April 24--Alexandra Miller died of a heroin overdose -- twice.
Both times, paramedics used medications to revive the 23-year-old Worthington woman. Now, she relies on a monthly shot of another drug, Vivitrol, to block her opioid cravings and stay clean.
"This is a battle for your life, and whatever you have to do, you do," Miller said.
Tiarra Harris places a dissolvable strip of Buprenorphine in her mouth twice a day. The medication helps her break a 10-year addiction to pain pills and cocaine that left her separated from her four children, pregnant with a fifth, and living in a van on the West Side.
Trying to quit cold turkey on her own was "like death," said Harris, 27. "The night sweats, cold sweats, aches and pains, you're running to the bathroom. You have this pain in your stomach, like taking a knife and slowly stabbing. It's horrible."
After decades of relying on abstinence and therapy to treat drug addiction, Miller and Harris are among an increasing number of addicts finding success with medication-assisted treatment to break the deadly grip of drug abuse.
It's not cheap. Monthly injections of Vivitrol alone can cost more than $1,000. Some, like Miller, have private insurance to cover most of the cost, while tax-funded Medicaid picks up the tab for Harris.
Gov. John Kasich's administration recently proposed several changes, including: making naloxone, a drug used to reverse deadly overdoses, available to homeless shelters, halfway houses and schools; and waiving the requirement that clinics providing methadone, used to treat heroin addiction, be state certified for at least two years.
President Barack Obama recently proposed spending $1.1 billion, mostly on medication treatment. Separately, Obama announced he will use his executive authority to increase the patient limit for doctors providing medicated treatment to 200 from 100. Only about 30,000 of 800,000 physicians nationwide are authorized to provide such treatment.
In Ohio, the amount of taxpayer money being spent on medication treatment, nearly all of it through Medicaid, the state-federal program for the poor and disabled, is growing.
In 2014, Medicaid paid $72.9 million for the treatment, including $52.9 million for Buprenorphine, $16.6 million for methadone and $3.4 million for Vivitrol.
By mid-2015, there were 87,071 Ohioans on Medicaid with a diagnosed opioid addiction, a 42 percent increase from 2012. Of those, nearly 27,000 were receiving drug treatment for their addiction. The number of Ohio residents getting such treatment through private insurance is unknown.
Some critics complain that treating drug addiction with another drug -- which people may have to take the rest of their life -- is a crutch and a short-term solution to a long-term problem. But many health experts and addicts see medication treatment as the best way to break drug abuse.
Dr. Alexander Walley, director of Addiction Medicine at Boston University Medical Center, said medication helps addicts break free from the "hijacking of the brain" caused by opioids.
"With just a little bit of methadone that lasts all day, you can right away break that cycle of withdrawal and euphoria," he said. Cravings are not entirely gone, but "the volume is turned down very low," Walley said.
"There's no wrong door to recovery. This is a highly deadly disease. We need to offer everything that works and not try to dictate the precise recipe for every individual."
Dr. Justin Trevino, assistant medical director at the Ohio Department of Mental Health & Addiction Services, said he believes in medication treatment as the bedrock instead of abstinence.
"If you want religion, go to church," he said. "Science tells us there are several effective interventions. Sometimes you need to pull out the big gun." To him, medication-assisted treatment is "the big gun."
He uses the metaphor of a crumbling house, symbolizing the result of drug addiction. To make repairs, scaffolding (medicated treatment) supports must be added to prop up the house, lest it fall apart. The support is not solving the issue, but giving the homeowner time to make repairs. Sometimes the scaffolding must remain in place indefinitely, Trevino said.
State experts also point to the high failure rate for treatment without medication -- up to 90 percent in the first year. The success rates triples with medication.
Paul Coleman, president and CEO at Maryhaven, the oldest treatment center in central Ohio, said there is "one goal but many paths" in treating substance abuse. While Maryhaven still believes in and practices the traditional 12-step program approach, it is heavily invested in medication treatment.
"The science is clear: Medication-assisted treatment works. There is no easy way," Coleman said, adding that is has proven so effective it is "almost malpractice" not to use it.
The opiate epidemic is directly responsible for a $2 million, privately funded building addition underway at Maryhaven's main facility at 1791 Alum Creek Dr., including eight new beds for detoxification patients and four beds for adult addiction treatment. The Franklin County ADAMH Board provided a $745,000 boost in operating funds for the addition.
Maryhaven has 601 patients in six counties undergoing medication treatment, Coleman said. The majority are on Buprenorphine, with smaller numbers on methadone and Vivitrol.
Despite the increasing numbers of people receiving medication treatment, health providers agree that access remains a serious problem. Like Obama, U.S. Sen. Sherrod Brown, D-Ohio, wants to change the 2000 federal law limiting doctors to treating 100 patients with medication.
U.S. Sen. Rob Portman, R-Ohio, included increased use of medication treatment and naloxone in his Comprehensive Addiction Recovery Act, which passed the Senate on a 94-1 vote last month and is pending in the House. The bill would increase prevention and education programs, help with treatment for addicted, incarcerated offenders, and launch new opioid and heroin treatment and programs.
Monica Kagey, program director for the Franklin County Family Drug Court, said medication-assisted treatment has helped to improve the court's success rate. In 2008, 17 percent of parents assigned to the court got clean and kept or were reunited with their children; last year it was 58 percent.
"Nothing is a quick fix for this population," Kagey said. "(Medication) is a critical piece, but it's not the only answer."
Most addicts, including Miller and Harris, also rely on individual therapy and group counseling.
Miller got clean at a residential treatment facility and then began injections of Vivitrol when she returned home. By curbing her opioid cravings -- the drug actually prevents patients from getting high from opioids -- the treatment allows her to focus on getting her life back together. She has a full-time office job, made amends with her family, and plans to return to school to become an addiction counselor.
Miller started drinking and smoking marijuana when she was 14, before switching to heroin shortly after graduating from high school. As the drugs took control, Miller was in and out of court and rehab programs that didn't work. She had friends go to jail. A few died.
She was shooting up heroin in a car with a friend in 2011 the first time she overdosed. She began having trouble breathing and passed out. Her friend tried to wake her as Miller turned blue and foamed at the mouth. Frantic, the friend called 911 before running away.
Emergency crews arrived and gave Miller naloxone, which reverses the effects of an opiate overdose almost instantly.
"I was angry they brought me back because when you are using every day and you are sick and tired, you don't really care if you are dying or not."
She overdosed a second time a couple of years later in a Hilliard parking lot. Again, paramedics broke her back from death.
"It's a daily battle," Miller said. "There is no cure. Vivitrol helps."
Harris was 17 when she began buying Percocet, a narcotic painkiller, and other pills off the streets. Soon, little else mattered but her next high.
"I was losing everything. I worked but all my money was going to pills. I wasn't taking care of our kids properly. I was selling our food stamps. I wasn't paying our bills. It got to the point I couldn't take care of my kids that children's services got involved,"said Harris, whose children are ages 2 months to 9 years.
"I wound up giving my kids to (their father's mother) because I wasn't in no shape to take care of them."
Later, she was ordered to stay away from them entirely after missing a court custody hearing.
"That was my rock bottom," she said. "I was sleeping in my van, found out I was pregnant with (her fifth child), didn't have no home, kids were gone."
She tried to quit numerous times but never succeeded until she started a treatment of Suboxone, counseling and group therapy. She's been clean seven months. If things continue to go well, she hopes to have her kids back and living in her own apartment this summer.
"It's so easy to get sucked back in," she said. "You have to work hard."