Monday, October 29, 2007

Part Three of Oxycontin Series

Here is the third part of the series that my local paper is running on oxycontin.

London Free Press - Local News - Oxycodone

In Clinic 528, addicts are treated with methadone, Free Press reporter Randy Richmond writes in the third of a five-part series on abuse.

Early morning and a steady path of people make their way to the counter.

Each one stops and takes a sip from a small, plastic medicine cup.

In each cup is methadone, a narcotic you also can buy off the street.

In Clinic 528 on Dundas Street, the methadone is legal.

In here, fire is being used to fight fire, one opioid drug handed out to battle others --plastic cup after plastic cup after plastic cup.

"I remember us thinking maybe we would end up with 350 people here," says Dr. John Craven, associate director of Clinic 528.

It opened on Dundas Street five years ago, after doctors running a smaller clinic and private methadone treatment practices realized the need was growing. Back then, in 2001, the doctors had 120 patients with 80 on a waiting list.

"About three years after opening, I thought things would plateau," Craven says.

"But everybody coming in, still to this day, tells us they know half a dozen other people out there."

About five to seven new people a week come in for treatment, he says. Now there's about 850 in treatment in London and another 180 at Clinic 461 in Woodstock.

More than 80 per cent of clients are addicted to opiate drugs prescribed through doctor's offices, Craven says. The most common are the oxycodone-based drugs, Percocet and OxyContin being the most popular brands.

Methadone replaces those drugs, but comes, supporters say, with a much lower price.

Methadone basically fools the brain into thinking it's getting a far more interesting and powerful opioid than it is, Craven says.

"Methadone is the most boring drug on the face of the earth," he says. "It is useful because it is a lousy drug. It fills up the brain receptors and doesn't do much of anything else. It stops people from going into withdrawal.

By all accounts, the physical withdrawal from opioid painkillers is a nightmare.

That physical dependence starts when the brain becomes used to an opioid. The drug changes the brain's chemistry so it demands more each day to obtain relief or euphoria.

When the drug is taken away, the brain and body rebel. "I would sneeze until I felt like my head would blow off," one told the Free Press.

"You get the runs. You would be on the toilet forever. You feel nauseous. You feel like you want to throw up. You get achy."

A factory worker named Steve, 39, says he tried twice to go through counselling at Addictions Services of Thames Valley, the central outpatient service for addicts in the region.

"I just couldn't do it, cold turkey," Steve says. "I felt like my feet and my hands were going to pop off my body."

He has a good family that he neglected more and more during the two years he was addicted to OxyContin. He spent all his savings on the drugs, lost a girlfriend and gave up his social life. Of all things, it was the repo man that turned him around.

"I had bought a new car and they repossessed it. I woke up one day and my car was gone. I thought, what am I doing?"

His elderly mother drove him to his first appointment last year. Imagine, Steve says, making your mom take you to a methadone clinic because you are an addict. He got clean in 12 days. After a year, he has a new girlfriend and is playing sports again.

"I don't want to say it saved my life. But if I wasn't here, I don't know where I'd be."

Not everyone sees Clinic 528 in such a positive light.

Provincial Conservative Leader John Tory, accompanied by police Chief Murray Faulkner, took a law-and-order tour of London last year and called for the clinic to be moved because it is close to Beal secondary school.

That prompted several London leaders to criticize the clinic's location and the work it does. But the city itself runs a coffeehouse two doors east at William Street that attracts a rough-edged crowd.

Dozens of dealers, users, those trying to kick and other down-and-outers mill on the sidewalk between the clinic and coffee house.

In the middle of the day, you can get several offers to purchase drugs on the sidewalk.

Homeless people make up about seven per cent of Clinic 528's patients, Craven says. Another 15 per cent are "one pay cheque away" from homelessness. The rest are working or in school or homemakers.

In the downstairs waiting area, though, a constant flow of rougher-looking patients come in each day for their methadone.

That's because 'downstairs' is where beginners and long-time addicts who can't get clean get their methadone.

Once someone tests clean for everything but methadone, they move 'upstairs.'

