December 11, 2012
AP Legal Affairs Writer
A new for-profit, cash-only drug clinic that uses medicine to treat painkiller addicts is raising concerns in a county known as an epicenter of Ohio’s prescription painkiller epidemic.
Kentucky-based SelfRefind opened the clinic this fall in Portsmouth, its first in the state. Selfrefind also has 11 clinics in Kentucky and one in Tennessee.
The clinic provides prescriptions to Suboxone, a medication that treats addicts’ withdrawal symptoms and blocks brain receptors to counter the effect of craving for narcotics like heroin or oxycodone.
Critics say Suboxone clinics keep people on the drug too long without the extensive counseling needed to break an addiction. They also worry such clinics contribute to the illegal sale of Suboxone, which is rising in Ohio and around the country.
Company officials, aware of the community’s concerns, are taking extra steps to assure residents they are not a pill mill in disguise. SelfRefind has met with local business and health care leaders and with the state’s top addictions officials to explain their mission.
“We’re a treatment program,” said SelfRefind spokeswoman Michele McCarthy. “We don’t just write a prescription and take money and move along.”
The company prefers money orders or credit cards to actual cash but doesn’t take Medicaid or private insurance for now. It hopes to add Medicaid coverage to its reimbursement plan by becoming state-certified.
The clinic is housed in a former pill mill on the outskirts of Portsmouth, an economically struggling city across the Ohio River from Kentucky about 100 miles south of Columbus.
For years, Portsmouth and surrounding Scioto County were home base to more than a dozen pill mills, cash-only clinics that distributed prescriptions on demand to addicts based on bare bones examinations.
Officials shut down the last such Scioto County clinic a year ago, and owners and operators of several of the clinics have been convicted of federal illegal drug sale charges. Authorities linked several drug overdose deaths to the clinics.
Officials who fought those operations are leery of new stand-alone prescription clinics.
“What I think we’re starting to see is a second generation of pill mills where money is the prime objective,” said state Rep. Terry Johnson, who fought the pill mills as county coroner and later as a state lawmaker.
He wouldn’t comment on the Selfrefind clinic specifically, but said he is concerned about clinics that treat people for months or years with high doses.
Suboxone should be used only to help someone withdraw from a painkiller addiction as part of an intensive counseling program, said Ed Hughes, who runs the Counseling Center in Portsmouth, one of the region’s largest addiction-counseling centers.
Others who battled the pill mills disagree, saying anything that helps reduce addiction rates is worth trying.
“These clinics aren’t treating pain; they’re treating addiction,” said Orman Hall, head of the Ohio Alcohol and Drug Addiction Services agency, who met with Selfrefind officials and says he was impressed with their approach.
Lisa Roberts, a public health nurse at the Portsmouth health department and one of the leaders in the pill mill fight, also supports the new clinic. Everyone has an obligation to look at scientific advances and see if there’s a way to give people better opportunities to recover, she said.
The federal government has approved 449 doctors and 48 treatment programs to use buprenorphine — a key component of Suboxone — for treatment in Ohio. A 2000 federal law approved Suboxone and a related drug for treating addictions.
Suboxone addicts say the drug changed their lives by allowing them to start working again, reunite with siblings and parents and in some cases regain children lost because of neglect charges.
Jane Schatz became addicted to Oxycodone after a car accident two years ago, losing her 9-year-old son because she couldn’t care for him. The Suboxone she has received through SelfRefind’s Frankfort clinic has allowed her to beat her addiction and regain her son. But the unemployed woman always worries about coming up with the $400 monthly cost of her office visits.
“I’m scared to go off it,” said Jane Schatz, 42, of Flemingsburg, Ky. “I still feel like I need that right now.”
The U.S. Drug Enforcement Administration says seizures of illegal doses of buprenorphine in 2011 were nearly eight times those in 2006. The national Drug Abuse Warning Network says the number of emergency department visits associated with nonmedical use of buprenorphine more than tripled from 2006.
Yet Suboxone’s legal use is also growing. Minnesota-based Hazelden, one of the country’s largest private drug and alcohol treatment centers, announced a medication-assisted program in October that includes Suboxone, citing the growing painkiller epidemic.
Neither Tennessee nor Kentucky regulate Suboxone clinics, but the director of Kentucky’s state health department’s substance abuse division said the clinics, with their focus on treatment, are a far cry from pill mills.
“It’s the difference between oranges and orangutans,” said Jeff Jamar of Kentucky’s Department of Behavioral Health, Developmental and Intellectual Disabilities.
SelfRefind screens potential patients through calls and an intake process, then starts addicts on short-term doses and requires them to stay sober to increase the length of a prescription. SelfRefind helps patients reduce the strength of the prescription over time, and cuts the cost of the prescription in half for patients who stay sober for more than 18 months.
“If a patient is doing well and sober, we look at other factors — are they employed, are they taking care of their family and their home, have they stopped breaking the law?” McCarthy said. “If the answer to all that is yes and we consider them a success to recover, why force them off?”