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Decreasing Opioid misuse with Medication Assisted Treatment

Mountain Medical Injury and Pain Professionals is open for business on Oak Street in Steamboat Springs, Colorado, and is ready to help the community decrease opioid overuse and the deaths and mayhem caused by misuse of opiates.  Nancy Smith Beste, MPAS, PA-C, CAC II and Executive Director of Mountain Medical, noted that according to data from the Center of Disease Control, in 2014, eight to ten opioid related deaths per 100,000 occurred in Routt County and in 2016, 19 opioid related deaths occurred.    Mountain Medical has been awarded the Pilot MAT grant to bring medication assisted treatment (MAT) services to Routt County and to educate area medical providers about how to utilize MAT in their practices. During 2018 and 2019 the MAT Pilot grant will facilitate training of ten nurse practitioners and physician assistants and the practices they work in to prescribe buprenorphine in Routt County.   Buprenorphine is the medication that is often used in MAT treatment for getting people off opiates without withdrawal or inebriation. Suboxone is a commonly know brand name of buprenorphine.

MAT utilizes a “whole patient” treatment approach for opioid addiction, combining Food and Drug Administration (“FDA”) approved medications, such as buprenorphine, with behavioral health therapy.  Buprenorphine allows an individual to discontinue opiate use without an uncomfortable withdrawal, therefore avoiding hospitalization for detoxification. Quitting any addictive substance, without MAT, from tobacco to heroin causes withdrawal.  Discontinuing an opiate can result in nausea, chills, aching, vomiting, diarrhea and misery for a week to a month with insomnia, depression and anxiety lasting for several months. Once transitioned to buprenorphine people avoid withdrawal, their pain is controlled and they feel healthy.  While using buprenorphine people think and function without impairment so that they can work, parent, socialize and participate in counseling to learn new methods to cope with pain and the craving for opiates.

Buprenorphine is an opioid partial agonist.  This means that it acts partially like an opioid and controls pain and provides a sense of wellbeing like an opioid would.    Unlike an opioid, such as, oxycodone, methadone, or heroin, when the optimal dosage of buprenorphine is reached the opioid effects level off and no further effects are experienced even with further dose increases.  This “ceiling effect” decreases the risk of misuse, dependency and side effects. Because buprenorphine covers the “opioid” receptors in the brain, the use of buprenorphine prevents opiate mediations, like heroin, from utilizing the receptors and stops all the effects of the additional opiates including the “high”.  By blocking the receptors, buprenorphine decreases the chance of overdose. Because buprenorphine does have opioid like effects, buprenorphine prescribed to replace opiates is combined with naloxone, to decrease diversion risks. Naloxone is an opioid antagonist and stops the effects of opiates, therefore, it makes buprenorphine/naloxone less likely to be diverted and misused.    If used as prescribed in the buprenorphine/naloxone products, the naloxone is not activated as an opioid antagonist and has no effect.

According to the National Institute on Drug Abuse,  MAT is shown to decrease “opioid use, opioid related deaths, criminal activity and infectious disease transmission.”   Buprenorphine has been prescribed in the United States since 2003 and has been studied extensively since 1978 when it was first proposed for the treatment of opiate dependence.  According to a study conducted through the National Drug Abuse Treatment Clinical Trials Network and supported by the National Institute of Drug Abuse (NIDA) that was published November 5, 2008 in the Journal of the American Medical Association, young adults being treated for opioid addiction who received counseling and buprenorphine-naloxone for 12 weeks had substantially better outcomes than those who received short-term detoxification and counseling.  This study investigated 154 opioid-addicted patients aged 15 to 21 at six outpatient substance use treatment clinics across the United States. One-half of the participants were randomly assigned to receive 12 weeks of Suboxone and 12 weeks of recovery counseling, and the balance of the participants received detoxification with two weeks of Suboxone and 12 weeks of recovery counseling. The participants using Suboxone for 12 weeks were less likely, according to urine toxicology monitoring to use opiates during the treatment period.  Follow up evaluations at 6, 9 and 12 months after treatment showed that rates of opioid use were lower in all the study participants, but were significantly lower in those who used Suboxone for 12 weeks. These findings are similar to those of older adults using Suboxone for longer-term opioid dependence.

