About 700 people come to the Millsboro clinic every day. In Dover, the number is about 400.

Each day hundreds of people in various stages of recovery line up at clinics and treatment centers for medication to help them move forward with their recovery.

Alex Cropper is site director for the Connections Community Support Program clinics in Dover and Millsboro. They dispense Medication Assisted Treatment, or MAT, to clients every day.

Cropper said Connections dispenses methadone and subutex to help recovering addicts manage withdrawal.

About 700 people come to the Millsboro clinic every day. In Dover, the number is about 400. The Dover number is up from about 300 a day last year, he said, and Millsboro has seen a constant and steady increase too.

About 65 percent of those are on methadone and 35 percent are on subutex, Cropper said.

“Subutex is pretty much used for those in early recovery,” he said. “Methadone is more for individuals who have been on for a longer period of time.”

Connections CEO Cathy McKay said they encourage medication assistance over going cold turkey because it increases the chance of a person staying opioid free.

“There is no evidence that going cold turkey is effective in the treatment of opioid dependence, and, in fact, it has been shown to increase the risk of death from overdose,” McKay said. “We do not encourage people to withdraw cold turkey, although some insist on it.”

After being in the program for a while, participants are able to get multiple doses so they don’t have to return every day, Cropper said.

“We actually have more clients that are on the program but have had significant clean times and are able to have take-home doses,” he said.

There is no time schedule for weaning off the medications. Cropper said that is up to the individual in consultation with their counselor and staff physicians. That same consultation takes place if the medication isn’t working, or if a higher dosage is necessary, he said.

“We have checks and balances with the counselor and interaction with the nurse and medical staff if the medication is not holding them,” he said.

They may do a new Clinical Opioid Withdrawal Scale – or COWS -- assessment, or run bloodwork to see how the medication is metabolizing in their system. The COWS 11-item scale helps physicians determine a person’s level of withdrawal.

“Each individual is on a case-by-case basis,” he said.

In some instances, the person might not want to increase their dosage.

“Some individuals will rely on coping skills learned in treatment,” Cropper said. “They do not want to go on a higher dose of the medication because it is harder to get off.”

Others, however, may stay on the treatment longer.

Benjamin Griffith, director of mobile crisis upstate for the Delaware Department of Health and Social Services’ Division of Substance Abuse and Mental Health, said there are different schools of thought on the topic.

Some experts believe patients should get weaned off those drugs after a certain time, he said, while others recommend their patients continue to use those meds for the rest of their life, arguing heroin addiction has already altered their brain chemistry, so it’s best for them to take medication to counter that.

In the end, Griffith said, the decision on how long a patient will be on methadone, suboxone or subutex will involve the patient and their manager, nurse and prescribing physician.

“People participating in these programs have a lot of choice when it comes to stopping treatment; some stay on indefinitely, some for several years,” Griffith said. “And some may only want to be on methadone for six months to a year and then titrate off. Typically the process of titrating off is done slowly in order to avoid any physical symptoms of withdrawal.”

Ultimately, Cropper said, the goal is to provide the tools that people need to stay opioid-free. He said Connections prides itself in creating a streamlined process that can help people every step of the way.

“We have mental health program, housing programs other programs to help them overcome whatever need they may have,” he said. “It is better to get help now than to prolong the process. We are here for you every step of the way. Life is mirrored by problems, barriers and obstacles, and this is a treatment community to get you through and navigate those problems. We can all recover together.”

NEXT - Intensive outpatient treatment, and building a support system that will help the individual stay clean.