinic, a Suboxone clinic located in Johnson City. Instead of just dispensing medication, the clinic also provides a number of resources to substance abusers and requires patients to see both a doctor and a therapist at the same time, ensuring they receive supplemental therapeutic intervention in conjunction with their medication.
“It’s very easy for addicts to convince one person, but it’s harder to convince two,” Irick said. “So they get therapeutic intervention every time they come. The most effective treatment method is Suboxone with therapeutic intervention.”
Dr. Dan Nicolau, an assistant professor in the East Tennessee State University Department of Psychiatry and Behavioral Sciences, believes Suboxone is more beneficial than methadone because it has a ceiling, meaning patients won’t feel overtly negative effects after taking more than the recommended dosage.
“The more (methadone) you take, the more effect it has on you,” Nicolau said. “It can cause cognitive impairment, it can cause respiratory issues, it can cause people to stop breathing if they take too much.”
Erick Herrin, a local attorney who has consulted with the city of Johnson City regarding methadone clinics, said it’s only a matter of time before one opens up in Johnson City.
Herrin said local governments like Johnson City don’t have jurisdictional oversight over the operations of local methadone clinics.
“We can’t go walking into a doctor’s office and start looking at files,” Herrin said. “We can’t make a professional, medical assessment of the quality of any clinic.”
While they don’t receive much scrutiny at the local level, Talbott said methadone clinics are one of the most over-regulated treatments in all of medicine.
“We submit to the (Drug Enforcement Administration) randomly coming in and checking on our pharmacies and our charts,” Talbott said. “I’m subject to state regulations, I’m subject to federal regulations under the Department of Health and Human Services. I think people truly have this vision that people come through, get juiced up, get high and that’s it.”
Herrin believes there isn’t sufficient oversight at the local level to ensure methadone and Suboxone clinics meet minimum criteria for treatment, but he maintains that, if substance-based recovery clinics can maintain a high quality of care, they can be a valuable resource in the fight against opioid addiction.
“We’ve got addicts in this town,” Herrin said. “As a community and as a society we can either turn a blind eye to it and not give a damn and let them live under a bridge, or we can bring some compassion to the program and try as a medical community.”