For some addicted to opioids, drug replacement therapy can be key to recovery
Stacy Zeigler stands for a portrait outside Open Arms Recovery Center in Hanover, York County. Zeigler has been off heroin for more than three years. She takes two doses of buprenorphine combined with naloxone each day. (Brett Sholtis/Transforming Health)
Like many others, Stacy Zeigler’s story of addiction begins in a doctor’s office.
In 2008 Zeigler was having severe back pain and was diagnosed with bulging discs and rheumatoid arthritis. Cortisone shots didn’t solve the problem, and as a single mother of three working full time, Zeigler didn’t see inpatient surgery as an option.
Zeigler was prescribed the painkiller Percocet. That stopped her pain for a few months. When it stopped working, she went back to the doctor.
“I took them like I was supposed to, and then eventually after a few months on those, he said, okay, we’re going to put you on Fentanyl patches,” Zeigler said. Soon, she was on OxyContin, and not long after, she was using the pills for more than just pain.
She was required to sign a narcotics contract that stated she wouldn’t abuse or sell the pills, a system that allows doctors to check in on patients and making them show how many pills they have left.
After Zeigler failed her pill count, she lost her prescription. With OxyContin selling for $30 or more per pill on the street, Zeigler made the jump that thousands of other prescription drug addicts make: the jump to heroin.
“I was at a friend’s house and ran into somebody that dealt heroin,” she said. “Well, everybody there was IVing it. I did it that way, and that was all she wrote.”
Soon, Zeigler was trying to balance a full-time job and raising children with a full-blown heroin addiction that had her shooting up several times a day.
A hallway wall at Open Arms Recovery Center is marked by names of those who entered the program but who relapsed and died. Stacy Zeigler, who has been off heroin for more than three years, said it’s a way to remember those who lost their battle. (Brett Sholtis/Transforming Health)
In 2010 she overdosed three times. She lost her job and lost custody of her children. Trying to get clean, she went to the black market to buy Suboxone, a brand-name version of buprenorphine, an opioid used to treat addiction to heroin and other opioids.
A coworker who learned Zeigler was buying Suboxone on the street told her about Open Arms Recover Center in Hanover, at the edge of York and Adams counties, that uses medication-assisted-treatment. Within a few days, she was in the program with a prescription for buprenorphine.
Buprenorphine and similiar drugs work for heroin users because they target the same parts of the brain that other opioids do. However, they are balanced by “antagonist” drugs like naloxone, which limit their euphoric effect. Medical experts tout the drugs, though they can be controversial because some people say the drugs are a Medicaid-funded way to get high.
Ziegler hasn’t touched heroin since she got on buprenorphine, and has been clean for more than three years. Eventually she left her job as a machine operator to work full-time for the clinic office, where she talks with others who are going through what she once experienced.
In some ways, Zeigler’s story is similar to the stories of about 600 people who have gone through Open Arms’ program since it opened in 2016, said assistant counselor Christina Martinez. The center is licensed for 200 patients, and is funded through Medicaid and insurance contracts charged for counseling services.
The center cannot charge for services related to prescribing buprenorphine, Martinez said. That means it has to rely in part on volunteers.
Gary Nalavany is an anaesthesiologist at UPMC hospital in Hanover. A few days each month, he volunteers at Open Arms, writing prescriptions for buprenorphine.
Nalavany has no personal ties to drug addiction. He says simply, he just wants to help. “Too many people are dying. That’s all.”
Former heroin users who go on an opioid replacement drug like buprenorphine and who also participate in the clinic’s counseling sessions are less likely to relapse than those who quit heroin without medication, Nalavany said.
“There are some gratifying results. Often what happens is, people will have children, and they’ll want to be a good parent for them, and that will be the impetus to go into treatment.”
Buprenorphine users can be weaned off the medication, Nalavany said. However, some people will stay on it for years. He said that’s still better than them being on heroin or dying of an overdose.
“It is true that you’re substituting one for another, but I’m just being pragmatic,” Nalavany said. “It works, and it’s safe.”
Stacy Zeigler points to scars, now barely visible in the sunlight, from where she used to inject heroin. (Brett Sholtis/Transforming Health)
Still, stopping the brain’s craving for opioids isn’t the only part of medication-assisted therapy, said Billy Duty, who is a substance abuse counselor at Open Arms.
Duty believes in pinpointing the “emotional root cause” of addiction. Sometimes, trauma and unresolved issues can prime someone for addictive behaviors, he said. Mixing therapy with medication allows people to focus on overcoming past issues while not having to fight off opioid cravings.
“I relate it to, you don’t tell a cancer patient, well, we’re not giving you medicine to help you cope with this,” Duty said. “The medication is what’s helping them cope with their disease while trying to live life.”
From Stacy Zeigler’s vantage point, people are getting better at understanding what leads someone to heroin addiction, as more and more people know someone personally who has gone through it.
“Of course, I have Facebook, and you see posts all the time, ‘they made that choice, they took that pill, they put the needle in their arm,’ but for a lot of people, like with my story, it didn’t happen like that,” Zeigler said. “I didn’t wake up one day and say, okay, I’m going to get addicted to pain pills and then get addicted to heroin. It was a gradual thing that I didn’t realize it was happening at first.”
More than three years since she got on buprenorphine, Zeigler does want to work with her doctor to wean herself off it. However, she’s afraid of relapsing, and doesn’t see any reason to rush it.
“I don’t get high off Suboxone. You can go a couple of days without it. Third of all, I haven’t relapsed. It does give me energy. I take one before work, and one after work.”
She said the one upside to her addiction is that it’s taught her to be patient and understanding with others. For her and others dealing with addiction, living with buprenorphine is a safe alternative to heroin that allows her to do what’s important: To be a mother to her three children, to work a job she cares about, and to live a normal life.