The poll was impromptu and far from scientific, but Carolyn Ireland figured that it might help explain some of the reasons her residential treatment program — among the oldest in Columbus — refuses to embrace a linchpin medication in Ohio’s battle against opioid addiction.
Ireland, the CEO of the 59-year-old House of Hope, walked into the lunchroom of the big house in Victorian Village and asked more than a dozen men whether they had previously abused the treatment medication Suboxone. Half immediately raised their hands.
“What’s happening is, I have guys coming in here, and when we ask, ‘What’s your drug of choice?,’ they say, ‘Suboxone.’ What do I do with that?” she said.
The pressure for treatment and recovery-housing programs to include so-called MAT, or medication-assisted treatment, has never been greater, Ireland and others say. Even House of Hope recently took a small step away from decades of an abstinence-only approach by allowing the opioid-blocking medication Vivitrol, which is administered as a monthly injection and can’t be shared.
Supporters of medication-assisted treatment, including state addiction experts, say there’s good reason to promote it: Numerous studies have shown that medication increases recovery rates, while access to such treatment still lags for many people struggling with addiction to heroin and opioid medicines.
But those leery of drug-based treatment point to what they see as mounting problems. The popular treatment medication Suboxone — that’s the brand name for generic buprenorphine combined with naloxone — is itself an addictive opioid, and some addicts use it primarily to stave off withdrawal until they can obtain preferred drugs. Drug-trend reports say it is regularly sold on the street.
The state also acknowledges that it doesn’t know how many of the doctors licensed to prescribe buprenorphine in Ohio do so at cash-only clinics, a practice that critics say increases the likelihood of misuse.
“I was using heroin for probably two years, and I heard that you could go to (a local hospital) and get Suboxone,” said Lukas, 24, who is now in recovery at House of Hope and didn’t want his last name used because he’s preparing to apply for jobs. “I was selling it and making good money selling it.”
Wendy Doolittle, president of the Ohio Recovery Housing’s board of directors, said policymakers need to understand the risks of medication-assisted treatment and keep an open mind to approaches that encourage short-term use.
“I think that we have to remember that while this is probably the biggest epidemic, when I came into this field 26 years ago, there were still heroin addicts, and a lot of them did get well,” said Doolittle, CEO of McKinley Hall, a treatment and recovery program in Springfield.
Dr. Mark Hurst, director of the Ohio Department of Mental Health & Addiction Services, says it’s important for treatment providers to have an array of options, as there’s no such thing as “one size fits all” treatment. But he said medication along with counseling still gives many people their best chance, and the state is working to significantly expand the number of doctors certified to prescribe Suboxone and other treatment drugs.
The total jumped by 65 percent — from about 1,100 to more than 1,800 physician prescribers in the state — over the past year. According to state Auditor Dave Yost, medication-assisted treatments cost Medicaid about $110.4 million in 2016, an increase of 719 percent since 2010.
“On some level, I get the philosophical divide,” Hurst said. “Why are you using an opioid to treat opioid-use disorder? Well, it’s a brain problem. It’s really not using a drug to treat a drug problem. It’s using a medication to treat a brain disorder.”
Although House of Hope is holding the line on Suboxone and methadone, the decision to allow Vivitrol at one of its eight recovery houses opens a path for addicts who opt for that course of treatment after receiving detoxification treatment at the Maryhaven Addiction Stabilization Center, Ireland said.
“We’re the next step in that system,” said Richard Mason, recovery housing coordinator at House of Hope.
This fall, the health center at Lutheran Social Services’ Faith Mission homeless shelter will begin providing medication-assisted treatment for homeless and low-income patients addicted to opioids, said Audrey Knaff, the behavioral-health manager. The program will offer Vivitrol or Suboxone.
“It’s a big task,” Knaff said, and Faith Mission “is not naïve” about the potential problems. “But this opioid epidemic is impacting our communities greatly, and it’s not getting any better.”
Ireland and Mason said they are collecting data to determine whether long-term sobriety rates differ for House of Hope residents who receive Vivitrol.
Both believe that counseling and employment, and especially recovery housing, are the biggest keys to their program’s success.
“Our guys are getting sober and staying sober,” Ireland said. “We have done a disservice, I think, to a lot of young opiate addicts by telling them that medication is the only way out.”
Rita Price, The Columbus Dispatch, August 19, 2018
More treatment centers debate role of drugs to combat opioid addiction