WARRENTON — Looking to relieve the pain of withdrawal from heroin or prescription opioids, a new treatment option in Clatsop County blends behavioral counseling with medication to block the cravings that drive addiction.
The philosophy behind medication-assisted treatment is to reduce opioid abuse and lower the risk of relapse or overdose. Like needle exchanges or methadone clinics, the idea is to treat drug addiction as a disease, rather than a moral failing.
“We have to get past in our heads that this is a medical treatment, just like we treat diabetes,” said Jeanette Schacher, the medical group director at Columbia Memorial Hospital in Astoria. “And you don’t expect a diabetic to be treated for six months and be cured.”
Doctors from Columbia Memorial visit a Clatsop Behavioral Healthcare clinic in Warrenton twice a week and prescribe Suboxone, a drug approved by the U.S. Food and Drug Administration to treat opioid addiction. A mixture of buprenorphine and naloxone, Suboxone reaches some of the same receptors in the body as heroin or prescription opioids, but can help wean addicts off the drugs while easing withdrawal symptoms.
Since June, about a dozen people have participated in treatment through the Oregon Health Plan, the state’s version of Medicaid. In the first year, the two doctors certified by the U.S. Drug Enforcement Administration to prescribe Suboxone can treat up to 30 people each, so the initial cap is 60 patients.
Clatsop Behavioral Healthcare and Columbia Memorial have been looking for referrals from the county’s needle-exchange program, the county jail and primary care doctors who have patients struggling with opioid abuse. Some patients first go through detox at Bridge to Pathways in St. Helens, the closest medical detox to Clatsop County.
“When we started doing this, we thought there was going to be a line out the door and down the street, based on the problem in this community,” said Amy Baker, the executive director of Clatsop Behavioral Healthcare, the county’s mental health contractor. “And we really haven’t seen that.”
One obstacle is finding people during the often small windows of readiness when they are open to treatment and willing to endure the anxiety of withdrawal. Another is overcoming the stigma among people who may be abusing prescription opioids initially meant to treat pain and, in their minds, do not fit the stereotype of an addict.
“There are people that you see in your everyday life that you wouldn’t consider an addict, but they are having a hard time kicking the amount that they’re on, and it’s really not serving them well, and so trying to taper them down to what is a more appropriate dose, or to a different medication in general, some people still struggle with that,” Schacher said.
“So this is an option for us, from the primary care standpoint, to help those patients wean down from those medications.”
More than 72,000 people in the United States died from drug overdoses in 2017, according to preliminary estimates from the federal Centers for Disease Control and Prevention, a record number driven by a spike in overdoses from synthetic opioids, such as fentanyl.
While many conservatives, and some in law enforcement, are uncomfortable with treatment options that substitute one powerful drug for another and do not stress abstinence, the Trump administration has embraced medication-assisted treatment in response to the opioid epidemic.
The FDA has encouraged greater innovation among drugmakers and called for expanded access to treatment, describing it as having the highest probability of success for people in recovery. Three FDA-approved drugs — buprenorphine, methadone and naltrexone — are commonly used in treatment.
The government also recognizes new ways to gauge progress beyond abstinence, such as reducing overdoses, preventing the spread of infectious diseases like Hepatitis C and improving well-being.
“They need medicine to return to work, re-engage with their families, and regain the dignity that comes with being in control of their lives,” Alex Azar, the secretary of the U.S. Department of Health and Human Services, told the nation’s governors in February. “These outcomes are literally the opposite of how we define addiction.”
Michael McNickle, the county’s public health director, who helped start the needle-exchange program last year, said medication-assisted treatment is a positive step forward.
“It is important to provide treatment for people struggling with opioid use disorder to prevent overdose or even death,” he said in an email. “I believe it is crucial to have access to evidence-based treatments to combat the opioid epidemic, including MAT. I think MAT should only be offered in combination with counseling and behavioral therapies.”
Once or twice a week
Launched with startup money from the Columbia Pacific Coordinated Care Organization, which oversees the Oregon Health Plan in Clatsop, Columbia and Tillamook counties, medication-assisted treatment is part of a broader effort to treat substance abuse locally.
Patients get prescriptions for Suboxone once or twice a week at the clinic to pick up at pharmacies. While they are subject to urinalysis to screen for drug use, and are expected to attend therapy, they are not required to stay completely free of other drugs, since the intent is to reduce harm during recovery and avoid the kind of dangerous relapse where there is a higher risk of overdose.
“No. 1, you’re keeping people alive,” Schacher said. “But you’re allowing people to be productive members of society, productive members of our community, present in their family.”
Schacher and Baker consider opioid abuse a significant problem in Clatsop County, which also has high rates of methamphetamine and alcohol abuse. Like in many rural communities, substance abuse helps fuel disparities in health care and mental health and bleeds into criminal justice.
“If you want to talk about it as being a choice or a moral failing, go talk to somebody who has lost a loved one to overdose,” Baker said. “It’s the pain and the frustration of not being able to help somebody when they’re struggling in the throes of addiction.”