GRAND RAPIDS, Mich. (WOOD) — The front lines of the opioid war form in pre-dawn darkness outside West Michigan’s six methadone clinics.
“I get up, no matter how sick I am,” Patrick Pierce told Target 8. “I gotta get my clothes on, gotta get in the car and fight my way on to the freeway.”
For a year, Pierce has made the early morning, 26-mile round-trip to the Southside Health Center in Grand Rapids from his home in Standale.
“There’s just too many people,” Pierce said of the crowd that gathers for early morning dosing. “What they’re doing is good, but they need to make some reforms. It’s ridiculous to go stand in line with 100 people.”
The client population at the clinic on Kalamazoo Avenue SE has doubled in the last five years. The center, operated by Cherry Health in Grand Rapids, now serves 1,013 people.
Forty percent of those clients get dosed on site daily, while the rest have earned the privilege — through clean urine tests — of obtaining some “take-home” doses.
Pierce, 51, doses daily.
That’s why when he had to go in front of a Grandville judge for missing a probation appointment, he feared going to jail and losing access to his lifeline.
“I won’t be able to get my medicine and I might get sick and that scares the hell out of me,” Pierce said tearfully. “I feel like I got a noose around my neck and I’m standing on the platform.”
Pierce did end up going to jail on a probation violation connected to a misdemeanor, but he was able to post bond within a couple hours.
“I’ve never missed a dose,” he said.
He’s afraid doing so would make him as sick as he was when he first tried to kick heroin.
“Sometimes I’d be puking before I even got out of bed,” he recalled. “It’s scary, violent, fast. I’d feel achy all over.”
But Pierce is relatively stable now, the methadone staving off cravings and withdrawal, while slowly restoring chemical balance to brain circuity hijacked by addiction.
“Lately I’m feeling more and more normal,” he explained. “Some mornings I wake up and it’s like I’m not even taking anything.”
Even so, he’s been tapering down his dosage and is anxious to get off methadone entirely.
For one thing, it makes it difficult to get work outside the Grand Rapids area or do any traveling because he’s tied to the clinic every day.
“There’s people telling me they’re (going to the clinic) seven, eight years,” Pierce said. “It’s driving me nuts. I want to get off the crap.”
Sara Schade recalls rushing to get off methadone and relapsing because of it.
“My family, they were very supportive, but they didn’t understand,” explained Schade.
Schade, now 38 years old and in long-term recovery, is a certified Peer Support Specialist and Recovery Coach in Grand Rapids.
“My family was like, ‘You’ve been on this for six months, you need to get off of it,’ so then I would bring my dose down too low, and it’s 8 o’clock at night and I’m dripping sweat and I feel like I’m dying, and I know what’s going to fix it.”
Ultimately, she spent eight years on medication assisted treatment before she finally achieved long-term recovery.
“It might have taken me a long time to be on medication assisted treatment and not be using other drugs,” explained Schade. “But I needed that time because it took a long time to get me from this little girl who was just hurt to become a full-blown addict. You can’t just go ‘Oh, poof, I’m better.’”
She’s been clean for 10 years and runs Unlimited Alternatives in Grand Rapids, a drop-in center for people with mental health issues. She cautions against pressuring people to get off treatment too quickly.
Schade also speaks out against the stigma associated with using medication maintenance to achieve recovery.
“MAT is not ‘trading one drug for another,’ it’s replacing what’s chemically missing in your brain because of repeated drug use, and while you are replacing that, being able to be in a behavioral health program, working on yourself, talking to therapists, working through traumas,” she explained. “So you can get to a place, if you choose, to get off MAT.”
The state requires that methadone clinics test clients weekly for other drug use, ensure they attend counseling and have regular face-to-face visits with doctors.
Clinic operators are also required to have certain levels of security on site.
“We manage the risks that are there,” said Mike Reagan, Chief External Relations Officer at Cherry Health.
Methadone, an opioid itself, is prone to diversion — being sold on the street.
“Can methadone be abused? Absolutely,” said Reagan. “Do we pay attention to that? Yes.”
In fact, Reagan reported that Cherry Health was forced to discharge 12 percent of its total clients in the past six months for various issues, including non-compliance with rules.
Methadone clinics themselves are heavily regulated by both the federal and state governments.
According to records from Michigan’s Department of Licensing and Regulatory Affairs, each of West Michigan’s six methadone clinics have been declared “out of compliance” on various policies at some point in the past several years.
The records, obtained by Target 8 through the Freedom of Information Act, show that the clinics are most often cited for being “out of ratio” or not having enough doctors, nurses or counselors per client.
But the state is currently reviewing the decades-old ratio regulations for potential revisions.
“I think the biggest number of citations you will see in our program is by people not meeting the right ratio but what we have to ask is, ‘Is a ratio the best measure?’” asked Larry Horvath, Director of the Bureau of Community and Health Systems within LARA.
He said the quality of care doesn’t always align with meeting a measure.
“You could be meeting the measure and still delivering poor quality care,” said Larry Horvath, Director of the Bureau of Community and Health Systems. “And you could not meet the measure and still be delivering good quality care.”
Horvath says the state is forming a small work group to examine its oversight of substance use disorder programs to determine if changes are warranted.
Meanwhile, Patrick Pierce is determined to be off methadone by Spring.
“I think I can do it,” he told Target 8. “If I just keep going down every day, two milligrams, maybe an occasional three milligrams, and when I start feeling funny stop, and then I’ll get back on track and I’ll drop again.”