Rain, sleet or snow, New Season Eau Claire Metro Treatment draws a crowd nearly every morning.
It’s not that this diverse group wants to make the daily journey to the small drug treatment facility on Eau Claire’s west side. Their bodies are telling them they have no choice.
The gathering is a visual symbol of the nation’s opioid crisis, as these folks are addicted to opioids and awaiting their turn to receive medication-assisted treatment in a desperate attempt to shake free from the grip of chemical dependency.
The medications they receive, Suboxone or methadone, are intended to wean them from opioids while helping them avoid the agony of withdrawal.
“Withdrawal is like flu times 10,” said Mel Poehler, regional director of Florida-based New Season, which operates more than 70 addiction treatment centers in 22 states. “Imagine the worst flu you’ve ever had, with your whole body aching, vomiting, diarrhea, chills, sweating, anxiety and you can’t sleep. It’s pretty rough.”
In the midst of such misery, “they know that one little pill or a line of heroin will take it all away instantly,” Poehler said. “That’s why the relapse rate is so high for people addicted to opioids.”
A similar scenario plays out at treatment centers across Wisconsin, as residents seek to avoid becoming a grim statistic in an opioid epidemic that preliminary reports show killed nearly 800 people and resulted in almost 5,000 opioid overdose ambulance runs in Wisconsin last year alone. State Department of Health Services statistics indicate that Eau Claire and Chippewa counties had a total of 14 opioid deaths and 81 opioid overdose ambulance runs in 2018.
At L.E. Phillips-Libertas Treatment Center in Chippewa Falls, about 15 patients go through detox and about five are admitted into a residential treatment program every day.
When Toni Simonson joined the center, a service of HSHS St. Joseph’s Hospital, three years ago, about half of the detox patients were for alcohol and a quarter for opioids. Those shares since have reversed, she said.
“Here in the Chippewa Valley, we tend to be a little later than other places with changes in our drug scene,” said Simonson, executive director of behavioral health for HSHS Western Wisconsin Division and Prevea Behavioral Care. “Now it seems like we’re following the rest of the state where opioids are taking over.”
Poehler agreed, saying, “The numbers are still going up. I don’t think we’ve come to a head yet.”
That leaves a lot of Chippewa Valley residents from all walks of life fighting to vanquish an addiction, one that for many starts with a painkiller prescription from their doctor or dentist and progresses to using illicit narcotics, heroin or even more potent synthetic opioids such as fentanyl.
“Addiction doesn’t discriminate,” Poehler said. “We have everything from soccer moms to CEOs to politicians to average citizens and what you might think of as typical drug users.”
Its widespread nature is part of the challenge of fighting the opioid epidemic.
Paul Krupski, director of opioid initiatives for DHS, acknowledged that Wisconsin, like other states, has been more reactive than proactive in its response.
“It’s an epidemic we had to catch up to,” Krupski said, because so many people were dying from opioid overdoses.
To that end, the department’s primary mission in the fight against opioid addiction is pretty basic: “Our overall goal is to reduce the number of opioid-related deaths in Wisconsin. We need to save lives,” Krupski said.
DHS officials hope to accomplish that directly by increasing the availability of naloxone, the overdose reversal medication commonly known by the brand name Narcan, and also by advancing prevention strategies and increasing access to treatment and retention of patients in treatment programs.
In 2015, the state opened treatment program offices in Ashland, Minocqua and Marinette to help address a shortage of services in northern Wisconsin. The state’s 18 opioid treatment programs served 10,626 people in 2017, up 70 percent from 2013, Krupski said.
DHS since received federal funding to open five additional treatment facilities around the state, including Arbor Place in Menomonie, which primarily serves patients in Dunn, Pierce and St. Croix counties.
Despite those expansions, he acknowledged there isn’t enough access to treatment available statewide or nationwide, and thus a majority of people who need opioid addiction treatment are not receiving it.
Krupski offered the example of a person addicted to opioids who lives in Hayward and for whom daily doses of methadone might be the best treatment. The problem is the nearest place for that individual to receive the treatment is Eau Claire.
“It’s just not realistic,” he said, citing the hurdles of making such a drive every day while juggling careers, families and an addiction.
