Inside State’s First 24/7 Opioid Treatment Center
Community Medical Services in West Allis saves lives, confronts stigma.
In December 2012, John Koch, was 24 years old and living on the streets of Chicago. He had just been released from prison, having served a 3½ year sentence –“my second adult prison sentence,” he told Wisconsin Examiner. The young man had struggled with heroin addiction since he was 15 years old.
That was just seven years ago. Now 30 years old, Koch proudly serves as director of community engagement at Community Medical Services (CMS), a medication-assisted treatment center for opioid use disorder that now has 28 clinics in nine states. CMS offers treatments including methadone, suboxone, and vivitrol coupled with psychological counseling. “We’re not just addressing your addiction,” he tells Wisconsin Examiner. “We like to address the whole person.”
In April 2019, CMS became the Badger State’s first ever 24-hour Opioid Treatment Program (OTP), with a center located in West Allis. Since it first opened its doors in Arizona in 1983, thousands of people have found treatment with CMS. Recovery is possible, and sometimes can open doors to unexpected places, Koch says.
“I never thought I’d work in the treatment field,” says Koch. “I was like, a construction worker most of my life. I didn’t think this was going to be my thing.” His personal road to recovery, along which Koch became CMS’s first peer support specialist, began with a traffic stop in southwest Chicago, “right off of heroin highway,” he recalls.
It was March 2013 and, despite still dealing with the fallout of his last prison sentence, Koch found himself pulling out of a McDonald’s parking lot holding “a bunch of heroin,” he recounts. “I’m with a guy who’s had warrants for three years.” As if that wasn’t enough, “I’m in this ridiculous car, and I forgot to turn my lights on.” A police cruiser started following the 1996 Toyota Camry, which was made up of a multi-colored patchwork of junkyard parts. “When I pull down the street I see the cherries pop behind me,” says Koch, referring to the police cruiser’s red and blue rail lights.
Believe it or not, Koch “felt a huge sigh of relief” as he pulled over into an alley. Estranged from his family, he was living on the street. “I’m having to do crazy stuff to obtain my drugs at the time,” Koch confessed. When the older white officer approached him, Koch didn’t have I.D. and didn’t know if the car was even his. “I still to this day don’t know how I got that car,” he told Wisconsin Examiner.
In that context, jail sounded like the best option, and he prepared to re-enter the system after less than a month of freedom. “I don’t hide the drugs, I don’t hide the needles,” he tells, “I’m like, ‘I’m cool with it. Lets go.’” After a brief dialogue, the officer handed Koch a blank warning slip with a treatment center’s contact information on the back. “He looks me in the face and says, ‘Kid it looks like you need some help. Call this number, let them know that I sent you. Get out of here, the highway’s that way.”
The next day Koch entered treatment. It wouldn’t be long before he met CMS CEO Nick Stavros, who was moved by the trials Koch endured. “I’m very blessed to be working with these people that gave me an opportunity,” he says.
Spreading The Message
Now several years into recovery, Koch has re-purposed his life and is dedicating himself to breaking down barriers to recovery for users. “Anyone can walk in at any time of day,” reports Koch. “We have some form of coverage 24 hours a day.” When people struggling with addiction walk through CMS’s doors, their needs are evaluated at the front desk.
“To start in our program,” he explains, “some people come in here and are still high. They’re maybe impaired, or they’re sick.” Doctors and counselors are available for new and returning clients around the clock at CMS. Those returning for further treatment can check in on an ipad-like screen near the front desk. The device sorts people as they wait for their medications. “Our average wait time for the whole company, not just here, is under five minutes,” Koch says.
Particular attention at CMS is dedicated to streamlining service for their patients. “We’ve had major universities come through and break down how we can best do our operations,” says Koch.
“Our clients have to be here six, seven days a week. And then they get privilege levels every 90 days, as long as they’re following the rules. We’re highly regulated,” Koch says. The Drug Enforcement Agency (DEA), Wisconsin Department of Health, Milwaukee County, and a crediting agency are just a few layers of oversight at CMS. Each therapy office is also required to be attached to a sound-canceling device, ensuring conversations between counselors and patients remain private.
