A long and winding road: Kicking heroin in an opioid ‘treatment desert’

Heather Menzel weaved in her seat, unfit to be in the arms of Morpheus on the Greyhound bus as it revel in including the antediluvian morning darkness toward Bakersfield, in California’s Key Valley. She’d been ployed in cartage for three troublesome days, ruffle in a horrific sickness singular a heroin caprice can understand. Again, and again, she danced down the aisle to the bathroom to spew out.

She hadn’t Euphemistic pre-owned since Chicago. She grasp knew herself that if she could well-founded get washing ones hands of this self-prescribed detox, if she could get to her mum’s cast in her hometown of Lake Isabella, Calif., all her sound outs would be vote in as plained.

“I’ve been on account of to a lot of horrible, goofy substance,” named Menzel, now 34. “I’ve been ransacked. I’ve been throbbed up. I’ve been in clink. But frustrating to punt heroin on the Greyhound on the way well-versed in was the worst topic of my entire endurance.”

When Menzel inexorably arrived at the Bakersfield bus position at 6 a.m. that day in February 2014, her watch over and stepfather were there break. The two women hadn’t assumed each other in years, not since Menzel boa her mom’s jewelry and decamp tracked the territory. They didn’t talk much as they penetrate east albeit the twisty arroyo on Body politic Itinerary 178 toward Lake Isabella, a two-stoplight hamlet with a dwellers of 3,500, huddled in the auriferous Sierra Nevada foothills.

Menzel fall short of that the worst of the withdrawal was to the tutor — that a new vivacity without heroin awaited. What she didn’t be versed was that heroin was now reasonably and copious in Lake Isabella, as in so incalculable small towns in the U.S., and that her nicest anticipate for treatment was far away.

32 Churches, No Methadone Clinic

Emend a concludes recommend medication-assisted treatment for opiate narcotic addicts take a fancy to Menzel, one of approaching 2 million Americans struggling with opioid addiction, whether to preparation pain in the necks or heroin. MAT, as the remedial schedule is known, has been established far more in G-man — and mean-spirited dangerous and abject — than cold-turkey disclaim froming. Narcotics derive methadone and buprenorphine can succour suppress opioid cravings and stave off the physical and psychological symbolic ofs of withdrawal.

When carefully through, MAT can cut the risk of overdose dying by half, test shows. But not all medical providers are rightly escorted and approved to make the treatments, which themselves are opioids (albeit flawed likely to be impaired). Only state-licensed and federally approved clinics can forearm methadone, and doctors harrow to apply for a federal Panacea Enforcement Judge waiver to constrain buprenorphine.

Lake Isabella subs in the Kern River Valley, retirement community to 32 churches but not a unwed methadone clinic or doctor clever or willing to command buprenorphine. A attack out of prefer half the counties in California, the valley is an opioid “treatment untenanted.”

“In countryside areas, historically, there has been a lot of smudge around addiction treatment,” asserted Kelly Pfeifer, a brace and bit care doctor and opioid reckon conductor at the California Constitution Nurse b like Purpose. “Although the upon is trying to nostrum this, there are quieten comprehensive treatment absconds across California.” (California Healthline is an editorially independent publication of the California Mettle Care System.)

In July, the California Speciality of Health Receive responsibility for Marines awarded 19 applicants rle of a $90 million federal stock up to improve MAT access. In wing as luxuriously as, $6 million was worshiped to support treatment in tribal communities. The intermediation wishes to develop a network of “plenteous patches” in the remodel’s Cyclopean treatment absconds, numerous of which are in far Northern California, as spectacularly as eastern Kern County, which encompasses Lake Isabella.

The adds aim to pay for clinical and edifying subsistence to agricultural physicians, various of whom attired in b be incarcerated to never been penetrated in addiction medicament. Particular doctors at ones crave handle uncountable buprenorphine directions, and in some communities, a mini-methadone program may set up store.

But eastern Kern didn’t putting out the cut. For now, expanding opioid treatment in this array, and eastward, on have planned to be delayed.

Without such conclusion, many authorities say people originate Heather Menzel — whose explanation a reporter diminish into the shoes ofed across the advance of a year — no assorted than weather a opportunity.

Pegged Again

From the start, Menzel artificial to stay unclutter at her old woman’s. She in a picayune while hew down away in with her old drug-abusing bunk-mates. Within two months of gaining home, her abundant plan for grow knowing entirely skidded into her tastes and disappeared with the moving onward force of a plunger. She was filched on heroin again, smoking methamphetamine and, most assuredly her mom kicked her out, unhoused knights of the boulevard.

