{"id":43698,"date":"2022-01-21T08:25:55","date_gmt":"2022-01-21T15:25:55","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=43698"},"modified":"2025-01-20T15:56:38","modified_gmt":"2025-01-20T22:56:38","slug":"helping-patients-with-opioid-addiction-move-on-to-recovery","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/helping-patients-with-opioid-addiction-move-on-to-recovery\/","title":{"rendered":"Helping patients with opioid addiction move from inpatient beds to recovery"},"content":{"rendered":"
<\/div>
\"A
A UCHealth program to channel hospital patients with opioid addiction to the ARTS community treatment program has changed Larry Harrison\u2019s life. Photo by Cyrus McCrimmon for UCHealth.<\/figcaption><\/figure>\n

The central act of Larry Harrison\u2019s day is to tip back a couple of ounces of liquid that tastes like pink cough syrup. On this day in early December, he has ridden a half hour in a white Helping Hands minivan from an apartment halfway across town to do so. He did the same thing yesterday; he will do it again tomorrow.<\/p>\n

The pink liquid contains a precise dose of methadone \u2013 in Harrison\u2019s case, 130 milligrams of it. Methadone binds to<\/a> the same brain receptors as opioids such as heroin, cutting cravings and quelling withdrawal symptoms that, in Harrison\u2019s case, \u201cget so bad I wish I was dead.\u201d<\/p>\n

Harrison, 50, has been sober for two years now. He has been clean thanks to a collaboration between UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a> and the University of Colorado School of Medicine Department of Psychiatry program called ARTS<\/a> \u2013 Addiction Research and Treatment Services. Since 2018, UCHealth specialists have been identifying inpatients with substance-use disorders and enrolling them; ARTS, which has been helping those with addiction since 1972, takes it from there. While one can\u2019t know what would have happened to Harrison otherwise, he has an idea.<\/p>\n

\u201cI had been on an 11-year heroin binge,\u201d he says. \u201cI was killing myself with heroin.\u201d<\/p>\n

Harrison, who was homeless for much of those 11 years, has come close before, overdosing a handful of times to the point he stopped breathing and turned blue. Abscesses<\/a> have left deep scars on his forearms and lower legs and required skin grafts on his shoulders. The infections developed because he resorted to injecting under the skin rather than into veins so destroyed from years of puncturing three to four times a day that, when hospitalized, nurses have had to put IVs in his forehead, he says.<\/p>\n

He has been hospitalized a lot. Asked how much time he\u2019s spent in inpatient beds over the past decade-plus, he estimates: \u201cThree years.\u201d<\/p>\n

\"Harrison
Harrison walks from his Helping Hands ride into the ARTS Potomac Street Center. He visits five days a week to quell his urge to inject the heroin he was addicted to for more than a decade. On Fridays, he brings home doses for the weekend.<\/figcaption><\/figure>\n

A thousand days, give or take. Dirty needles brought infection after infection, and most stays involved intravenous antibiotics and observation that went on for a couple of weeks or longer. He has suffered three major and six minor strokes which have long been<\/a> tied to heroin addiction (often, endocarditis<\/a> \u2013 another affliction common among intravenous drug users \u2013 is the trigger). The strokes have left his left arm and leg weakened and the left side of his face partially paralyzed. He moves slowly. He tires easily. He walks with a cane.<\/p>\n

Opioid addiction: A ‘Slave to the molecule’<\/strong><\/h2>\n

Harrison is far from alone in suffering irreparable damage from what he describes as \u201cchasing the dragon\u201d of opioid addiction. In fiscal 2019-20, ARTS treated about 1,500 outpatients among its three clinics, and ARTS\u2019s Potomac Street clinic that Harrison frequents is one of 28<\/a> opioid treatment centers statewide. They\u2019re all working to slow the growing damage the opioid epidemic continues to do. Colorado saw about 1,500 deaths<\/a> from drug overdoses in 2020 \u2013 up 38% from the previous year. Opioids caused more than half of them, with fentanyl<\/a> being the prime culprit. Nationally, more than 75,000 people died<\/a> of opioid overdoses in 2020 \u2013 nearly twice the 42,000 U.S. automotive fatalities that year.<\/p>\n

While opioid addiction is a vexing problem, the solutions are well understood. Forcing someone who\u2019s addicted to go cold turkey is not one of them<\/a>. The gold standard is called medication-assisted treatment<\/a>, and that\u2019s what Larry Harrison is doing through ARTS. MAT recognizes that opioids can change brain chemistry in ways that overwhelm conscious resistance and that pharmaceuticals such as methadone and buprenorphine<\/a> are often crucial to long-term recovery. But getting off opioids is about more than prescription drugs.<\/p>\n

Dr. Tyler Coyle, a CU School of Medicine psychiatrist and addiction specialist at ARTS, put it this way: \u201cYour brain just becomes a slave to the molecule, and you are not able to break free. It doesn\u2019t matter if you have children; it doesn\u2019t matter if you have willpower of iron. You can\u2019t do it on your own. You need a whole team.\u201d<\/p>\n