Talk therapy occurs in sound-proofed offices, including rooms with various calming themes. Koch says the so-called “bird room” is most popular. Patients, however, can also choose the seashell room, or a room with no theme at all. The rooms are designed to provide personal conversations in which the patient feels listened to, and valued. “If you were to look at another methadone program, you’re not going to see it look like this,” he says proudly.
A variety of payment options is also available for patients, whether through Medicaid or the County. “If you don’t have Medicaid, we have a program where we foot the bill for you until you get back on your feet,” explains Koch. “We don’t want payment to be a deterrence to treatment. If you’re not in treatment, you’ll probably die. And we don’t want that for anybody.”
Koch also pushed back against assumptions about medication-assisted treatment. “People think we hand out pills and all this stuff,” he told Wisconsin Examiner. In the case of methadone, “we give a liquid, it’s put into a little cup. You get a glass of water, and you drink water with the methadone. It tastes like crap, I used to be on it.” Patients also are given suboxone, “the nurse will watch you on it and watch it dissolve in your mouth,” explains Koch.
The important part isn’t the medication, it’s working through trauma
Vivitrol shots are also provided through CMS, though with less frequency. According to Koch, less than 1% of the people who’ve sought treatment at the clinic get on vivitrol. “Some people think of it as a miracle shot,” explains Koch. “But the big part about this isn’t the medication. It’s actually the counseling, and the doctor’s visits, and peer support, so you can learn to work through your trauma.
”Everyone’s recovery is individualized. “Some people will be on it for six months, some people will be on it for 20 years,” he explains. “And that’s OK.”
Koch points out that over 23 million people nationally identify as being in recovery, but only 3 million are part of a 12-step program. It’s important to look at all aspects of a treatment program, including the risks and benefits. “A five day detox costs as much as a whole year of our treatment.” According to the National Institute on Drug Addiction, 40-60% of patients struggling with addiction relapse.”
Despite the benefits, medication-assisted treatment as a practice, sadly, is subjected to a variety of unproductive stigma. “The main stigmas you hear is, ‘replacing one drug with another.’ Another is, ‘it’s free dope or why do they get methadone when I have to pay for my medication. Another thing is, ‘You’re not clean. Or you’re not in ‘recovery.’” Despite these negative assumptions Koch says, “everybody’s recovery is different.”
Dr. Drew Palin MD, one of the friendly faces patients encounter at CMS, says these ideas cut deeper than people realize. “The stigma that society has on Opioid Use Disorder is the major obstacle to us dealing with it effectively,” he explains. To combat the idea that addiction is a choice, Dr. Palin emphasizes the numerous biological factors at play.
“For 30 to 50% of the people who use it,” he says, “the first time they use it, they’re almost hooked. Because they’re so genetically predisposed to it when they take it, they suddenly feel normal. They feel human.” Eventually, “they don’t get high anymore and they’re just using it to not get sick. Which is a sad commentary.”
“The saddest thing about it, in my mind, is that it’s happening to more and more young people,” he adds.Explaining that the 21 to25-year-old age group has seen the highest increase in overdoses, Dr. Palin says, “That’s when you’re creating your life, your career.” Even younger users struggling with addiction “don’t have any energy and interest in that,” he says. “So for the rest of their lives, they’re behind the eight ball.”
Trauma plays a bigger role in addiction than any failings in character or will-power on the part of the addicts. According to Dr. Palin, some 60% of women in a methadone program have experienced physical or sexual abuse. “Why wouldn’t you take a drug?” he asks. “It’s a rational thing to do when you’re trying to get away from that kind of pain.” The real problem, Dr. Palin says, is “that society has defined it [addiction] as a moral failure.” It’s not. “That’s a real society failure.”
Stigma is a barrier to treatment
Government bureaucracy isn’t always the biggest hurdle for alternative treatment options. “We tried to open in Milwaukee and got ran off,” Koch recounts with some regret. CMS initially tried to open a clinic on Capital Drive, near a neighborhood with lots of houses. While local alders supported CMS, some community members pushed back.
“It was a lot of NIMBY (Not In My Back Yard) kind of stuff,” say Koch. “You know, ‘We want drug treatment, just not here. Why don’t you open up over here, or over here?” He says, “they [the community] thought we were bringing drug addicts to their neighborhood. Which actually, the heat map showed that was one of the most overdosed areas in Milwaukee.”
Rumors also circulated on social media that “people might try to attack,” Koch recalls. This forced the library which hosted the public forum to request extra security. No incidents occurred, but the message was loud and clear.
