Overcoming addiction to opioids takes more than a desire for change. When uncontrollable cravings and unpleasant withdrawal symptoms make sobriety seem unattainable, there is hope to be found at the Lincoln Community Health Center (LCHC).
The Bridges to Recovery program, funded by a grant from the U.S. Department of Health and Human Services, is a joint effort of several health care organizations in Lincoln County and is comprised of prevention, treatment, and recovery services.
At LCHC, a division of Lincoln County Health and Human Services, providers have been taking the necessary steps to deliver what is thought to be one of the safest treatments. Suboxone (also known as buprenorphine) is an opiate blocker that “quiets the brain” and reduces cravings. In order to prescribe Suboxone, providers must undergo specialized training and apply for a “waiver” to utilize the controlled substance.
After spending several months developing the service, LCHC officially launched its office-based addiction treatment (OBAT) program in September. Jamey Burris-Fish, a psychiatric nurse practitioner, is one of three providers able to prescribe Suboxone.
“We definitely look at Suboxone as one of the safest alternatives to getting off of opioids,” she explained. “It improves a person’s ability to think, to return to work because they aren’t constantly thinking about where they will get the drug, and it offers them hope.”
The process for enrolling in the program is simple. Patients are initially screened by a nurse, who explains the program and asks some basic questions. They are scheduled for both a physical exam and a psychiatric exam to determine if there are other medical or mental health problems that need to be addressed.
Also delivering the OBAT program is Family Nurse Practitioner Jason Vang-Erickson and Corie Charnley, who has a Doctor of Nursing Practice (DNP) degree.
Once patients are approved for the program, they start by visiting the office weekly for a supply of the medication that is taken as a strip of film that dissolves under the tongue. Each visit also requires a drug screening.
“We are assessing what substances they might be using in addition to opioids for harm reduction to help save their lives. We aren’t judging them, we just want to try and help. We also are monitoring to see if there is Suboxone in their system,” Burris-Fish noted.
Providers are expecting to find Suboxone in the system. Since it can also be diverted for illegal uses, making sure patients are actually using the treatment is important.
“If an individual can’t get heroin, for instance, Suboxone will help them not go through withdrawal. If a dealer has run out and isn’t sure when they will get more heroin, they may try to sell Suboxone, and people will buy it off the street,” she explained.
While the LCHC Bridges to Recovery program doesn’t deliver counseling services, they do require that patients partake in some type of outpatient clinic or program like Alcoholics Anonymous, Narcotics Anonymous, or Reconnections Counseling.
“We stress to patients that counseling is important. Medication is just one part of treatment. Counseling is also needed to learn new ways to deal with challenges and that will ultimately help reduce the chance of relapse,” said Burris-Fish.
Relapse is not uncommon in recovery, and that’s true with this program as well, but the nurse practitioner reports that the instances of relapse are reduced for those who are utilizing the Suboxone, as compared to those trying to conquer their addiction without it.
The length of time a patient is on the medication varies from person to person. Over time, the frequency of office visits lengthens from the original weekly appointment to bi-weekly, and then monthly. Cost is not a barrier for LCHC patients, as the Federally Qualified Health Center accepts insurance or, when the patient is uninsured, uses a sliding fee scale based on income.
“After patients have a had a year or even longer of sobriety, they may ask to start tapering down to see if the cravings come back,” she noted.
According to Drug Enforcement Agency guidelines, providers are allowed only 30 Suboxone patients at any given time in their first year of prescribing. They can apply to serve 100 patients after that first year is complete.
In addition to physical examination, psychiatric screening and prescription medication, this program also connects patients to a case manager who can help with issues related to transportation, housing, and other factors that might impede their progress.
“In other places where I’ve worked before, I’ve seen people experience major improvements. It was kind of shocking in some respects when I would see them on opiates and then we transition them to Suboxone and they say ‘oh gosh, I can think, my head’s not filled with cotton’ and it’s a really positive situation,” Burris-Fish said.
“Most importantly, we treat them like a person,” she added. “Relapse is viewed as a bump in the road, and we want to help you get over it.”
To contact the Lincoln Community Health Center OBAT program, call 541-265-0477.