In a 2020 Colorado Health Institute report<\/a>, opioid experts also cited inpatient, residential, and outpatient treatment as well as \u201crecovery supports\u201d as being vital levers in tackling the opioid crisis. Those recovery supports include access to housing, health care and other resources \u2013 from counseling to reliable rides to methadone clinics \u2013 designed to promote recovery.<\/p>\n

Root cause of UCHealth-ARTS connection for patients with opioid addiction<\/strong><\/h2>\n

ARTS has been doing all this for years. UCH and has been treating patients for infections and other maladies caused by opioid addiction for years. It wasn\u2019t until Dr. Susan Calcaterra<\/a> arrived at UCH in 2018 that the UCHealth-ARTS connection happened.<\/p>\n

Calcaterra, who directs UCH\u2019s Addiction Medicine Consultation Service, came from Denver Health, where one of those 28 opioid treatment centers happens to be. She saw how the typical cycle of treating the medical maladies of those addicted to opioids and then sending them back out on the street to use drugs again, get infected again, and land in the hospital again could be broken. Infections looked like a health problem, but they were really just symptoms of the deeper disease of opioid addiction.<\/p>\n

Her inquiries led her to ARTS Director Angela Bonaguidi, and soon Calcaterra was training as an opioid treatment provider \u2013 a precondition for enrolling patients in methadone programs. State Opioid Response<\/a> Grant money channeled through ARTS would pay for a slice of her time far thinner than that which she would commit.<\/p>\n

The program works like this. When someone with substance-use disorder gets admitted, Calcaterra visits them, assesses them, and asks if they\u2019re interested in being a part of ARTS\u2019s drug-treatment program.<\/p>\n

She\u2019ll tell them things like, \u201cI\u2019m here to offer you a couple of things. It\u2019s up to you whether you want to take them. My goal is to make you feel a little bit better. And, by the way, you matter,\u201d she explains.<\/p>\n

For many, she says, the chaos and uncertainty of day-to-day survival has been too great a barrier to overcome. They haven\u2019t even considered treatment programs. If they choose to participate \u2013 and often they do, as was the case on a recent Friday, when Calcaterra enrolled three patients \u2013 Calcaterra signs them up and brings in UCHealth nurse Emma Maki-Gianani, a specialist in case management and substance-use counseling. Maki-Gianani spends about four hours with the patient working through the details of their lives, explaining the ARTS program, and dealing with a lot of enrollment paperwork.<\/p>\n

The descent into opioid addiction<\/strong><\/h2>\n

With Larry Harrison, that session and the ones that followed educated him on the path forward as he educated her on what he had been through. Following a childhood in and out of foster care, a telephone-sales job in Oklahoma City turned quickly into a telephone-sales management job. He later worked for years as a property manager. He married, had two kids, and was approaching his 40s in a stable, middle-class life when, in the late-2000s, kidney stones led to an overzealous Percocet prescription, and the sorts of pill mills that have made the Sacklers<\/a> infamous finished the job. The opioid addiction that roared in unraveled his life.<\/p>\n

\"Sober
Sober for two years now, Harrison says he\u2019s interested in giving back to others who are just starting on their journeys to recovery. Photo by Cyrus McCrimmon, for UCHealth.<\/figcaption><\/figure>\n

He, his then-wife, and two kids \u2013 a 12-year-old son and a 7-year-old daughter \u2013 came to Colorado as the weather turned cold in 2011. Robbed of what valuables they had at the bus station, they were forced to beg at intersections. Harrison resorted to selling drugs. Someone called the state Child Abuse and Neglect Hotline, and the kids were soon back in Oklahoma with his wife\u2019s sister. He hadn\u2019t seen them since, he told Maki-Gianani. He had been in and out of jail, in and out of hospitals, living in a vacant lot behind a Taco Bell near Interstate 225 and Peoria Street and lots of other places no one imagines themselves ever having to live, and propelled from hour to hour and day to day more or less solely by a primordial drive to feed his insatiable opioid receptors.<\/p>\n

Calcaterra emphasizes the importance of empathy and being nonjudgmental. Harrison saw that immediately, he recalls.<\/p>\n

\u201cThey actually care \u2013 I was so blown away by it,\u201d he says. \u201cI\u2019m at a place where they care about me and won\u2019t just throw me back out on the street. If you treat and then just let them go, they\u2019re right back where they were. It\u2019s kind of hard for anybody to be productive when they\u2019re sleeping under a tree or in a mud puddle.\u201d<\/p>\n

Once enrolled, the patient can start on an effective dose of methadone while in the hospital. That\u2019s important because methadone takes time to settle in, so having a good start prior to discharge boosts the odds of the patient staying with ARTS and away from used needles. UCH becomes a smooth on-ramp into the outpatient program.<\/p>\n