Ultimately, CMS found a location at 2814 S. 84th street in West Allis, next to a Payless ShoeSource. “There was a lot of community support and they were experiencing a lot of overdoses out here,” says Koch.
Community Medical Services has expanded as demand has increased for flexible treatment centers. In 2017, more than 70,000 people died of a drug overdose in the United States, according to the National Institute on Drug Abuse. Wisconsin’s rate of opioid overdose deaths for that year was 16.9 per 100,000 persons, higher than the national average of 14.6. Addiction and death do not discriminate. “It’s something that can affect anyone,” says Koch. Nearly one in three people nationally knows someone who has struggled with addiction to opioids and opiates.
At the end of the day, Koch says, the common denominator is providing love and compassion for hurting people. “I prescribe methadone,” says Dr. Palin, “but what I really try to do is give them some respect by treating them as normal human beings who have a tough problem. And they need to be encouraged and honored for trying to deal with that. It’s not easy.”
Koch pleads with cities and communities, “We have to break down the stigma. It’s vital to people staying alive.”
Reprinted with permission of Wisconsin Examiner.
More about the Opioid Crisis
- Council approves hiring outside counsel to recover opioid epidemic costs - Ald. Michael Murphy - Oct 15th, 2019
- Oxycontin Maker Gave $65k to Marquette University - Rich Kremer - Oct 7th, 2019
- Wisconsin Not Settling With OxyContin Manufacturer - Brady Carlson - Oct 2nd, 2019
- Milwaukee Experiencing Unprecedented Number of Drug Overdoses - Isiah Holmes - Sep 25th, 2019
- Kaul Rejects Settlement with Oxycontin - Melanie Conklin - Sep 12th, 2019
- Opioid Settlement Could Aid County - Isiah Holmes - Sep 4th, 2019
- U.S. Senator Tammy Baldwin Announces Nearly $5.2 Million in Federal Funding to Reduce Opioid Overdoses in Wisconsin - U.S. Sen. Tammy Baldwin - Sep 3rd, 2019
- Inside State’s First 24/7 Opioid Treatment Center - Isiah Holmes - Aug 29th, 2019
- Opioid Addiction Can Be Beaten, Experts Say - Isiah Holmes - Aug 15th, 2019
- State Health Agency’s New Data Tool Shows a Decline in the Number of Opioid Deaths in Wisconsin - Wisconsin Department of Health Services - Aug 14th, 2019
- DHS Takes Coordinated Approach to Dealing with Opioid Addiction - Brady Carlson - Aug 9th, 2019
- Why the Weekend of Fatal Overdoses? - Isiah Holmes - Jul 31st, 2019
- Wisconsin Is Awash in Opioids - Isiah Holmes - Jul 28th, 2019
- City May Sue Opioid Manufacturers - Alana Watson - Jul 26th, 2019
- Attorney General Kaul Files Lawsuit to Hold Purdue Pharma Accountable for Role in Opioid Crisis - State Rep. Gordon Hintz - May 16th, 2019
- AG Kaul Announces Wisconsin, Four Other States, File Lawsuits Against Purdue Pharma - Josh Kaul - May 16th, 2019
- Medicaid Expansion Would Help Opioid Addicts - Laurel White - May 9th, 2019
- U.S. Senator Tammy Baldwin Helps Reintroduce Legislation to Combat the Opioid and Substance Use Epidemic - U.S. Sen. Tammy Baldwin - May 8th, 2019
- Kaul, AGs Warn of More Opioid Problems - Shamane Mills - Apr 2nd, 2019
- Bipartisan Coalition of AGs Express Concern Regarding HHS Pain Management Draft Report - Josh Kaul - Apr 1st, 2019
- Opioid Crisis Affecting State Businesses - Shamane Mills - Apr 1st, 2019
- U.S. Senator Tammy Baldwin’s Bipartisan Work Recognized by National Organization - U.S. Sen. Tammy Baldwin - Mar 28th, 2019
