Opioid addicts are given few options to escape the full force of withdrawal while trying to curb their addiction.
As a result, drug-assisted methods of opioid treatment with the help of pharmaceutical options like Suboxone, a partial opioid agonist, make treatment more attractive to addicts who don’t want to suffer the full symptoms of withdrawal. But Suboxone, an increasingly popular method of sidestepping the withdrawal symptoms, is quite rare in western Kansas and dangerous to abuse.
With a low Suboxone provider count in the western half of the state, those that do provide the drug feel that their services are not well-known behind a cloud of unavailability. Without options like Suboxone, those same providers worry that opioid addicts are not coming forward for help and are instead feeding their addiction through any means necessary.
According to the Centers for Disease Control and Prevention, most people who abuse prescription opioids get them from a friend or relative, but those who are at the highest risk of overdose, people who use prescription opioids non-medically for 200 or more days a year, acquire them differently. The CDC reports that 27 percent of high-risk users utilize their own prescriptions, 26 percent get opioids from friends or relatives for free, 23 percent buy them from friends or relatives, and 15 percent buy them from a drug dealer.
Those at highest risk of overdose are about four times more likely than the average user to buy the drugs from a dealer or other stranger.
• Go to https:// gatehousekansas. com/opioid/ to see more stories by Kansas’ Gatehouse newspapers about the growing opioid problem in Kansas.
Administrative officials at Compass Behavioral Health, a community mental health center that offers substance abuse options for opioid addicts, say people often do not feel they have a problem because doctors prescribe their opioid medications.
CBH, based in Garden City, serves 13 counties in southwest Kansas, including Finney, Ford, Grant, Gray, Greeley, Hamilton, Hodgeman, Kearny, Lane, Morton, Scott, Stanton and Wichita counties.
Despite CBH’s implicit focus on mental health services, the organization’s Garden City location also employs one of just two providers of Suboxone treatment for opioid addicts within a 250-mile radius of Garden City, according to the Substance Abuse and Mental Health Services Administration. The only other provider, who works with Genesis Family Health, is also based in Garden City and began offering Suboxone treatment a year ago.
Wolf in sheep’s clothing
Suboxone, a common brand-name version of the drug Buprenorphine with added naloxone to reduce the likelihood of abuse, is one of the most frequently used and preferred forms of drug-assisted treatment for opioid addiction. It is also technically an opioid.
Suboxone assists patients by reducing their withdrawal symptoms and cravings. It also gives patients the opportunity to treat opioid dependence in the privacy of a doctor’s office. People treated with Suboxone do not typically need to be hospitalized or make daily visits to a clinic, allowing more time for work, family and other activities.
Prescribers are generally of the consensus that Suboxone is effective, but because it limits withdrawal symptoms, it can still be abused, with dangerous results.
Megan Garcia, regional director of the CBH Garden City office, said Suboxone can help regulate pain without the same dependency cause by traditional opioids, which she described as such:
“After you’ve been taking an opioid substance for so long and you stop, your brain receptors actually go up, so you feel more pain than what is considered average or normal,” she said. “So if you had a knee injury, and you were taking Percocet for three or four months, and you had surgery — everything was fine and you stop — your pain will actually spike for about a week and get horrible, as bad as it was before the injury, because your body has become physically dependent and it wants you to take more of that medicine.”
According to Garcia, CBH collectively sees 32 patients seeking Suboxone treatment. She said the CBH network currently treats a total of 131 patients with an opioid abuse disorder, including some who come from out-of-state areas like eastern Colorado and northern Oklahoma.
Lisa Southern, CBH executive director, said she thinks more patients would come if they were aware of the drug addiction treatment services offered at CBH.
“I am hoping for the sake of western Kansas, we see growth in the number of (Suboxone) providers, because I think right now our numbers could be higher if probably more people knew that we prescribed Suboxone,” she said. “I think because we’re seen as a behavioral health or mental health center, people don’t always think that we have the drug and alcohol services. It is a small percentage of our services, but we are able to take care of this.”
