Robert Van Natter was rocking out at a Charlie Daniels concert during the summer of 2013 when he fractured his right foot.
Two months later, he underwent surgery to have a metal rod installed to stabilize the broken bone. To aid in his recovery, a doctor prescribed painkillers. And for the next 14 weeks, Van Natter sat on a couch watching movies, playing video games and popping pills.
“It was almost like those pills, at that time, ... I don’t want to say they were my friend, but they were the one thing that made sitting at home by yourself all the time OK,” he said.
It was the start of a three-year opioid addiction.
Van Natter now travels 106 miles a day, five days a week, round-trip from Pagosa Springs to Durango, to receive counseling and methadone treatment from Southern Rockies Addiction Treatment Services.
“Everyone says, ‘Wow, that’s a lot,’ but no one ever saw the extent I was going through to get drugs – like the amount of time I would take for that,” he said. “It’s worth every mile I drive.”
Southern Rockies Addiction Treatment Services, which opened a little more than a year ago in Durango, treats opioid addiction by prescribing opioids. The idea is to wean people off heroin and prescription drugs by using less intense narcotics such as methadone and Suboxone.
In many cases, it is unreasonable and sometimes dangerous to expect an addict to give up opioids cold turkey, said Dr. Daniel Caplin, owner of Southern Rockies Addiction Treatment Services, which has about 100 clients and is about to expand.
Most experts agree medication-assisted treatment is the best option for treating people with opioid addictions, Caplin said. It is similar to treating smokers with nicotine gum and reducing the dosage over time, he said.
“We don’t just tell people to stop using, because that doesn’t work,” he said.
It can take two years or more of drug-replacement therapy for brains to heal from prolonged addiction. As the supplemental dosage is reduced, clients are provided with counseling to help them understand their addiction and give them the tools to manage it.
Methadone is a synthetic drug developed about 1940 as a pain reliever that has proved effective with the detoxification of opioid dependence. It provides the effects of opioids without causing the intense highs and crashes common with opioid use, Caplin said.
“It turns the cravings off once you get the appropriate dose and allows people to become normal, get counseling, therapy, focus on themselves and focus on what they’re treating,” he said.
The methadone is kept behind heavy metal doors that more closely resemble prison doors than a doctor’s office. After being let in, clients walk up to a glass window where they sign for a daily dose.
They take the liquid substance in front of the staff, and depending on their level in the program, they are given a take-home dosage so they don’t have to return every day.
Van Natter is entrusted to have two take-home dosages per week – for Sunday and Tuesday; every other day of the week he must visit the clinic. Clients also take drug tests, and if they fail, they loose a take-home day and must start reporting to the clinic with more frequency.
“You just kind of slowly earn your days,” Van Natter said. “... The methadone, you don’t get that really euphoric high that you get off taking heroin and stuff. You certainly don’t get high off of it.”
Caplin said among those addicted to opioids, about a fourth are introduced to it through a doctor’s prescription. But in Durango, which has an above-average active outdoor lifestyle, about half of his clients were introduced to the drug after a sports-related injury.
“It’s not the typical stuff that other addiction doctors are seeing, where three-quarters are recreationally started,” Caplin said. “It’s football and skiing and snowboarding injuries, and back injuries and dirt biking injuries – you name it, people are playing hard here.”
He added: “There are a lot of very responsible doctors out there, but there are a small percent who are very irresponsible.”
Van Natter said his doctor never inquired about his pain medication, including how he felt about the dosage or the psychological and emotional effects it was having. It may have helped, he said, if his doctor had lowered the dosage near the end of his recovery rather than keep the dosage high until the prescription ran out.
When his prescription expired, he found a street dealer who could supply him with pills. But pain pills are expensive compared with heroin, and like so many people who are addicted to pain pills, he made the switch to heroin.
“That’s why heroin is taking over, because it’s so much cheaper,” he said. “The pain pills are just a problem, all around.”