Mountain Medical Injury and Pain Professionals has the funding to train ten nurse practitioners or physician assistants and the practices in which they work to prescribe buprenorphine.  The providers who learn to prescribe buprenorphine-naloxone will be paid by the grant for the hours entailed in the training. Mountain Medical Injury and Pain Professionals will provide each medical practice that trains a provider to prescribe buprenorphine-naloxone with a treatment protocol, screening, monitoring and documentation tools, to make MAT a profitable viable resource for each practice’s patients.   “I plan to spend up to 60 hours working in each clinic to help the providers and staff master how to utilize MAT,” Beste said.

The grant awarded to Mountain Medical on Dec. 1, 2017 under Colorado State Senate Bill 17-074, (“SB74”) is a grant pilot program that specifically addresses opioid use disorders in Routt and Pueblo counties by expanding access to medication-assisted treatment (“MAT”) for opioid use disorder.

SB 74 allocates funds to local medical providers and medical practices to increase the number of trained and licensed medical professionals to treat opioid use disorder. Specifically, the grant includes funds to train nurse practitioners and physician assistants in local medical practices to dispense the specific FDA-approved medications for opioid use disorder. In addition, the grant will increase access to MAT along with other evidence-based treatment and behavior therapies for individuals with opioid use disorder.  “The SB74 grant will allow us to educate the community and area medical professionals about how to help people to stop using opioids. This grant allows us to provide a comprehensive, multi-modality specialty practice that will incorporate local medical providers in an effort to reduce the opioid addiction rate,” Beste said.

Jose Esquibel, Director of Community Engagement with the Office of the Colorado Attorney General, said Routt County was chosen as a Pilot MAT site due to the increase in drug overdose rates in Routt County from 2014-2016.  Drug overdose rates in Routt County increased nearly six-fold from 2014 to 2016, and over 65% of those deaths were related to prescription opioids. “Expanding MAT among nurse practitioners and physician assistants in Routt County also provides benefits to residents in need of this service that reside in surrounding counties, especially Jackson County, where there were also high rates of drug overdose deaths,” Esquibel added.

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“My mission is to help medical providers in the area to learn to utilize buprenorphine in their practices to limit the development of opiate misuse,” said Beste.  According to the Northwest Colorado Health Partnership, “Dependence on controlled medicines like opioids may develop within as few as three-seven days.” “Replacing opiates with buprenorphine and offering people positive alternatives for managing pain stops the chaos of opiate misuse and avoids the destruction of the lives of the opiate user and his or her family,” said Beste.

Beste is in charge of administering the grant awarded under SB74 and providing periodic progress updates to University of Colorado College of Nursing. Beste has specialized in addiction and pain medicine for over 15 years, and said she sees a need for  non-opioid comprehensive pain management treatment alternatives in Routt County to stimulate less opioid misuse.

Steven Wright, M.D., Medical Director for Road to Recovery, will assist Beste in the Routt County office. Dr. Wright is Board Certified in Family Medicine, Addiction Medicine and is a pain specialist.   Dr. Wright works across the United States lecturing and educating medical providers about best practices for addiction and pain medicine. Like Beste, Dr. Wright said he looks forward to bringing innovative addiction care and non- opioid medical pain management to the Routt County community.  “Providing new evidence-based addiction services to a community is most of all of great benefit to those who continue to struggle. It is an honor to be a part of their lives in meaningful ways. For medical providers seeing these patients who often present not with simply a long review of systems but a review of a nightmare, the corresponding medical challenges can often be effecting resolution of multi-system symptom and functional crises through effective treatment of addiction,” Dr. Wright said.

Applications are now being accepted for nurse practitioner and physician assistant who wish to train to obtain a legal waiver to prescribe buprenorphine/naloxone.  a medication used to replace opioids.  Ten nurse practitioners or physician assistants will be chosen to train  and each will be paid $75/per hour for the 26 hours of training.

Three people in Routt County will be chose to train to become certified addiction counselors, (“CAC”).  These CAC trainees will receive scholarships to complete the courses required to obtain state certification for CAC levels I, II and up to CAC level III .  Costs for necessary license and exam fees will be paid.

Interested in applying to train to prescribe MAT or  be an addiction counselor? Please contact Nancy Beste at Mountain Medical Injury and Pain Professionals/Road to Recovery.   970-761-2207 or mountainmedicalinjury@gmail.com

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