Addiction-fighting meds work for many
Suboxone and methadone — the two principal drug treatments for opiate dependence and addiction — are available through private clinics in Greenfield, and Suboxone through the rare general medical practice.
If used properly, neither impart the euphoria of an opiate high, but hold off the pain of withdrawal and reduce cravings.
Methadone and buprenorphine, the main ingredient in Suboxone and Subutex, occupy roughly the same real estate in the brain as heroin or other opiates, making it very difficult if not impossible to get high off of something else.
Subutex is buprenorphine, Suboxone is buprenorphine plus naloxone, a drug used alone under the brand name Narcan to induce near-instant sobriety in patients overdosing on opiates. Both were approved by the FDA in 2002, 30 years after methadone.
Buprenorphine and methadone treatments are available only by prescription, but both are abused, with varying degrees of difficulty.
Narcan does not require a prescription. The state’s Opioid Overdose Prevention and Reversal Program seeks to train opioid users, their friends and families to recognize the early signs of overdose and react appropriately. An appropriate reaction includes calling 911 — Good Samaritan language passed into law at the state level in 2012 protects overdose victims or witnesses from possession charges when calling 911 — rescue breathing and administration of Narcan. Comparable to medically advanced smelling salts, the nasal shot blocks opioids and restores normal breathing. Locations across the state offer training and doses of the medication, the nearest at Tapestry Health in Northampton, 16 Center St., 413-586-0310; Tapestry Health or La Voz at 130 Maple St. in Springfield, 413-363-9472; Holyoke Health Center, 330 Appleton St., 413-536-8721.
Dr. Amanda Wilson is president and CEO of CleanSlate Addiction Treatment Centers, which opened one of its first Suboxone treatment centers in Greenfield in 2009. That center currently has about 500 patients, Wilson said.
The Main Street office began with Suboxone treatment for opiate dependence and has since expanded to include all outpatient addiction medicine.
Because buprenorphine is considered less dangerous and less readily abused, it is not subject to the overwhelming government regulations that restrict methadone treatment to clinics.
Wilson describes her offices — she uses the word clinic but on reflection prefers to distance her business from the term — as no different from a dermatologist’s practice. The prospective patient makes an appointment and visits a medical provider who might prescribe Subxone after a physical and blood work. It is not necessary at the first visit, but before beginning the medication the patient must be in partial withdrawal.
Patients collect their prescriptions from a pharmacy and return to the office at regular intervals for new prescriptions. For the first few weeks, patients visit a couple of times a week with a physician or nurse practitioner to go over lab work and discuss how the medication is working.
Part of the purpose of frequent visits early on is to verify through urine tests that the patient is taking rather than selling their medication. While formulated to have essentially no effect on an opiate-dependent patient, someone who is “opiate naive” would easily get high off buprenorphine, Wilson said, and it goes for about $10 a pill on the street. She is also aware that some who buy illegally do so to self-treat for addiction or to ward off withdrawal rather than to get high, but says this isn’t safe. The user’s liver might not be strong enough, they might do damage by mixing it with other drugs and they are more than likely to overestimate the dose.
“After that, if they’re doing well they’re seen weekly pretty much right away,” Wilson said. “Which enables them to have the freedom to go back to work and really get their lives back in order.”
Opioid replacement therapy may end with the patient weened off or it may last indefinitely.
“The goal for the vast majority of patients is weening off, and usually that can happen in anywhere from two to three years’ time,” Wilson said. “There are a select few who were on opioids for 20 or 30 years and may well be never able to ween off. At a certain point your body becomes dependent on it permanently and they may need some small amount of opioid replacement for the remainder of their lives.”
The business runs on insurance. Most insurers cover addiction treatment, and if the prospective patient does not have insurance the office helps find it.
Once the patient is off buprenorphine, the prescription changes to Vivitrol, a shot administered once a month — typically for six months to a year — that blocks the opiate receptors in the brain.
Wilson said the success rate is about 70 percent.
Dr. Todd Mandell is the chief medical officer for Community Substance Abuse Centers, the company that operates the only methadone clinic in the county, on Shelburne Road in Greenfield.
Government regulation restricts methadone treatment to clinics. Patients, sent from other programs or self-referred, show up for a daily liquid dose, with a carefully-screened few permitted take-home doses. Mandell said the Greenfield center currently has approximately 90 patients.
Mandell describes methadone as the most-studied medicine in the pharmacopeia, and his take-away is that it works.
“Addiction is a brain disease, and medication-assisted treatment helps,” he said. “It works.”
Neither Mandell nor Wilson present their drug therapies of choice as a silver bullet; both the methadone and Suboxone centers require that patients be enrolled in counselling.
“I think it’s important to remember that medicine alone isn’t treatment,” Mandell said.
ServiceNet and Clinical and Support Options are two organizations working with the other side of treatment.
Helen Lincoln-White works in ServiceNet’s outpatient Substance Abuse Intervention programs, based at 55 Federal St. in Greenfield, and offering individual, family and group treatment. Groups include Contemplating Recovery, for those not yet fully committed to the idea, and Seeking Safety, which focuses on the combination of trauma or PTSD and substance abuse.
Substance abuse and trauma are often linked, and Lincoln-White said that link goes both ways. “People put themselves in places where they become victimized,” she said.
An intake process matches people with the appropriate group or individual treatment.
Clinical and Support Options provides a variety of behavioral health services, often intersecting with substance abuse recovery.
Amy Olson directs Clinical and Support Options’ Greenfield outpatient clinic, located at 1 Arch Place.
Olson said a large percentage of her substance abusing patients have experienced some sort of emotional trauma. Drugs or alcohol may have become a coping mechanism, and it takes a great deal of courage to learn to live without that mechanism.
Among CSO’s recovery programs is RECOVERe. Funded by a 2011 federal grant, the program applies technology to the particular difficulty of treatment in rural areas. Facets include “Text4Recovery,” providing a free cellphone — for a limited period — on which participants receive regular motivational texts and reminders for appointments and group meetings. Another is high-tech video conferencing. Program director Allison Garriss said the idea is that Greenfield area participants will be able to come to the Greenfield office and participate in a discussion group offered only in Northampton.