Local opinions diverge on new addiction treatment
A recent Harvard University study conducted more than 2,000 miles away could hold life-changing breakthroughs for those struggling with addiction here in Castle Country. Carbon County's own struggle with pain pill and heroin addiction is well documented and ongoing, according to local law enforcement and substance abuse treatment professionals.
However, there is a growing divergence among local officials concerning the best way to achieve long term sobriety for those caught in the cycle of addiction.
"What this study indicates is that addiction is a brain disease, a chronic, relapsing illness, characterized by compulsive drug seeking and use, and that it can be treated successfully in the long term by continued medical dosing with buprenophine/naloxone (Suboxone)," explained Price area surgeon and primary care physician Sterling G. Potter. "When we treat mental illnesses like schizophrenia, bi-polar or even obsessive compulsive disorder with medication, their success rate is really pretty good. You wouldn't take a schizophrenic, for example, once they became delusion- or hallucination-free off of their medication. If the general view is that addiction is a mental illness, not a moral weakness, then why are we treating these individuals differently."
According to Potter, the Harvard study, which was released in the Archives of General Psychiatry last week, is a step toward consensus among professionals which would make continued medical treatment with Suboxone in a primary care setting the standard for opioid addiction.
The trial, looked at two treatment models: long term medical treatment with (Suboxone) vs. detoxification using the drug, as well as the value of self-help counseling during both forms of treatment. In the study, more than 600 treatment-seeking outpatients addicted to prescription opioids received Suboxone in combination with brief standard medical management. Half of the participants also received varying intensities of addiction counseling as provided by trained substance abuse or mental health professionals.
Results showed that approximately 49 percent of participants reduced prescription painkiller abuse during extended Suboxone treatment. This success rate dropped to 8.6 percent once Suboxone was discontinued. Reductions in prescription painkiller abuse among those in the trail were seen regardless of whether or not the patient reported suffering chronic pain. Additionally, participants who received intensive addiction counseling did not show better outcomes when compared to those who did not receive this additional counseling.
While the study is the first of its kind as it does take into account prescription medication addiction, treated in a primary care setting vs previous Suboxone studies which focused on heroin addicted patients who sought intensive rehabilitation. It talking with Potter it becomes quickly apparent that he feels strongly about the treatment of addiction, asserting that the conditions is definitely a mental illness and that its effects reach into every area of the socioeconomic spectrum. Potter's contention is that ongoing medical treatment in an office setting can provide long-term alleviation from the symptoms of addiction for everyone from business professionals to the homeless.
"The success rate of treatment is six to eight times more successful with medical management than it is with counseling alone," he said. "I treat quite a few people who have been through rehab programs that use counseling and they use different styles of counseling and even drug court and eventually, many of them end up in this office seeking medical treatment."
Potter's license to treat addiction medically allow him to see 100 total patients and he regularly reaches that figure, which the produces a waiting list at his office.
"I have one patient that I started on Suboxone a little over four years ago, he gone off Suboxone twice, he has gone to several inpatient and outpatient treatment programs and he has relapsed every time. He is currently back on Suboxone and doing very well, planning to get married," said Potter.
Another patient described by Potter came in the week prior to our interview. At that time she reported smoking 120 milligrams of Oxycontin per day in addition to ingesting two Opana per day. Potter and his staff were able to take the young lady off of narcotics with Suboxone.
"Within three days we had her feeling pretty good," he said, describing her detoxification process. "And this is as an outpatient, and now she is staying off the other drugs. Of course at this point, her life is somewhat of a disaster, but it will improve I think."
According to Potter, payment for this type of medical treatment is also something that is attainable by most everyone, as even though Suboxone itself is relatively expensive when compared to other medical treatments such as methadone, it is much cheaper than inpatient rehab or opioid addiction.
Potter reported that over one-third of his patients either have no insurance or are on PCN-Medicaid, which means that the patients are responsible for payment of their own medication.
"This treatment is much cheaper than the street," quipped the local physician. "However, I have noticed in my discussions with patients that paying the pharmacy seems to be more painful than paying the drug dealer. It's funny. Heroin addicts who have been paying hundreds of dollars a day to maintain their addiction get very upset about the cost of a medication that is incredibly helpful to their financial situation."
According to Potter, Suboxone produces a clean urine sample within two weeks, allowing those who seek treatment at his office to obtain employment in a short amount of time.
"These patients have been given the chance to go out and get and job, and they are," he said. "They are doing incredibly well and they are staying clean as long as they stay on their Suboxone."
While it is Potter's assertion that the recent Harvard study will help to create a consensus concerning the long term use of Suboxone, many are still not sold. Neither the Carbon County Felony Drug Court, nor the Intensive Outpatient Treatment Program available locally at Four Corners Community Behavioral Health allow the long term use of Suboxone in their programs. Additionally, as Suboxone is a relatively new drug, there are no long term studies available which speak to its possible side effects.
It is important to note that all those who are prescribed the medication in Potter's office take urine screens on a regular basis. Those prescribed the medication must not take it with other narcotics, additionally, the test insures that patients are taking their own medication rather than selling the Suboxone. The doctor is candid about the potential for patients to get around the system but stresses that most who show up at his doorstep have hit bottom and are desperate for relief.
According to Potter, the success demonstrated by his patients is more than enough reason to continue prescribing the drug. Moving forward, he is also planning on conducting his own local patient outcome studies.
"Within our office, close to 75 percent of those who take their medication as directed stay successful and that is far better results than I have witnessed in any other treatment program," he concluded. "I feel this medication process works because it forces patients to take responsibility for their own treatment while presenting a program which offers a high rate of success."