That means they can get 'carries' -- several days worth of methadone at once, and get individual counselling from one of three doctors.

"All I do is prescribe methadone, get them in the door, get their feet on ground, then try to educate them on how they got in this mess in the first place and how to get out of it," Craven says.

A third of his patients are upstairs, a third downstairs trying to get upstairs. "And one third are determined to kill themselves through their addiction," he says.


Upstairs and downstairs patients can meet twice a week in group recovery sessions. Mondays they talk about what they want. Thursdays they listen to a short recording by Craven and mostly stick to that subject.

There are rules here. No interruptions. First names only. A few veterans talk at a recent session about some other rules they'd like to see. No nodding off during session. No opening a bottle of pills for an aspirin.

"How do they know those aren't my triggers,?" says one in exasperation.

At this session, they talk about honesty. A regular member, a woman in her 30s, fidgets in her chair. She tells the group she feels ashamed because she trusted a friend and the friend lied.

"Why do you feel ashamed? It's your friend who should feel ashamed," a group member says.

"I'm embarrassed because I want to help people but I can't because I am not recovered yet," the woman says.

"You can't give what you don't have," Craven tells the group. "You have to help yourself first."

Another group member tells them, "My conscience is working overtime now."

That's normal, because during addiction, you can't get emotional about what you do, Craven tells them.

"Don't beat yourself up," a veteran of the clinic says.


After the meeting, the veteran says he's been on methadone for seven years.

There are no deadlines to getting off, Craven says. Only after a year on a regular dosage should anyone even try to taper the amount, he says.

Opioids change the brain chemically and feed a growing hunger of fears, worries, past abuses and guilt.

That is one criticism of methadone treatment: It replaces one addiction with another.

Even those on it worry.

Tom, 34, an out-of-work furniture installer, used to drive by Clinic 528.

Why don't these people just quit? he wondered.

He signed up in February 2006. Three years earlier he hurt his back at work, then spent years battling an addiction to OxyContin. "I tried to quit on my own. It was debilitating. I looked down on these people until it was me."

His daughter saved him. Her grades were failing and she was getting into trouble at school. "I had to get the pills out of my life or I was going to lose my daughter. I think I just barely got away."

It took him six months to move upstairs because he continues to smoke marijuana.

Ironically, the same thing that keeps some people away from the clinic was the thing that made him strong enough to get clean and move up.

"There are some pretty hard tales and some pretty hurting people downstairs," Tom says. "It inspires me to get better."

It took him a year to get his energy back and only now has he begun to call up old friends he left during the addiction years. He's even thinking about going back to work.

"The past year I was content to have not much money. It helped me quit."

It's been a while since he had a craving for the drugs.

"I had a lot of dreams about it that are really where you are going and scoring and going home and doing it. Right now, I don't think I will ever go back. I don't want to ever go back to where I feel that low about myself."

There's just one worry.

"The methadone is a really good painkiller so I wonder how long I am going to be on it. When I am off, I don't know how much of my pain will return."


- Opioid: Drug made from the opium in poppy. Commonly called narcotics or opiates. They are effective painkillers, but can also produce euphoria, making them prone to abuse.

- Oxycodone: An opioid and key ingredient in prescription painkillers such as Percocet, Oxycet, Endocet and OxyContin.

Oxycodone can create addiction and physical dependence.

- Percocet: Contains 5 mg of oxycodone and gives about five hours pain relief. On the street, "percs" refers to both Percocet and generic forms of the drug.

- OxyContin: Contains higher levels of oxycodone, usually 10 mg to 80 mg. It has a time-release coating offering pain relief for 12 hours. Chewed, crushed and snorted, or injected, the time release is bypassed and all the oxycodone is released at once.

- Addiction: When a drug is so central to thoughts, emotions and activities the need to continue its use becomes a compulsion.

- Physical dependence: The body has adapted to the presence of the drug, and withdrawal symptoms occur if use is reduced or stopped.

- How they work: Opioids bind to brain receptors, and over time block those receptors. That forces the brain to require more opioid to produce the same euphoria.

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