- U.S. Senator Tammy Baldwin Announces New Federal Funding To Help Wisconsin Combat the Opioid Epidemic - U.S. Sen. Tammy Baldwin - Mar 27th, 2019
- Three Hospitals Offer 40 Recovery Coaches - Mary Kate McCoy - Mar 22nd, 2019
- State Officials Meet to Tackle Drug Epidemic - Shamane Mills - Mar 18th, 2019
- The Enduring Allure of Opioids - Hayley Sperling - Feb 24th, 2019
- Hagedorn Campaign Releases First TV Ad: “Lily” - Brian Hagedorn - Feb 19th, 2019
- Opioid Prescriptions in State Down 29% - Shamane Mills - Feb 11th, 2019
- Have County Overdose Deaths Peaked? - Ximena Conde - Dec 31st, 2018
- Drug Task Force Seeks Community Input - Max Nawara - Dec 20th, 2018
- Ald. Tony Zielinski to Sponsor Legislation to Ensure Proper Coverage for City Employees Struggling with Addiction and Other Mental Health Problems - Ald. Tony Zielinski - Dec 17th, 2018
- Opioid Task Force Issues Recommendations - Ximena Conde - Dec 4th, 2018
- Final report released by Heroin, Opioid and Cocaine Task Force - Ald. Michael Murphy - Nov 30th, 2018
- 4th Dimension Recovery Center Opens to Address Opioid Epidemic in Wisconsin - 4th Dimension Recovery Center - Nov 12th, 2018
- Governor Walker Announces 32% Decrease in Opioid Prescriptions Since January 2015 - Gov. Scott Walker - Oct 31st, 2018
- #HopeActLiveWI: Wisconsin Awarded Nearly $3 Million to Combat Opioid Epidemic - Wisconsin Department of Health Services - Oct 10th, 2018
- U.S. Senator Tammy Baldwin Announces More Than $20 Million Awarded to Wisconsin Communities to Fight the Opioid Epidemic - U.S. Sen. Tammy Baldwin - Sep 21st, 2018
- Senator Baldwin’s Reforms Pass Senate with Overwhelming Bipartisan Support - U.S. Sen. Tammy Baldwin - Sep 18th, 2018
- Another Attorney General Not Named Brad Schimel Sues Opioid Manufacturer - One Wisconsin Now - Sep 15th, 2018
- Bipartisan Senate Opioids Response Legislation Includes Senator Baldwin’s Reforms - U.S. Sen. Tammy Baldwin - Sep 12th, 2018
- The State of Politics: Counties Struggle With Opioid Costs - Steven Walters - Aug 20th, 2018
- Vipond Campaign: ‘Opioids: Clear & Present Danger’ in Race to Replace Sensenbrenner - Dr. Jennifer Hoppe Vipond - Aug 1st, 2018
- PDMP Report Shows Continued Decline in Controlled Substances Dispensed - Gov. Scott Walker - Jul 30th, 2018
- Illegal drugs are strangling the life out of our neighborhoods - Ald. Bob Donovan - Jul 19th, 2018
- Meth A Bigger Issue Than Opioids? - Shamane Mills - Jul 6th, 2018
- Sensenbrenner-Backed Legislation to Fight Synthetic Opioids Clears House - U.S. Rep. Jim Sensenbrenner - Jun 15th, 2018
- Community Engagement Session Hosted by Heroin, Opioid and Cocaine Task Force - Ald. Michael Murphy - Jun 4th, 2018
- Brad Schimel and Scott Walker Repeat Mistakes Past; Refuse to Take Legal Action Against Opioid Manufacturers - One Wisconsin Now - Jun 4th, 2018
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- City-County Plan Targets Opioid Epidemic - Edgar Mendez - May 22nd, 2018
- Brad Schimel Election Ad Blames Families, Not His Pharmaceutical Donors for Opioid Crisis - One Wisconsin Now - May 17th, 2018
- Governor Walker Announces 10% Drop in Opioid Prescriptions Dispensed Over the Past Year - Gov. Scott Walker - May 16th, 2018
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- U.S. Senators Tammy Baldwin and Bill Cassidy Introduce Bipartisan Legislation to Halt the Flow of Illicit Fentanyl into the U.S. - U.S. Sen. Tammy Baldwin - Apr 24th, 2018
- U.S. Senator Tammy Baldwin Joins Colleagues to Call on Administration to Take Immediate Action to Reduce Price of Life-Saving Opioid Overdose Reversal Drug - U.S. Sen. Tammy Baldwin - Apr 20th, 2018