Both L.E. Phillips and New Season reported that they attract patients from within about a 90-mile radius of Eau Claire.
As the opioid crisis has evolved, DHS has tried to respond. The emergence of the synthetic opioid fentanyl, which the U.S. Centers for Disease Control and Prevention says is 50 times more potent than heroin, represents the latest, and potentially deadliest, challenge, as law enforcement officials report it is being cut into opioids and other illicit drugs. That means individuals can be exposed to fentanyl, and thus face a high risk of overdose and possibly even opioid addiction, without even knowing it.
DHS launched a pilot program in late 2018, as part of a needle exchange program at the AIDS Resource Center office in Milwaukee, to provide education about fentanyl and testing strips to users so they can test for the presence of the synthetic opioid in whatever substance they are taking. The idea behind the program, which could be expanded if it proves successful, is to prevent overdoses and change behavior, Krupski said.
While all of the initiatives will take time to make much of a dent in the opioid epidemic, Krupski remains hopeful.
“I’m really confident that with the commitment we have ... we are moving in the right direction and we will turn the tide and start seeing changes,” he said.
Already, preliminary reports suggest 2018 opioid-related deaths in the state may have declined for the first time in two decades, Krupski pointed out.
Dose of hope
L.E. Phillips-Libertas and New Season both focus on medication-assisted treatment supplemented by counseling and education — what Krupski described as the “gold standard” of treatment.
“We offer a very robust, comprehensive program that covers all aspects of a patient’s life,” Simonson said, noting that patients can get inpatient treatment at L.E. Phillips-Libertas or outpatient treatment at the Prevea Medical Services building in Chippewa Falls.
In response to the continued rise in opioid abuse, the Prevea network added the Chippewa Falls clinic in September and soon will add outpatient medication-assisted treatment for opioid use disorder in Eau Claire.
The facilities use Suboxone and Vivitrol in their treatment.
Suboxone, a controlled opioid, prevents people from getting high while also preventing cravings for opioids, while Vivitrol also reduces cravings and blocks any pleasurable feelings with a monthly injection.
“The medication kind of clears a pathway so that treatment can begin,” Simonson said, adding that the long-term success rate of treatment doubles with the use of medication. “It’s really tough for someone to do it on their own.”
Without the medications that prevent cravings and reduce withdrawal symptoms, many people relapse and abandon their efforts to halt their addiction.
“Our concern is that so many people are overdosing and dying,” Simonson said. “This approach helps prevent more deaths.”
The methadone that most New Season patients receive also is an opioid, but it is delivered at a therapeutic level that reduces the risk of overdose and also has a blockade effect that prevents the user from feeling euphoria if they use any other opioids, Poehler said.
Initially, patients are required to go to the clinic every day for their medication before eventually being allowed to take prescriptions home — subject to random drug screenings and medication supply checks to ensure they aren’t misusing their methadone.
The clinic, which had about 100 patients at the end of 2018, generally treats as many patients as allowed based on its number of counselors.
“There are not enough programs to treat all the patients, and there is also a pretty significant counselor shortage,” Poehler said.
While a majority of the clinic’s patients are on Medicaid and thus have their services covered, others grapple with affordability issues if they don’t have health insurance or their treatment isn’t covered by their policy, she said.
Mayo Clinic Health System also has a number of physicians certified to treat addiction patients with Suboxone, said Dr. Terrence Witt, a family practice physician in Eau Claire who is a member of the Mayo Clinic Opioid Stewardship Program’s steering committee.
The group was formed to establish safe prescribing standards for opioids, and its guidelines have led to a significant decline in the number of opioid prescriptions written — an important development considering Witt said the vast majority of his patients who are addicted to heroin have indicated their addiction started with a prescription painkiller.
The patients typically move to street acquisition of narcotics, heroin or fentanyl-laced drugs after their prescriptions run out — a pattern that officials report has been repeated across the country.
A key hurdle to helping opioid-addicted patients is getting them to recognize they need treatment.
“Probably the most significant challenge is getting patients to take that step,” Witt said.
Once they do, often despite relapses and other bumps in the road, treatment providers said the results can be life-changing and even life-saving.
“I hear all the time from patients who are so thankful for treatment,” Simonson said. “They say, ‘Without your services, I don’t think I’d be here today.’ “