As Mecklenburg opiate deaths rise, clinic programs provide low-cost, no-insurance treatment

Jul. 10--Opiate addiction takes a brutal toll on the body, but there's another cost: the financial one.

Medication-assisted treatment, uses drugs that help people hooked on drugs like oxycontin, heroin and fentanyl stave off cravings long enough to quit.

Full out-of-pocket costs for medication-assisted treatment can cost hundreds of dollars per visit, according to Dr. Jay Fernando, a Charlotte physician who is board-certified in addiction medicine.

Fernando is heading up a new program at the Charlotte Community Health Clinic to provide buprenorphine (the common name of opioid Suboxone) treatments to low-income patients without insurance on a sliding scale, dropping their costs to as low as $25 a visit.

"When you're strung out on heroin, you probably don't have health insurance," said Betsy Ragone of advocacy organization Michael's Voice, which she founded after her son Michael overdosed on fentanyl-laced heroin at her Charlotte home in 2016. Ragone is unaffiliated with the cost program.

And doctors who prescribe the mitigating drugs may not even take insurance, Fernando said. He said that some Charlotte physicians may have policies that turn away patients who can only pay with Medicare or Medicaid, both of which will be accepted in the pilot program.

How will it work?

The grant-funded program has enough spots for around 30 people. Payments are on a sliding scale, with allowances given to those with Medicare and Medicaid, as well as unemployed people and those with dependents. If a person has Medicaid health insurance, their cost could be only $3 a visit.

Several drugs are currently approved on the market to combat addiction. Buprenorphine, which is used by the Charlotte Community Health Clinic program, is an opiate that suppresses cravings for more harmful opiates like heroin and fentanyl.

Individual buprenorphine films -- typically taken under the tongue up to three times a day -- cost $3.25 each out-of-pocket.

Fernando said that a regular course of treatment would run at least nine months to a year, though dependency to the new drug can develop. Other clinics in the Charlotte-Mecklenburg area use methadone, which functions similarly but can create euphoric effects, leading to the possibility of abuse, he said.

McLeod Addictive Disease Center, a statewide network with a branch in Charlotte, offers both methadone and buprenorphine treatments for $12-18 a day after intake costs. That center takes several varieties of insurance and has Medicaid evaluations and may offer grant-funded treatment to the uninsured, said center president Mary H. Ward.

Much of the cost comes from supplemental treatment in addition to the medication, Ward said. This includes counseling and psychological services.

The health clinic pilot program also combines counseling with a variety of medical checkups, from dental to physical -- often finding ignored conditions from heart murmurs to STDs. Addiction is best combated by improving a patient's whole life, Fernando said.

"The medication is for them to enjoy the new life [and] to realize 'my goodness, how much better this is,'" Fernando said.

With this treatment program, cycles can be broken, allowing people to return to normal life. But for some, treatment may be in the form of life-long chronic disease management, Ward said.

And controversy persists in the local recovery community, Ragone said, about treatment plans at all -- people view swapping one dependency for another as not really quitting.

"We don't even think twice about someone being on an antidepressant for the rest of their life," Ragone said. "This (heroin) is a drug that just rips the life out of people. How could you not support someone [quitting]?"

Why now?

Overdose is the CDC's highest cause of death to adults under 50 in the country. And within Mecklenburg County, overdose rates are on the rise.

"There is a huge need for this program," Charlotte-Mecklenburg Police Department Detective Donna Ring said. Ring, now a missing persons detective, previously worked with heroin-related crimes within the county.

In 2017, there were 168 opiate overdose deaths in Mecklenburg County. . Between 2012 and 2017, opiate overdose ER visits rose by 127%.

Last year, providers in Mecklenburg County dispensed over 21,348,000 opioid pills to residents. And as people start to get hooked on the drugs, their future and their options narrow if they can't afford costly rehab programs or monthly-injection treatments like the kind Fernando dispenses in his private practice.

During one quarter of 2018, over 800 people with opiate addictions and no insurance sought help within Mecklenburg County at programs like the McLeod Center. There's also what Ragone called the "Medicaid gap" -- for people who have government insurance that isn't premium enough to pay for some physicians' addiction treatments.

Ragone said that accessible programs are still "gravely needed" in Charlotte and similar communities. "It's still in the closet, there's still so much denial and shame," she said.

She said that if resources were more available, there might have been more that could have helped her son. "By the time I got through fishing through the red tape, he was gone," she said. "He was gone."

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