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- U.S. Senator Tammy Baldwin Helps Introduce Bipartisan Legislation to Address the Opioid Crisis - U.S. Sen. Tammy Baldwin - Apr 17th, 2018
- Op Ed: Stronger Action Needed on Opioid Crisis - Matt Flynn - Apr 14th, 2018
- U.S. Senator Tammy Baldwin Helps Introduce Bipartisan Legislation to Allow Safe Disposal of Unwanted Drugs in Hospice - U.S. Sen. Tammy Baldwin - Apr 13th, 2018
- Leah Attends Opioid Taskforce Meeting about Alternative Treatments to Pain - State Sen. Leah Vukmir - Apr 13th, 2018
- Walker Signs Vukmir Bill Battling Opioid Crisis - State Sen. Leah Vukmir - Apr 10th, 2018
- Combating the Opioid Crisis: Governor Walker Signs Bipartisan Bills on Opioids into Law - Gov. Scott Walker - Apr 9th, 2018
- Bipartisan Alternative Drug Treatment Program Signed Into Law - State Rep. Evan Goyke - Apr 3rd, 2018
- U.S. Senator Tammy Baldwin Hosts Roundtable with Green Bay Officials on Fighting the Opioid Epidemic - U.S. Sen. Tammy Baldwin - Apr 2nd, 2018
- U.S. Senators Tammy Baldwin, Todd Young and Edward Markey Introduce Bipartisan Legislation to Fight Opioid-Related Infectious Diseases - U.S. Sen. Tammy Baldwin - Mar 23rd, 2018
- U.S. Senator Tammy Baldwin Announces New Funding for Wisconsin to Combat the Opioid Epidemic - U.S. Sen. Tammy Baldwin - Mar 22nd, 2018
- Vukmir Battles Opioid Epidemic - State Sen. Leah Vukmir - Mar 20th, 2018
- Supervisor Peggy West: Time to Hold Drug Makers Accountable - Sup. Peggy A. West - Mar 14th, 2018
- U.S. Senator Tammy Baldwin to Health Insurers: Step Up Response to Opioid Epidemic - U.S. Sen. Tammy Baldwin - Mar 5th, 2018
- Latest Report Highlights 20 Percent Decrease in Opioid Prescriptions Dispensed from 2015 to 2017 - Gov. Scott Walker - Mar 2nd, 2018
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- Governor Walker Discusses the Opioid Epidemic at Sheriffs and Deputy Sheriffs Conference - Gov. Scott Walker - Feb 5th, 2018
- Vukmir, Nygren Lead Efforts to Combat the Opioid Epidemic - State Sen. Leah Vukmir - Jan 19th, 2018
- Governor Walker Takes Additional Action to Fight Opioid Crisis - Gov. Scott Walker - Jan 19th, 2018
- U.S. Senator Tammy Baldwin Calls on President Trump To Renew The Opioid Public Health Emergency - U.S. Sen. Tammy Baldwin - Jan 12th, 2018
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- U.S. Senator Tammy Baldwin Joins Bipartisan Group of Senators Urging Congressional Leadership to Commit Resources to Opioid Epidemic - U.S. Sen. Tammy Baldwin - Dec 15th, 2017
- Murphy’s Law: Brad Schimel’s Opioid Problem - Bruce Murphy - Nov 14th, 2017
- Op Ed: State Leaves Counties to Sue Drug Companies - State Senators Janet Bewley and Dave Hansen - Nov 11th, 2017
- Special Report: Opioid Crisis Hits City Hard - Edgar Mendez - Nov 9th, 2017
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- Op Ed: Nygren, Sidener Dramatize Opioid Problem - Casey Hoff - Oct 18th, 2017
- Op Ed: The Heroin and Opioid Crisis Is Real - Isiah Holmes - Aug 28th, 2017
- The State of Politics: John Nygren’s War on Drug Abuse - Steven Walters - Jul 10th, 2017
- Op Ed: Opioid Crisis Demands Bipartisan Solutions - Jeff Plale - Feb 24th, 2017
- Governor Walker Announces Members of the Task Force on Opioid Abuse - Gov. Scott Walker - Oct 25th, 2016
- Prescription Drugs Lead Way to Heroin - Wyatt Massey - Mar 17th, 2016
- Heroin Deaths Up 241% Since 2010 - Wyatt Massey - Mar 16th, 2016