Southern said Suboxone providers are limited by the federal government in how many patients they can see and how much Suboxone they can prescribe. She said CBH’s provider, Dr. Fernand Gautier, is limited to a maximum of 100 patients seeking Suboxone treatment. She added that providers can only see about 30 patients during their first year of Suboxone licensure.
Patients at CBH and other clinics are monitored and regulated in their use of Suboxone, but that is because opioid addicts who attempt to use Suboxone to escape withdrawals while maintaining their opioid addiction through drugs like oxycodone can amplify the depressant properties of both drugs with fatal results, especially among users with respiratory problems.
“They have to follow protocol,” Southern said of prospective Suboxone patients, “and if they come in and they test positive for an opioid, then we know that they’re still using even though they’re taking the Suboxone. At that point, generally they get one chance, and if they test positive again we can’t treat them anymore because it’s not safe to have someone on this medication and have them continuing (to abuse opioids) on the side.”
A high price to pay
Another barrier to Suboxone treatment is the price. Southern said Suboxone is more expensive than traditional opioids, including the most potent varieties. According to GoodRx.com, a search engine for bargain drug prices, the lowest price for the most common version of Suboxone is around $59.26 for 14 sublingual tablets, 59 percent off the average retail price of $131.30 for the same amount.
Conversely, the lowest price of oxycodone, a popular and powerful pharmaceutical opiate used to treat moderate to severe pain, is around $18.58 for 120 5-miligram tablets, which is 71 percent off the average retail price of $64.15.
“Because some people don’t have insurance, that’s one of the barriers to them coming in for treatment, because they can’t afford to pick up the medication,” Southern said, adding that she believes Suboxone can cost patients as much as $1,000 a month.
“The addiction is way less expensive than the treatment,” she said, making it financially easier to maintain an addiction than to actively seek drug-assisted treatment.
Not only is Suboxone treatment significantly more expensive than pharmaceutical opioid prescriptions, heroin is the cheapest of all. Garcia said people often start with pills, then move on to snorting and injecting, and eventually translate those habits to heroin.
“Because of the cost of the pain pills, of buying them on the streets, or they don’t have health insurance to go into the doctor to get prescriptions of it, they’ll switch to heroin because typically it’s a little bit cheaper and the high is a lot stronger and faster,” she said.
According to Garcia, reports of heroin use by patients at CBH have slightly increased among residents native to the Garden City area.
“Not people who were outside coming in,” she said. “These were lifelong residents.”
A problematic approach
Some treatment centers are more skeptical of Suboxone as a catch-all solution to opioid addiction.
City on a Hill is a faith-based drug treatment organization with centers in Marienthal, Garden City, Liberal and Sedan. CoH CEO Christopher Lund said that since the organization’s founding in 2008, more patients with opioid addiction have been coming in for treatment.
In 2008, about 80 percent of patients struggled with alcoholism or meth addiction, Lund said. By 2010, patients began reporting problems with prescription medications, including opiates, over-the counter drugs like cough syrups, and benzodiazepines such as Xanax.
In 2011, CoH introduced Suboxone treatment, which Lund said has proved problematic in some instances.
“It’s effective medication, but the problem that we saw was that the clients that were most addicted to opiates could also abuse Suboxone,” Lund said. “After a year or two of unsuccessfully trying to treat opiate addicts with Suboxone in outpatient services… we would only administer or allow them to get on Suboxone… if they were in our residential centers.”
Lund said he thought Suboxone was a “fantastic” medication at first, but added that a vast number of patients attempt to abuse the medication like they would a traditional opiate, which eventually changed his mind.
“Unfortunately, our experience with Suboxone has been solving one problem with another,” Lund said. “I only know what I know, and there’s a big push right now to handle the opioid epidemic. The best thing they can do now is control those opiates.”
Lund was referring to the federal government, which has been embroiled in controversy after a recent 60 Minutes investigation found that Congress has helped to fuel the national opioid crisis by passing a bill in 2016 that made it harder for the DEA to impose fines on distributors sending too many opioids to a particular location.
Lund says he has seen instances of 500 opiate tablets being prescribed to one person for a 30-day period.
