In December, the U.S. opioid crisis was reported as the top health story of 2018. The number of opioid related deaths and suffering across the nation prompted the White House to declare a “Public Health Emergency” and Pennsylvania to issue a statewide “Public Health Disaster Declaration.” Especially hard-hit are rural communities.
Opioids are a class of drugs used to reduce pain. They include prescriptions, such as OxyContin, Vicodin and morphine; fentanyl and heroin.
Often viewed as an urban problem, the numbers reveal a devastating phenomenon –starting in 2006, rural rates of fatal drug overdoses surpassed those of urban areas. The statistics are alarming. Even more alarming, was the news that the crisis had made its way into our own neighborhoods, having devastating consequences.
So, is there hope? The short answer is “Yes!” While many rural areas find it difficult to provide quality treatment options for their communities, those affected by addiction in the area are finding comfort. Penn Highlands Integrated Recovery Care, a service of Penn Highlands DuBois and a partnership with Clearfield Jefferson Drug and Alcohol Commission, or CJDAC, is providing quality options to local residents.
Funding designated by Governor Thomas Wolf administered by the state Department of Human Services has expanded treatment choices by creating Centers of Excellence, or COEs, for medication assisted treatment. By partnering with the CJDAC’s COE, the care clinic has recently opened with Michael Hall, MD, as its director. Hall is board certified in family medicine and addiction medicine.
It is estimated that over 80 percent of those residing in rural counties simply do not have access to specialized treatment, and of those that do, inadequate financial means and unavailable transportation make help difficult to access. “I was a family doctor in Elk County for 28 years,” Hall said. “Over my time there, I certainly had patients with drug and alcohol problems, but like most primary care providers, I did not have the training or tools to treat them in my office... when the opioid crisis was starting to spring forth, I was approached by someone who asked me to become involved in addiction care,” he continued. “She told me that there were over 80 individuals suffering from substance dependence who were having to travel to other counties to receive care.”
“I became interested and started learning about medication-assisted treatment, and I realized that these treatments were very helpful,” Hall said. “Patients who were treated with opioid-based therapies had stayed in treatment, reduced or eliminated their use (of illicit drugs) and were much less likely to die of an overdose.”
Medication-assisted treatment is provided, in a very structured way at Integrated Recovery Care. Treatments for opioid addiction include changing out a person’s drug of choice for products such as Suboxone and Zubsolv. These “copy-cat” drugs occupy the receptors in the brain that would have been stimulated by drugs like heroin. The medications are not a cure for opioid addiction or opioid use dependency. They are used to decrease cravings and limit withdrawal symptoms. Unlike quitting “cold-turkey,” the treatment allows the patient to quickly resume their day-to-day life. Especially beneficial, this gives a person the ability to start counseling and address the other issues associated with addiction, all much sooner.
This is not a methadone clinic.
“Methadone is considered the most effective treatment but is limited to use in Opioid Treatment Programs,” but it is not used here.
A common thought is “…but, I don’t do drugs.” Penn Highlands Integrated Recovery Care offers treatment for several types of addictions including opioids, alcohol, tobacco and cocaine. “We can provide treatment for all of these,” Hall said.
“Treatments for alcohol abuse or alcohol use disorder include three FDA (Food and Drug Administration) approved medications,” Hall said. There are oral and injectable forms of Naltrexone, and the widely-known Antabuse, which causes a very uncomfortable reaction if alcohol is ingested.
There are several addictions that can be safely treated with the use of medication, but sadly, not all. Hall said “I wish there was an effective medication for methamphetamine abuse, which is a huge problem here, but so far no medications have shown much efficacy.”
Most wonder, “Aren’t we just replacing one drug with another?” Hall tells his patients, that medication will help keep them alive, help keep them from using again and help keep them in treatment.
“I let them know that the standard of care for the length of MAT is indefinite, they will not have to come off until they have developed the ability...to deal with the stressors and triggers that have caused them to use in the past. And I let them know that by working the program, they will gain back some of the things that they have lost.”
Medication therapy is only one part of a treatment plan. From the beginning, Hall and CJDAC COE case management staff determine the most appropriate level of care and medication through screening and assessment. “Case management is an integral part of the continuum of care for MAT services”, stated Susan Ford, executive director of the CJDAC. “Providing an integrated care model (physical and behavioral health) with Dr. Hall has helped to create a gold standard program in our area,” she said.
“In our program, behavioral therapy is mandatory,” Hall said. Patients can find help through area agencies or private counselors. Other services include immediate inpatient medical care in initially severe cases to outpatient therapy or 12 step facilitation for a mild use disorder.
But, does treatment really work, or do patients always go back to their bad habits? Referring to the successes Hall has seen in the treatments, he said, “Addiction is all about compulsive use of substances despite loss, be it of money, relationships, family members, employment, freedom, health, dignity, even life. With treatment, I have seen some Lazarus effects, but even when I see even little gains in an addict that others have written off, I know that this person has a chance.”
For any prospective patients, the first step is to have a full assessment through the intake specialists at Clearfield-Jefferson Drug and Alcohol Commission – even if you are not from Clearfield or Jefferson counties, it is worth the call to assess options in your area. Call 371-9002 to start the process.