New services brought to opioid addiction fight

May 13--ROCK FALLS -- As opioid addiction becomes more pervasive, local officials are strengthening their partnerships to fill in the services gaps.

The Whiteside County Health Department is in the early stages of new programming elements that, utilized together, could be a game-changer.

Medication-assisted treatment, or MAT, combines behavioral therapy with medications to treat substance abuse. The health department, with its growing behavioral services program, and the ability to administer a different medication to fight opiate addiction, is now uniquely qualified to take that treatment approach to a new level.

Dr. Kelley Guthrie, health department medical director, has been licensed to provide Suboxone. Suboxone is supplanting methadone as the drug of choice in fighting heroin addiction. While federal regulators consider the drug safer than methadone, it is difficult to get and carefully monitored.

"This is a federal clinic, and the feds and the Whiteside County Health Department felt we needed a Suboxone program for opiate addicts," Guthrie said.

Suboxone contains buprenorphine and naloxone, which allows it to kill cravings and keep withdrawal symptoms at bay. The dual effect could be key to maximizing the advantages of holistic treatments.

"If you look at a withdrawal curve, Suboxone takes you halfway up the graph, so people can function and work their programs because they aren't high or experiencing withdrawals," Guthrie said.

The health department, at this time, isn't working with anyone on methadone, and is overseeing only four people using Suboxone. Federal clinics are not allowed to have both methadone and Suboxone, and methadone can be prescribed only by paying clinics.

"We've only been doing this for about 6 weeks now, and federal regulations limit us to working with no more than 30 people in the first year, so this is in the infancy stages," said Beth Fiorini, public health administrator for Whiteside County.

To find a similar Suboxone treatment program, the closest destination had been Rockford and the Quad Cities.

Fiorini said the program has three stages -- initiation, stabilization, and maintenance.

"The first phase is when they are just starting to come down, and we monitor them very carefully," Fiorini said. "We see them for 3 to 5 days, and the physician gives them the medication until the patient is doing well."

Patients must check in regularly with the physician during the stabilization phase. They also must go to individual and group therapy at the health department. It can be a long process, one that Fiorini says is much too labor-intensive for hospitals to handle.

"It can take 2 years to get off Suboxone, and the behavioral health piece continues to be a part of the process," Fiorini said. "After they are stabilized, they can take it on their own."

Suboxone does have street value, largely for its ability to ward off withdrawal symptoms, so the federal Drug Enforcement Administration is very strict about how it is used. Safety concerns also warrant close monitoring. While Suboxone is believed to be safer than methadone, it can be fatal if not used properly, especially if the user is mixing it with opiates.

"Suboxone is 100 times stronger than methadone in binding to the brain's mu-receptors," Guthrie said. "We tell them not to use Suboxone if you're still using, because it's very easy to overdose when their tolerance is gone."

Suboxone is packaged in child-protective foil pouches, and it comes in the form of a small film strip that looks like a piece of a Band-Aid. The strip is put under the tongue, where it dissolves within 30 seconds, and starts working in a few minutes.

Guthrie said the doctors who go through the certification process are warned they are likely to have patients die when fighting opiate addiction, but Guthrie believes the chances of winning are better with Suboxone.

"I know I'll lose some battles, but now I'm in the fight," she said.

The health department's behavioral health care services continue to evolve since it received a $130,000 federal grant in November 2014 for expansion in that area. The clinic was actually approached about making Suboxone part of a carefully monitored MAT program.

"This was driven by a demonstrated need and lack of resources in the community," Guthrie said.

Guthrie is also a licensed clinical social worker, so she is both medical doctor and counselor.

The drug won't be given unless the user is dedicated to working the behavioral programs, which include individual and group therapy.

"If you work the steps, this program works, but we can't provide the medication without the behavioral programs," Guthrie said.

Ronelle Allen, a licensed clinical professional counselor with Alliances Consulting in Dixon, is helping Fiorini develop the outpatient piece of the process.

Allen is experienced in addiction-related counseling, and is a strong supporter of taking a holistic approach to treatment. She has partnered with Safe Passages, and what she learned from her clients prompted her to approach the health department.

"I was doing family recovery group work, where I work with many different types of addiction," Allen said. "I was often told that treatment wasn't addressing certain issues, so I approached Beth about developing this program."

The outpatient program is done in association with MAT, but it is also used for other clients. The outpatient groups are called Experience, Strength and Hope. The Suboxone clients at the health department will be in the program, but the counseling is more individualized to accommodate the recovery process.

"There are very specific requirements -- they have to meet so many times a week with the counselors, and do regular drug tests -- but we put in services they can manage and handle," Allen said.

A full mental health assessment is done and the health department professionals meet as a team to do evaluations.

One of the groups focuses on teaching life skills, which includes things like finding a job, finding housing, and even nutrition.

"People in the recovery community struggle with basic things like properly feeding themselves," Allen said. "It's very important to get people physically ready so they can handle the intense emotional aspects of recovery."

In addition to Guthrie, the health department recently hired a second doctor who is there 2 days a week, and could soon be there more. Guthrie also has three physician assistants, and three nurse practitioners. A psychiatrist oversees the behavioral health programs.

About Suboxone

Go to www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf for detailed information about Suboxone from the U.S. Food and Drug Administration.

Free OD antidote, training available in Dixon

DIXON -- Free training in the use of naloxone, a drug commonly known as Narcan that can stop an opioid overdose immediately, will be provided at 1 p.m.May 21 at the Dixon Elks Lodge, 1279 Franklin Grove Road.

Free naloxone kits will be distributed after the group training is complete, which will take at least 45 minutes.

Those who wish to attend must RSVP to David "Moss" Mossholder at dixonareana@gmail.com or 815-677-8763. The training will be anonymous (although it will be done in a group), so you do not need to provide a name, but you must let Mossholder know how many will be attending so he knows how many kits he will need to provide.

Call him for more information, or to schedule individual training.

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