Opioid addiction treatment services expanding

Opioid by county 2018

ENID, Okla. — A new treatment soon will be offered, with no out-of-pocket expense, for opioid addiction treatment in North-central and Northwest Oklahoma.

Northwest Center for Behavioral Health (NCBH), a division of the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), is finalizing plans to offer Suboxone in all five of its regional clinics. Suboxone is the brand name for a combination of the opioid medication buprenorphine, and naloxone, the drug used to treat opioid overdose.

The move is the latest step in a state effort to expand availability of medication-assisted treatment for people suffering from opioid addiction, as the state continues to see an epidemic of opioid addiction and overdose deaths.

The scope of the problem

According to data provided by NCBH, an estimated 12.3 million people in the United States suffer some form of substance addiction, and approximately 80% of heroin addicts began their addiction with a doctor’s prescription for opioid painkillers.

Charita McOsker, LPC, NCBH program director, said it’s important people understand “addiction is a disease, not a moral failure,” and it’s a disease claiming the lives of Oklahomans almost daily.

From 2013-2017, more than 1,900 Oklahomans died of an unintentional prescription opioid overdose, according to NCBH, and in 2017, enough opioids were dispensed for every adult in Oklahoma to have the equivalent of 156 hydrocodone 10mg tablets.

The opioids fentanyl, oxycodone, hydrocodone and morphine remain four of the top eight sources of substance overdose deaths in Northwest Oklahoma, according to NCBH, and accounted for 16 of the region’s 26 unintended overdose deaths in 2013-2017.

More than four out of five unintentional prescription drug overdose deaths in Oklahoma involve at least one prescription opioid, accounting for more than all illicit drug overdoses combined, according to NCBH, and 32 Oklahomans die every month from unintentional opioid overdose.

An underutilized response

In hopes of curbing the surge in opioid-related overdoses, Congress in 2000 passed the Drug Addiction Treatment Act (DATA), which allows doctors to apply for waivers through the Substance Abuse and Mental Health Services Administration (SAMHSA) to prescribe buprenorphine for opioid addiction treatment.

Unlike methadone, which typically is administered during daily visits to specialized clinics, DATA waivers allow doctors to prescribe buprenorphine in an office setting, and to send home days- or even weeks-worth of the medication.

But, despite 20 years of promoting the waivers, the Department of Health and Human Services (HHS) found in a January report “only a small percentage of Americans who need treatment actually receive it.”

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Part of the issue, HHS found, is only a small percentage of doctors in the country have applied for the waiver. According to figures from SAMHSA and the Kaiser Family Foundation, 82,000 doctors in the United States have filed for the DATA waiver — representing only about 8% of all active physicians, and about 17% of primary care physicians in the country.

And those who have the waiver are disproportionately working in urban areas, leaving the availability of buprenorphine treatment scarce in rural areas.

HHS, in its report, found 40% of counties in the United States did not have any waivered physicans in 2018, and “even more concerning, waivered providers were not necessarily found in the areas where access to MAT (medication-assisted treatment) is most critical.”

HHS identified 1,100 counties in the country with the greatest need for buprenorphine services, and found 56% of those counties “likely had inadequate capacity to treat patients with buprenorphine in an office setting.”

The HHS report indicated Garfield and Kay counties are “high-need counties with average to high capacity for treatment.” Nine other counties in North-central to Northwest Oklahoma region, including Kingfisher, Canadian, Blaine, Dewey, Custer, Roger Mills, Ellis, Woodward and Woods counties, are “high-need counties with low-to-no patient capacity.”

In all, 42 of Oklahoma’s 77 counties fall into that latter category, according to the HHS report.

Expanding services

McOsker, with NCBH, said the ongoing plans to offer Suboxone in the region aim to help bridge those gaps in rural areas.

“Northwest Center for Behavioral Health recognizes that research indicates that opioid addiction is a medical disorder,” she said, “that can be treated effectively with medications to be used along with psychosocial counseling and treatment for co-occurring disorders.”

She said counseling and support group treatment are invaluable, and irreplaceable. But, she said, people addicted to opioids usually need the assistance of an opioid-based medication to avoid relapses.

“The addiction to opioids is a situation that people often do need help addressing,” McOsker said. “There’s lots of kinds of addiction, such as alcohol or other kinds of drugs, and they are all difficult to overcome, but opioid addiction in particular is difficult, and different than other drugs, because it affects the brain differently. For some people who have opioid addiction, it is helpful to use the medication to help them stay out of that addiction.”

Buprenorphine offers the opioid component of the medication, and McOsker said the addition of the naloxone, the active ingredient in Narcan overdose treatments, adds an element of safety to the treatment regimen.

And, unlike other opioid medications, buprenorphine does not alter the patient’s “ability to drive, ability to think, to function in life,” according to NCBH.

“When we use Suboxone, they’re getting a combination of an opioid and a drug that fights the opioid,” McOsker said, “to keep them safe and keep their brain safe and in a normal range of functioning.”

According to an ODMHSAS information sheet, drugs like methadone and buprenorphine “are longer-acting than other opioids like heroin and so are not ‘just substitution,’” and medical studies going back to 1965 “show that maintenance treatment with these long-acting opioids helps keep patients healthier, keeps them from getting into legal troubles, and helps to prevent them from getting other diseases such as Hepatitis and/or HIV/AIDS.”

Currently, Suboxone is offered in the Oklahoma City and Tulsa metros, but in NCBH’s 12-county area it’s only offered by a handful of doctors, and only to those who have the funds or insurance to cover its cost.

Implementation plans

Opioid prescriptions by county in 2018

A NCBH board-certified psychiatrist already has received the DATA waiver needed to prescribe Suboxone, through a program at the Oklahoma State University School of Medicine.

McOsker said when the program is up and running it will not be available to people who are actively under the influence of opioids. She said for the Suboxone to be effective, the patient has to be off the drug and in the early stages of withdrawal.

The drug is then administered in pill form under the supervision of a doctor and nurse. The first time it’s administered, the patient has to remain at NCBH for about three hours, for observation and to ensure the correct dosage has been reached.

After that, McOsker said the patient is prescribed one week’s worth of medication at a time, as opposed to the daily doses typically prescribed at methadone clinics. In order to stay in the medication program, patients must also attend three hours a week of counseling and group therapy.

Cost for the program is covered by a federal opioid treatment grant administered through ODMHSAS. McOsker said if patients have insurance, NCBH will file with the insurance company, but no patients will be denied Suboxone treatment over inability to pay, and there will be no out-of-pocket cost for the treatments.

“A lot of our patient population cannot afford medication assistance without that help here,” McOsker said.

Plans call for offering the Suboxone treatments at each of NCBH’s regional clinics, in Enid, Alva, Fairview, Woodward and Guymon.

McOsker said she hopes to have the program up and running in early summer — possibly in May.

For more information on NCBH and its services, visit http://www.ncbhok.org.

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