“They do that because that person didn’t start off with 500 pills,” Lund said. “They saw the same doctor over a 10-year period for a back injury they had, and what they originally were taking as two a day became four a day became six a day became eight a day, and their doctor, thinking that opiates are addictive and this person has been here for five or six years, now needs this much to maintain it. And they’re friends now, because they’ve been seeing each other for 10, 20 years, and there were no restrictions (at that time.)”
CoH’s residential centers, located in Marienthal and Sedan, are restricted to women. Lund said one out of every eight women in treatment is an opiate addict. He added that he has seen one man addicted to opiates come to an outpatient facility.
As for heroin, Lund said western Kansas has largely been spared of the heroin addiction prevalence that often follows prescription opiate addiction.
“We do have some, but it’s maybe 1 to 2 percent (of the patient population), whereas if you go to New Hampshire, where it’s just been overrun with heroin, 70 to 80 percent of the clients that are in treatment are heroin addicts.”
According to Lund, CoH’s patients come from all over Kansas, including the eastern half of the state, but not for Suboxone treatment. CoH’s most recent Suboxone provider retired in recent years after taking the job in 2014. The organization has not offered Suboxone treatment since.
“The answer, in my opinion, is to do it the old-fashioned way,” Lund said, “which is to sweat and throw up and do all that stuff you need to do until you’re sober enough to stand up straight.”
New treatment options
But as one group removes the mantle of Suboxone treatment, another has taken it up. Genesis Family Health has been providing Suboxone treatment since the start of this year, according to Robin Unruh, a clinical social worker and addictions counselor with the organization.
She said just five to six patients have been seeking the treatment, but echoed sentiments that there is more to the opioid epidemic in western Kansas than meets the eye, adding that the lack of drug-assisted opiate addiction treatment in western Kansas and other neighboring areas has contributed to the paucity in patient turnout at treatment centers.
Unruh emphasized that opiate addiction affects all walks of life, even young people.
“We had a couple 18-year-olds who have been in here,” she said. “I think we’ve had some cancer patients that were addicted to it and the doctor was trying to wean them off.”
Unruh noted that GFH has received two grants in the last two years specifically targeting opioid abuse treatment. The most recent grant was given this year.
The 2017 Access Increases in Mental Health and Substance Abuse Services grant from the Health Resources and Services Administration provided $200 million this year to 1,178 health centers for the expansion and integration of mental health and substance abuse services. The $175,000 allocated to GFH has allowed the organization to hire a new psychiatrist and case manager as it endeavors to combat regional opioid addiction.
Genesis CEO Julie Wright said the grant will specifically be used to expand psychiatric services for patients undergoing Suboxone treatment, adding that the grant also will help expand psychiatric services in the Genesis family health unit to give more medical oversight of treatment programs.
The service will focus on treatment, prevention and awareness of opioid abuse in a primary care setting by increasing personnel, utilizing health information technology and providing additional training.
In accomplishing those goals, Genesis has hired a new psychiatrist and case manager and will expand its telemedicine services to connect communities serviced by Genesis in southwest Kansas and reduce driving time for patients.
The expanded funding is part of the DHHS’s five-point strategy to combat the opioid epidemic by improving access to treatment and recovery services, targeting use of overdose-reversing drugs, strengthening understanding of the epidemic through better public health surveillance, providing support for cutting-edge research on pain and addiction and advancing better practices for pain management.
Though word of mouth is growing that Genesis offers Suboxone treatment, Unruh said Dr. Okeke, the group’s provider, is only available at the GFH center in Garden City one day a week. She said GFH hopes to eventually expand Suboxone treatment services to their other facilities in Ulysses, Liberal and Dodge City.
“We don’t have enough providers in this area,” Unruh said. “I don’t view City on a Hill or Compass as competition because we don’t have enough opportunities out here anyway. We just don’t. It’s scary to think about the people with the opioid problems with the prescription meds. They’re not seeking help yet. They’re still trying to deal with it on their own.”
Contact Mark Minton at firstname.lastname@example.org.