MORENCI — It’s just before sunrise as Maggie Phillips wakes her three children in the darkness.
The oldest, Jaxon, a second-grader, is headed to school. For the two youngest, Phillips packs clothes, snacks and toys for the hourlong trip to the methadone clinic.
Jesse, 3, runs around the small room he shares with his brother, Jayson, 4, looking for his favorite Spider-Man jacket. All three are dressed and ready by 7:30 a.m., when the school bus arrives for Jaxon. Phillips, Jayson and Jesse say goodbye as he climbs aboard.
Phillips straps her younger sons into their car seats and pulls out of the driveway for their once-a-month trip to Safford. The round trip is long for kids, but it’s half as long as it once was — Phillips used to travel all the way to Tucson, every day for months, until Community Medical Services opened a year ago.
She has to get there before the clinic closes at 11:30 a.m. If she misses her appointment, she has to make the same trip the next day, or suffer drug withdrawals and miss another chance to beat her addiction.
“I have kids. I want to be sober for them,” said Phillips, 29, a homemaker whose husband stays behind to work.
Fighting opioid addiction is always tough, but it’s even tougher for rural residents who live miles from treatment clinics. Most clinics in the U.S., built in response to the heroin epidemic of the 1970s, are in big cities. These days, drug abuse has expanded to the suburbs and rural areas, but the facilities to treat it have lagged because of funding shortages and the stigma around drug-treatment facilities.
In Arizona, 12 clinics treat addiction with methadone — a synthetic opioid used for decades to stabilize users and minimize withdrawal symptoms — but most are in the Phoenix area.
Tucson and Safford each have one clinic to serve the rest of Arizona, meaning many rural residents seeking medication for opioid addiction must travel hundreds of miles.
Advocates and opponents wrangle over whether methadone is the gold standard for treatment, if it merely substitutes one drug for another, or whether other treatments, including therapy and medication, are better.
For Phillips, who was once reluctant to take methadone, it’s a necessary step on an exhausting journey to recovery. She said not taking methadone plunges her into darkness.
“That’s the worst place I’ve ever been in my life,” she said.
Heavy toll in lives, costs
In 2016, the opioid crisis in the U.S. cost more than $56 billion in law-enforcement costs, emergency-room visits, lost productivity and premature deaths, according to the Centers for Disease Control and Prevention.
Even as deaths have quadrupled over the past decade, the CDC says the number of people in methadone treatment has ticked up by less than 25 percent. Arizona health officials have recorded nearly 20,000 overdoses and nearly 2,800 deaths since 2017.
Phillips has struggled with opioid abuse since she was 15, starting with prescription pills before moving on to heroin. Her move to sobriety began when she was 20 and discovered she was pregnant with Jaxon, and decided to get sober. Phillips said she stayed away from drugs for a couple of years, but relapsed after she was given medication to treat an injury.
Phillips started her methadone when she was 25 and pregnant with her second child. She was reluctant at first, believing she would just be replacing one drug for another.
“I was like, ‘I really don’t want to do the methadone,’ and there was this awesome nurse that explained everything to me.”
Methadone imitates how opiates act within the brain, changing how the brain and nervous system respond to pain. It lessens the symptoms of opiate withdrawal and blocks the euphoric effects of such opiates as heroin, morphine and codeine. The right dose of methadone can eliminate withdrawal symptoms without the patient feeling high.
Clinics like the one in Safford usually are open for six hours a day, closing by noon or, at the latest, early afternoon. But at least Phillips has her 2014 Chevrolet Impala to drive to the clinic once a month.
“We encounter a large majority of our patients having transportation issues, and living here in a rural area like Safford, Arizona, you don’t know where they’re coming from,” said Keith Jeffery, clinic manager for Community Medical Services.
When patients first start treatment, they must visit the clinic every day — a travel time of one to four hours. Several months later, the trips may decrease to twice a month, later once a month.
But the lack of transportation leads to some patients missing treatments, which results in more relapses.
Treating addiction
Methadone is considered the gold standard of care for those seeking to recover from opiate addiction, according to the National Institute on Drug Abuse. Health professionals say methadone treatment is most effective when combined with substance-abuse counseling and other supportive services.
Heroin addiction controls the life of the person and ends his or her ability to make healthy choices or good decisions. But once someone starts methadone treatment, the person is back in the driver’s seat, advocates say.
“We have patients come in every day, and we see the transformation, from day one to day 30, they’re not even the same person anymore.” Jeffery said.