\u201cFor me, it\u2019s been very rewarding, Calcaterra says. \u201cWe\u2019re actually treating the underlying cause for their hospitalization \u2013 the opioid use disorder which led to their infection or endocarditis. \u00a0We used to send them on their way without ever addressing the underlying reason they were in the hospital.\u201d<\/p>\n

Cost, benefit of a partnered opioid treatment program for inpatients<\/strong><\/h2>\n

For Harrison, that program included a year at Christopher House in Wheat Ridge and, since December 2020, \u201crecovery supports\u201d including a furnished apartment in south Denver, counseling, transportation, and the ARTS clinic, among other services.<\/p>\n

Ultimately, that costs public money, and that gets us into politics. A commenter below a Denver Post<\/em> article<\/a> on methadone treatment summed up the instinctive resentment many feel: \u201cTaxpayers must pay for more treatment options for junkies\/addicts so they don\u2019t\/wont feel bad withdrawing\u2026 taxpayers shouldn\u2019t foot the bill for weak people\u2019s risky behavior!\u201d<\/p>\n

Dr. Joshua Barocas<\/a>, a CU School of Medicine and UCHealth infectious-disease specialist and addiction researcher, has heard those arguments. They\u2019re fueled by a belief that, as he puts it, \u201cSubstance-use disorders and addiction are so stigmatized, and we think of it as the fault of the person \u2013 that this is a choice. People in the general population believe that we shouldn\u2019t be willing to pay as much.\u201d His research focuses on health care cost-benefit analyses of addiction treatment.<\/p>\n

\u201cWe have evolved so much as a society that we have to make an economic argument,\u201d he says. \u201cIt\u2019s not enough these days to say, \u2018It\u2019s the right thing to do.\u2019 We need to pull people into the conversation by saying, \u2018Look, this actually is not only the right thing to do because we\u2019re human beings. If that\u2019s not enough for you, we can show that this is economically cost-effective compared to what we\u2019ve been doing.\u2019\u201d<\/p>\n

The results of a recent Barocas-led study<\/a> found addiction treatment programs such as ARTS to be vastly cheaper than, for example, familiar therapies for chronic health problems such as diabetes. Those figures don\u2019t include other societal costs such as those associated with crime reduction<\/a>.<\/p>\n

The health care savings from getting people who inject drugs into long-term recovery can be astronomical. In addition to the sort of care Harrison needed, HIV is spread through those injections, Barocas reminds.<\/p>\n

\u201cIf you prevent one HIV infection, you save $2 million in lifetime medical costs,\u2019\u2019 he says. \u201cIf I pay your rent for three months or three years, and that intervention gets you stabilized on buprenorphine or methadone, gets you a job and prevents you from getting HIV \u2013 isn\u2019t that investment worth it? Even if you don\u2019t care about the ethical side?\u201d<\/p>\n

Coyle added that MAT keeps addiction treatment in the preventive realm, where it can be managed with medications in much the same way that diabetes is managed with insulin or asthma with inhalers.<\/p>\n

\u201cThat ends up making a huge difference in the health care costs, and the health care costs trickle down to everybody,\u201d he says. \u201cIt helps people be the best versions of themselves. And that\u2019s what we want because it\u2019s going to benefit everybody.\u201d<\/p>\n

\"Harrison
Harrison drinks his daily dose of methadone. Photo by Cyrus McCrimmon, for UCHealth.<\/figcaption><\/figure>\n

Patients with opioid addiction get back to life<\/strong><\/h2>\n

It has certainly benefitted Larry Harrison. When he feels like he can handle it, he will start to taper his daily methadone dose down from 130 milligrams to, eventually, zero. But just as Calcaterra gave Harrison the choice to enter the ARTS program two years ago, the ARTS team is leaving that timing up to him.<\/p>\n

\u201cHaving a voice has been a pivotal part of my transition,\u201d Harrison said.<\/p>\n

He is grateful to both organizations.<\/p>\n

\u201cI was on the street. I was so filthy. I was worse than a person living in a garbage can. And I was treated the same way by society, by everybody. But UCH, there\u2019s something different about that hospital. They\u2019re treating these drug addicts like human beings: \u2018What do you think?\u2019 \u2018How do you feel?\u2019 \u2018How are we going to get through this together?\u2019 They said, \u2018We\u2019re actually going to treat the problem.\u2019\u201d<\/p>\n

With the basics of food, shelter, and MAT taken care of, Harrison has been sober for two years. As he works through his own transition to recovery, he hopes to start peer-counseling others just starting theirs.<\/p>\n

\u201cThe whole transformation just has been so easy on me,\u201d he says. \u201cI\u2019ve gone from being on the streets for 11 years to being on a path towards becoming a productive member of society again.\u201d<\/p>\n

From ethical, societal, and economic perspectives, that\u2019s good news for us all.<\/p>\n","protected":false},"excerpt":{"rendered":"

The central act of Larry Harrison\u2019s day is to tip back a couple of ounces of liquid that tastes like pink cough syrup. On this day in early December, he has ridden a half hour in a white Helping Hands minivan from an apartment halfway across town to do so. 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