Medication Assisted Therapy Clinic at Weeks Reports Successful First Year
by Tara Giles
Roughly one year ago, word of an incoming Medication Assisted Therapy Clinic at the Weeks Medical Center in Lancaster was floating about town. Opinions on the clinic varied disapproval to a much needed welcome for the area. The one year update for the new program has proved successful as told by staff at the clinic.
Last spring, a grant was awarded to support the pilot program. The program began with six patients and has since grown. The numbers have proved successful and the program has since expanded into the Whitefield branch of Weeks Medical Center.
The interdisciplinary team has grown, however the core crew consists of medical director Lars Nielson, MD, primary care provider Christopher Laurent, APRN, case manager Thomas Pickford, and behavioral therapist Shawna Delworth, LADC. The team at the clinic has grown to now include three licensed alcohol and drug counselors and one social worker. The social worker on staff makes home visits, helps with transportation along with financial concerns, and fills in for group therapy.
Laurent said the program has been very successful, noting “We now have two locations and have progressed from individual counseling to group counseling, which we found has become more popular.
“Our model is that the patients use Suboxone for one year then begin to taper. One person could take up to a year to taper and another one six months. This is not a dispensing clinic, it’s a treatment center with the behavioral science being the most important component,” explained Laurent.
The program has graduated four people over the past year and has about 40 enrolled, with room for 60 more patients. Individuals receiving treatment are from the surrounding area to include Berlin and Littleton.
Local police say there has been a marked decrease in overdose deaths. Laurent feels the clinic is a big contributor to those numbers decreasing.
When someone first enrolls in the program they meet with a licensed drug and alcohol counselor who then determines the appropriate dose of medication. During the first exam, blood work is drawn to check for HIV and hepatitis C, among other viruses.
Laurent says, “The patients have to attend a weekly counseling visit for the first six weeks. If they move forward they then go to every two weeks for six weeks, then every month. The counseling depends on what an individual needs.”
Laurent explained that there have been a few failures, which he explains is ‘pretty low,’ adding that some of those have been because of lack of financial resources and health insurance. Without insurance, Suboxone costs up to $800 per month. Vivitrol is another medication used at the clinic and is an injectable form of naltrexone, which costs $1,800 per month. Vivitrol is the next step after Suboxone.
“The tricky part is, someone will be approved through their insurance to receive a specific dose, if we need to increase the dose, the insurance companies won’t cover it, which puts the patients at risk because we can’t treat them properly,” explained Laurent.
The cheapest generic Suboxone costs $50 per week. To reduce the amount of Suboxone that could find its way on to the streets, a new injectable from called Sublocade will become available. The biggest challenge with this, is that insurance won’t approve it.
“For a single adult to receive Medicaid with no children is very difficult, so those people are left out in the cold,” said Laurent.
Narcan is given to those patients who are at high risk.
“Most people don’t want to spend the money on a high then have it terminated. One strip of Suboxone on the street is $34-35 per strip depending on the dose. People who are prescribed the drug could sell it to others,” said Laurent.
When someone asks to be placed into the program a urine and toxicology screen is performed to make sure they actually have a problem. We also test for Fentanyl.
Laurent explained, “If a test is positive, and their numbers don’t start to decrease, we remove the Suboxone portion from their treatment but continue with counseling until they are ready to stop using. Fifty percent of the patients we see are in withdrawal when we first see them. They need to be off of the opioid for 24 hours before we will give them Suboxone.”
Laurent noted that most overdoses occur when people have quit then go back on the drug thinking the same dose they used to use will cooperate with their bodies.
“They just don’t have the tolerance anymore, causing the overdose,” said Laurent.
Heroin and other opioids create a euphoria, explained Laurent, adding “The escape from reality is what they’re looking for which makes it so hard to quit as well as the physical dependency. This is why counseling is so important. They are relearning how to handle reality sober. This epidemic goes across all economic groups to unemployed people to those that have good jobs and are prominent members of the community. From poor to rich, this group has a sort of camaraderie, that’s why the group therapy is so popular.”
President of Weeks Memorial Hospital Mike Lee said there is a 74 percent retention rate to date.
“We are seeing the program grow slowly, it is quite a commitment that patients must make to undergo the rigorous therapy and compliance monitoring,” Lee said. “One very large challenge that presents is for people that do not have insurance or have very high deductibles. The Suboxone is costly and Weeks tries to make arrangements but is looking for funds to assist.”
Article reprinted from the Coos County Democrat, August 15, 2018. Used by permission.