It's not even 6 a.m. when Amy and Christie begin a 45 minute drive south.
The two friends are headed to a clinic in Hernando County where they’ll get a dose of methadone. They take this trip seven days a week, they said, to keep from relapsing into the pill addiction that nearly destroyed their lives.
But it's not an easy commute from their homes in Citrus County, about 90 minutes north of Tampa. Health News Florida is not using Amy or Christie’s last names to protect their identities.
“She's driving from her house … all the way to my house … then we drive all the way down here and all the way back,” said Amy, a 36-year-old mother of two grown children.
The women live in one of Florida’s 41 counties without a methadone treatment center. Though there are clinics in only 26 of Florida’s 67 counties, the Department of Children and Families has issued only two licenses for methadone clinics since 2014.
So as Floridians deal with an opioid crisis that killed nearly 2,800 Floridians in 2016, the gold standard in opioid addiction treatment is not easily accessible for thousands of addicts.
“There's just no excuse,” said Joycelyn Woods, director of the National Alliance for Methadone Assisted Recovery, one of the few groups that advocates for patients.
Woods says that most states have responded to the epidemic by making it easier to open more methadone programs. Nationally, deaths from opioid overdoses have been increasing each year for more than a decade with nearly 50,000 people killed in 2017 alone.
“The state should have years ago worked out easy ways to get people licenses,” Woods said. “That's what they should have been doing.”
Instead, Florida has been fighting lawsuits over its process for issuing licenses for methadone clinics for years.
The latest came in 2017 when the Department of Children and Families issued an emergency order to open 49 new methadone clinics -- many in counties where there wasn't one.
But the state's first-come, first-served method of awarding the licenses, led to three companies receiving the authority to open 47 of the 49 new clinics. Treatment providers that missed out argued the process was unfair and a judge agreed.
The Department of Children and Families spent 2018 drafting a new process.
But in the meantime, many addicts in counties where there are no clinics go without treatment.
Amy says the distance becomes one more excuse why her friends who are still using won't get help.
“I can't afford it. I can't get there. There's always a reason,” Amy said. “But they don't realize that there is help.”
Not all agree that methadone is the best treatment for opioids. Critics say it’s trading one opioid for another. But statistics show that when a methadone clinic opens, deaths from overdoses in the area go down, along with drug-related crime.
According to the Centers for Disease Control and Prevention the opioid overdose death rate in Citrus County was 32 percent higher than the state average. And it was 35 percent higher than Hernando County to the south, where the methadone clinic is located.
Amy says she's seen the impact first-hand.
“Last year alone I think I lost probably 8 to 10 people from drug addiction” Amy said. “It's bad. When you're living in such a small town when it happens it hits home because you know these people, you went to school with these people, you partied with these people and they just didn't find a better way.”
Last month, the department of Children and Families issued another emergency order to increase the number of methadone clinics in the state. The order suspends a requirement that the state first determine how many new clinics are needed. DCF leaders have not said how many licenses would be issued or where new clinics would go. They declined to be interviewed for this story.
Providers have until Feb. 4 to submit their applications.
Jon Essenburg is with Operation PAR, a counseling and treatment center that serves addicts across the Tampa Bay area. Before the order was issued, he said his company was ready to open clinics in counties that need them.
“Citrus County, Hendry County, Charlotte County for sure,” Essenburg said. “We already have a satellite program in Charlotte.”
But even if they received approval tomorrow, he said it would take about two years to open a new clinic.
Those who are desperate for treatment in rural counties could have a long wait.
Or like Amy and Christie, a long commute. But the women say it’s worth it because the methadone has
allowed them to pause their addiction while they put their lives in order.
“When you get into treatment and your life starts to get better and you start to accumulate all those things that you though you would never get back, you have a light at the end of the tunnel,” Amy said. “You start to move forward and say you know what? Maybe this is possible. Maybe I can get my family back. Maybe I can get my kids back. And you get a little hope.”
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