(Lebanon) -- Dawn Forsythe and Gene Quinter have lived through the ups and downs of using methadone to combat heroin addiction.
The downs can be harrowing: when Forsythe was recently forced to withdraw from methadone, symptoms such as stomach cramps and inability to sleep were so bad she would spend hours crying on her couch over how badly she wanted to get high. But that paled in comparison to the upside - methadone allowed Forthsythe and Quinter to keep cravings for more dangerous drugs at bay.
It helped them conquer a decades-long enslavement to heroin that led them to several prison sentences and left them sleeping on the floor above the garage where Quinter worked. They are now proud homeowners in Wernersville, Berks County.
"Methadone is the only thing that ever worked for me," Quinter said.
Methadone is one of the oldest drugs used to treat heroin addiction. Some addicts say it helped them conquer their addiction after nothing else worked. Sean Heisey, Lebanon Daily News
That doesn't mean methadone is best for everyone. But Forsythe and Quinter are sure of one thing: that forcing people to abruptly abandon their methadone treatment when they enter prison makes it more difficult for them to stay clean when they re-enter society.
Several scientific studies and recommendations from major health agencies support that view. However, many county prisons in Pennsylvania - including those in Lebanon, York, Franklin and Adams counties -- don't allow addicts using methadone to continue their treatment, citing regulatory concerns, costs and the drug's potential for abuse.
As a result, many people have to experience severe withdrawal while adjusting to prison.
"Especially when you're confined to a cell for 22 hours a day, your skin is already crawling and you just get panic attacks and anxiety," Forsythe said. "They go nuts. Most of them end up in medical because of it."
Advocates say there is a better option.
Methadone is not the only medication used to assist heroin addicts. Vivitrol, which blocks the opioid receptors in the brain and prevents people from getting high, is preferred by many experts because it is not addictive.
Franklin County is almost ready to begin allowing inmates to receive two shots of Vivitrol before leaving prison in hopes that they continue the treatment afterwards, said Warden Bill Bechtold.
Still, methadone -- like heroin, a type of opioid -- remains by far the most common treatment for heroin addiction. It is so common, in fact, that about 40 prisoners who enter Lebanon County Correctional Facility each year must detox from methadone.
Historically, treatment for prisoners with drug abuse disorders has been rare. Among state prisoners in 2004 throughout the United States who had been drug users, fewer than 1 percent received a maintenance drug or were treated in a detox unit, according to a Bureau of Justice Statistics report. Fewer than half received any addiction treatment at all.
Yet a series of studies and policy recommendations collected by the National Association for the Treatment of Opioid Dependence recommend maintaining methadone treatment in prison, so as to increase the likelihood a prisoner will stay clean when they re-enter society.
"There's no rational argument against this," said Mark Parrino, president of the association.
It also makes sense to Berks County Deputy Warden for Treatment Stephanie Smith. Berks County Prison is one of the few that allows inmates to continue methadone treatment.
"It's a program that's helping them manage their addiction while they're here," Smith said. "They're not just accessing the medication, they're accessing the counseling services that are required to go along with the medication."
Berks County Prison's approach to methadone treatment is unusual, however.
In Franklin, Adams and York counties, prisoners must immediately withdraw from methadone, although they receive other medical treatment that helps reduce withdrawal symptoms, said Todd Haskins, spokesman for PrimeCare, which provides medical services for all three facilities. Lebanon County, which operates its prison medical care independently, also requires a medically supervised withdrawal but with a tapered reduction of methadone by 5 milligrams per day, according to a county policy.
Pregnant women are an exception. They can maintain methadone treatment throughout their pregnancy in all four counties because withdrawal increases the risk of a miscarriage.
The state Department of Corrections also doesn't typically allow prisoners to continue methadone treatments in state facilities. However, it will eventually begin providing methadone "where deemed appropriate," according to a plan released in October 2015.
"Research has shown once and for all that traditional approaches to address this problem, such as 'just saying no,' are just not working," according to a Department of Corrections informational handout. "Instead, (medication-assisted treatment) sheds some light on what's been a dark outlook for many years."
Although there are cost and logistical barriers to providing methadone in prison, the biggest challenge might be attitudes toward the treatment itself. The Pennsylvania Department of Corrections identified negative attitudes among staff in treatment facilities and 12-step programs toward using medication to treat addiction as the primary barrier to administering it.
Jocelyn Woods, executive director of the National Alliance for Medication Assisted Recovery, described the attitude of many prisons as a "Medieval mindset."
"(When it comes to) maintaining the health of the inmate they have in custody, they just feel like they have no responsibility for that," she said.
Methadone has its fair share of detractors - even outside the prison setting - particularly because it is itself an addictive substance, and quitting can cause severe withdrawal symptoms. The Florida-based Novus Medical Detox Center on its website described methadone as a "trap every bit as terrible as heroin or OxyContin addiction."
Based on personal experience, Quinter disagrees. For him, methadone helped him kick his heroin habit in a way that Narcotics Anonymous support groups and time spent in jail never could. Even though it is addictive, it doesn't make him feel high, allowing him to maintain a steady job and avoid trouble with the law.
"Some people do abuse it, don't get me wrong. But it's not the same high," he said. "I don't take it to get high. I take it because it keeps me clean."
The bottom line, according to Parrino: "You have to have a warden that understands the value of this and wants to do it."
Local prison officials insist they do care about the health of their prisoners. However, allowing methadone treatment to continue in prison requires coordination between a willing methadone clinic, the county, and the prison medical provider, and there are several potential barriers to this being successful, said Todd Haskins, spokesman for prison medial care provider PrimeCare. These include:
It costs an average of $4,700 per person for a full year of methadone maintenance treatment, according to the National Institute on Drug Abuse.
The Lehigh County Department of Corrections used to permit its methadone clinic provider, New Direction Treatment Services, to come to the prison to provide methadone and associated counseling services, said Director of Corrections Ed Sweeney. That arrangement ended in August 2015 because New Direction found it to be financially unsustainable, Sweeney said.
The big problem, he said, was the insurance coverage gap: Medicare generally stops paying for health care while a person is incarcerated, shifting that cost to the prison facility. Most prisoners, particularly those destined for state prison, were unable to reimburse New Direction for the cost.
Berks County pays for people on methadone maintenance before they enter prison to continue treatment in the county prison. The annual cost varies, from more than $16,000 in in 2015 to a projected total of more than $25,000 in 2016, Deputy Warden for Treatment Stephanie Smith said.
Smith wouldn't say every county should pay for in-prison methadone treatment - "every county's budget is different" - but in Berks County, she believes the benefits to society justify the expense.
"There are costs associated with it. However, there are costs associated with addiction and crime and people causing issues with society at large, and if we can get them on an effective program, that will help them stay sober," Smith said.
There are a variety of state and federal laws regarding the legal administration and use of methadone, including requirements that it be given in conjunction with addiction counseling, Haskins said.
Some prison officials raised reservations about permitting methadone since it is an opioid and could be trafficked and abused within the prison. Sweeney, however, said prisons should be able to overcome that obstacle.
"From my perspective, that's not really a barrier," he said. "We have a responsibility to make sure that medications are secure."
Methadone is often a liquid, not a pill, said Jocelyn Woods, executive director of the National Alliance for Medication Assisted Recovery. Therefore, the nurse can make sure the prisoner actually swallows it, unlike a pill that could be put under one's tongue.
This story is part of a partnership between WITF and the Lebanon Daily News.
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