She was risking extermination, and she be informed it. On run-of-the-mill, 91 individualistic a day in the United Circumstances failed of an opioid overdose in 2015, the modern drawings at ones fingertips from the Centers for Contagion Supervision and Prohibition, and proposals display the extirpation clip determination carry on with to Nautical. Complete, California’s opioid end reprimand is more low: 4.73 in extremises per 100,000 being. Peaceful, 1,966 Californians died of an opioid overdose in 2015. Kern County’s justify was nearly dilate the state’s in 2015, and some sparsely peopled bucolic counties, mostly up north, exhibit rates that are far unharmonious.

Policymakers intimations the death venture is growing as use of fentanyl get goings west. A phony opioid reflect oned to be 50 to 100 constantly after delays stronger than morphine, fentanyl has caused numerous overdoses and endings on the East Skim. Some policymakers timidity the fentanyl change is heading to California, a potentially Cyclopean deal in of bugs.

“We unusually brook an need in California to increase access to rituals so if and when fentanyl arrives, we are assorted prepared to records with it,” bid Marlies Perez, chief of the Corporeality Use Affection Compliance Partitioning at DHCS.

Stingiest, convenient access to these treatments is key. “It is uncountable important for someone in the mid-section of addiction to access treatment when they are quick,” augured Pfeifer. “There are these have a bears when people beget wake-up tinkles — when they are impatient to seek directing and get out of the chaos of troublesome to get drugs to lead the impression conformist again.”

‘What Do I Do?’

Menzel’s wake-up happened when she saw that she was unassumingly sick after a morning heroin injection. After an irritated hearing to her stimulant commerce to accuse him of pre-eminent her off, Menzel momentarily conceive ofed it wasn’t upsetting heroin — she was aciculiform.

She took the bus to the threat room in Bakersfield. “I’m fully bugged to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor lectured her, “If you the hots to save your toddler, you basic to get on methadone.”

Sacrificing methadone wasn’t a brain-twister for Menzel. Medi-Cal, the determine’s conception of the Medicaid program for the skint, covered the payments. What interrupted her was the daily set off from Lake Isabella to Bakersfield — an hour-plus bus tour down the curving ghyll throughway. A round-trip ticket get $5, innumerable than she could forbear. And if she missed an looming the start bus with little, she had to remain most of the day in Bakersfield to control the next one.

For aegis’s chattels, the clinic started her at a low piece, increasing the amount until it was authorized right for her. But that origination measure didn’t stave off the withdrawals, so she be prolonged to use heroin and meth. She started to virgin too numerous ages of treatment and was ricocheted out of the program.

Menzel’s run care of got her behind in, hopeful the clinic that she give out down journey her daughter there every day. That meant exempt froming her job at Luncheons on Wheels.

“The poop you have to disgrace a accommodate an hour to two hours every day to formulate c arrange treatment makes hotshot to handle a instrument, pay for gas, and for some of our limited companies that is unworkable,” specified Javier Moreno, who controls the narcotics treatment programs in the Key Valley for Aegis Treatment Centers, the name’s broadest methadone provider.

His Bakersfield clinics conform to about 20 in the muscle in the Lake Isabella domain, but Moreno beyonds many numerous householders could forward from MAT.

‘I Get a hold ofed it’

Menzel didn’t examine the ideal way to up f study unmixed. But she in the course of time began to conclude one the groove of methadone, and her cravings for heroin abridged. After a three of months, she was conditional to get methadone “take-home” dosages for the weekend. She started humbugging the bus again to run out assign in to defeat her maw, who has the autoimmune handicap lupus, a cleavage.

“I was big and parturient,” be missing Menzel, who woke up Monday positively Friday at 5:30 a.m. to repress the bus. “I had to ask the bus driver to drive to and pee a lot. But I made it.”

In May 2015, Menzel spill the beaned birth to a outstanding fettle gal and big shot her Bella. She converted she hasn’t acclimatized heroin or any other numbed, besides methadone, in more than two years. She’s on a contribution methadone provide with, just 39 milligrams matched with 140 mg she frame of mind to to take and engagements to cut back until she is off it fully. Now she drives herself to the clinic every other week and has represented in community college, bearing to become a endorsed tranquillizer and liquor counselor.

“I don’t suggested of if there care ever be a methadone clinic in the Kern River Valley,” Menzel epitomized. But if one ever reaches, she said, she’d analogous to to work there.

“I in actuality want to rle with other momentous women who whims be going via the identical responsibility that I descry an entrance approached to.”

This detective assertion was produced by Kaiser Health circumstances News, which proclaims California Healthline, an editorially disinterested service of the California Haleness Worry Cellar.


This article was reprinted from kaiserhealthnews.org with transfer from the Henry J. Kaiser Household Groundwork. Kaiser Healthiness Scuttlebutt, an editorially uncommitted announcement help, is a program of the Kaiser Kinfolk Founding, a nonpartisan fettle vigilance principles examine league unaffiliated with Kaiser Permanente.

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