Over a decade ago, Regina Sampieri’s mom called the police on her because she was afraid she would die. Sampieri was abusing painkillers and getting dangerously thin.
“I used to describe being on drugs as being on the merry-go-round from hell,” Sampieri says. “You’re up, down, up, down, around and around—and all you want to do is get off this crazy, awful merry-go-round—and you can’t. You’re stuck there.”
As part of her probation, she had to get into treatment. After Sampieri went to two inpatient programs and couldn’t stay clean, she switched to a program that offered methadone.
“I get up in the morning, I take my methadone, I take my multivitamin, and I go about my day,” Sampieri says of her current routine.
But Sampieri has to travel two hours from her home in Fairfield to a clinic in Marion to get the pink liquid that she says allows her to live a normal life. That’s because there are no methadone providers in southern Iowa.
When she started the program 11 years ago, she had to make that trip every single day.
“It was worth it for me, though, because it was something that worked so well almost immediately for me,” Sampieri says. “I felt like this is the right thing for me. I felt normal again.”
Many Iowans can’t drive four hours roundtrip every day. That means they can’t access all the options for medication that—when combined with therapy—is considered the most effective way to treat opioid addiction.
Iowa’s increasing number of opioid-related overdose deaths got the attention of state lawmakers this year. They are considering bills to prevent doctor-shopping, to identify patients who might be addicted to painkillers, and to save lives when heroin users overdose.
The next step—making sure those people can access addiction treatment—is missing from that legislation. But stakeholders say expanding access to treatment that includes medications like methadone may not be as simple as a legislative fix.
At UCS Healthcare, a Des Moines-based addiction treatment center, Clinical Director Missy Howard says a lot of people have the preconceived notion these medications, and the people who use them, are bad.
“These people are being looked at like they’re using a crutch,” Howard says. “You would never look at a diabetic who’s using insulin and say, ‘That’s just a crutch for you.’”
Treatment advocates say that attitude is the biggest barrier to expanding access to medications that aid recovery for opioid addiction. There’s a general lack of education and enthusiasm for it that extends to physicians, other treatment facilities, and health insurance companies.
“And so we’re trying to remove stigma,” Howard says. “It’s a battle.”
Many of Iowa’s existing treatment centers don’t offer “medication-assisted treatment,” which is what medical professionals call the combination of medication and counseling to treat addiction.
Stephan Arndt, is director of the Iowa Consortium for Substance Abuse Research. He says in 2016, 46 of Iowa’s 163 substance use disorder treatment agencies offered some form of medication-assisted treatment.
“Some people can use abstinence only as a way of getting clean and sober,” Arndt says. “I think there’s ample research to show, though, that people fare better with medication-assisted treatment.”
The severe pain associated with withdrawal from opioid use is one reason treatment providers say medication is especially helpful for these patients.
Brandon started getting methadone at UCS about a year ago after struggling with heroin addiction.
“The withdrawal symptoms were terrible. It prevented me from getting up out of bed, and it pretty much controlled my life,” Brandon says. “And as soon as I started the [medication-assisted treatment] program, that changed my life immediately. I was able to go back and do the things that I normally do.”
IPR agreed to use Brandon’s first name only because of his history of illegal drug use. He says he’s been able to save up money since he started treatment and is planning to go to college soon.
“There’s a sense that these people are using the old-fashioned methadone clinic with people standing in lines early in the morning to get their methadone in poor areas of the cities,” says Mike Polich, CEO of UCS Healthcare.
His treatment organization looks like any other clinic, with a waiting room, offices, doctors, nurses, counselors and pharmacists.
“It’s a regular medical arena where it has all the services a person suffering from a substance use disorder needs,” Polich says.
More people struggling with addiction in other parts of the state will soon have access to this kind of treatment. With the help of UCS and a federal grant, southern Iowa is set to get its first methadone provider in late April. UCS will be offering the full range of medications out of an existing treatment center in Ottumwa.
“It’s a real joint effort going on out there,” Polich says. His organization is also expanding use of these medications in Waterloo, Ankeny, Knoxville and Burlington.
Clinics that aren’t licensed to provide methadone can get certified to offer a different kind of medication, often dispensed in the form of Suboxone. The list of medical providers who can prescribe it is growing fast, according to the Iowa Department of Public Health.
Grants from the federal government are also helping to expand medication-assisted treatment in the state.
Still, it’s estimated that only about 13 percent of Iowans who need treatment for drug use are getting it.
Rep. Chuck Isenhart, a Democrat from Dubuque, is proposing a bill with the goal of getting 80 percent of those people into treatment.
“To do that, we need a monumental increase in system capacity, number of providers, and for people who can’t afford it, the public funding to pay for those services,” Isenhart says.
His bill, which he acknowledges is unlikely to move forward in the remaining days of the legislative session, would put a tax on opioids to raise funding for addiction treatment.
Rep. David Heaton, a Republican from Mount Pleasant, says the state’s Medicaid program needs to make sure this kind of treatment is encouraged and paid for. Doctors say they often run into problems when seeking authorization to prescribe Suboxone for patients who are insured through Medicaid.
Other proposals include convincing more doctors to get involved in addiction treatment, getting all insurance companies to cover the medications and counseling, and removing some of the strict regulations on prescribing Suboxone.
“I don’t know if it’s a lawmaker solution at all,” Polich says. “I think we need to do a lot of educating everywhere about substance abuse treatment and these pharmaceuticals that are being used to support the treatment.”
Regina Sampieri says she can’t understand why it has taken so long to expand access to something that works.
“We need a change, we need a fix, and we need it now,” she says. “Because people are dying every day that don’t have to be, if they had access to this.”
With a new clinic slated to open closer to home, Sampieri says she has a few friends who might be saved by it.
