YORK, Maine — It doesn’t happen here. We don’t have people addicted to heroin, no people who can’t get off oxycodone. York Hospital substance treatment counselor Sally Keck has heard it all.
“Underlying this addiction has been a stigma, a stereotype. It’s those people, not us,” she said. “The fact is, there are a significant number of people struggling with substance-use disorder in York County.”
She sees signs of change, that communities are beginning to deal with their addicted friends, neighbors and family members. “We see people putting down an overdose as the cause of death in obituaries. We see families forming support groups. All these tragic headlines are in our face. It’s getting harder to say we don’t see it anymore.”
York Hospital has embarked on a new program that aims to provide a way out of addiction for Seacoast residents. It has opened a new medication-assisted treatment program for those with substance-use disorder. It’s the first of its kind in southern York County, but a model gaining more and more traction nationwide. Health and Human Services Secretary Alex Azar recently said treating opioid addiction without medication-assisted treatment is like “trying to treat an infection without antibiotics.”
Patients are expected to come mostly from the York Hospital catchment area — the hospital has clinics in Kittery, Wells, Berwick, South Berwick and Sanford, in addition to York, that serve those and nearby communities. But the program is open to anyone, including New Hampshire residents, said the new recovery center’s medical director, Argilla George.
The York Hospital Recovery Center opened April 18. Although the hospital’s former Cottage Program offered intensive counseling for other addictions, such as alcohol, when the hospital decided to embark on medication-assisted treatment it made a decision to rename the center to more accurately reflect its expanded role.
Medication-assisted treatment pairs intensive counseling and therapy with an FDA-approved medication to treat opioid-use disorder. The Recovery Center offers its patients buprenorphine (Suboxone), a prescription medication that acts to curb cravings and lower the potential for abuse.
To say buprenorphine is a game-changer for people with addictions is a bit of an understatement, George said.
“Soon after taking this medication you’re physically feeling better. And when you feel better, you can be wholly involved in your recovery,” George said.
“This medication allows someone to be engaged,” said recovery center consultant Eric Haram, who started the first medication-assisted treatment program in Maine and for years was the resource addiction center director at Mid Coast Hospital in Brunswick. “It quiets the addiction. Within 45 minutes of taking it, people say, ‘I haven’t felt like this since I was 13.’ If you haven’t been able to think from your frontal cortex and suddenly you can, it’s really powerful for people. Within 45 minutes, the person’s skill set has doubled and the overdose potential has gone down in half.”
The recovery commitment on both the hospital’s and the patient’s part is significant. The Recovery Center has adopted a “hub and spoke” model of providing services. The center is the hub, where patients come to participate in a 24-week, intensive outpatient program. The spokes are individual primary care physicians who have gone through federally mandated training to prescribe buprenorphine, who then provide maintenance help once the program is completed.
When someone calls the center seeking help, it is likely he or she has reached a pivotal point and wants help — now.
“When they make that call, we want to see them as quickly as we can,” Haram said. “Because they could change their minds quickly. Whatever has caused it, we want to be able to help as soon as possible.”
The center is committed to seeing people within 48 hours, when a counselor undertakes an initial evaluation. If the counselor feels like the patient is a good candidate for medication-assisted treatment, he or she is seen by a doctor shortly thereafter. George said 10 York Hospital doctors have completed the mandated buprenorphine prescription training and one of them is at the center every Tuesday. Before his or her appointment is over, the patient will have taken the medication and will be monitored continuously during the 24-week program.
Going forward, the person is required to attend group sessions from 3 to 7 p.m. three days a week for six to eight weeks, followed by an 18-week aftercare group that meets once a week for 90 minutes. People who are working can access the Family Leave Act, “and we usually find employers are willing to work with the employee because then they will have a much more productive worker,” said Keck. At the program’s conclusion, the person is referred to one of the “spoke” doctors for ongoing maintenance.
Understanding it may be difficult for some patients to find transportation to the center for sessions, a hospital van will pick them up and bring them home. The hospital also recently opened a help center to assist its patients, George said. In the case of a medication-assisted treatment program participant, these services might include helping people figure out how to pay for medications and providing information on area social service organizations.
The hospital is in rarified company in offering a medication-assisted treatment program, Haram said. Only 15 out of 200 substance use treatment programs in Maine offer medication as part of the therapy. The reasons for that are numerous, Haram, Keck and George said.
Begin with stigma, Keck said. “There’s this fear that all these uninsured, addicted individuals are going to arrive on your dooryard,” she said. “For many institutions, the thought of that can be overwhelming. They’re not wary of the medication, they’re wary of the population of users.”
George said another challenge is the commitment on the part of doctors to undergo the training to prescribe buprenorphine. But Haram laid a large part of the blame on state leadership, which has not put forth a comprehensive plan to deal with the opioid epidemic. The result is that addiction “blossomed into an epidemic. And that in turn is an indicator of federal inaction,” he said.
That landscape is beginning to shift, however, as more attention is paid to this issue in Augusta and Washington. The Legislature passed a bill to provide $6.6 million to help uninsured Mainers access opioid-addiction treatment. That bill was one of many introduced this session, including one by state Rep. Patricia Hymanson of York to create a cabinet-level working group on the opioid crisis.
At the federal level, President Donald Trump outlined a plan last month to combat opioid addiction in the country. Included is a push to expand medication-assisted treatment programs. A grant program, a continuation of an Obama-era initiative, provides funding to states based on the number of fatal opioid overdoses and the number of people unable to find treatment.
Haram said the Recovery Center is committed to be self-sustaining, regardless of whether a patient has an ability to pay. He has already applied for several foundation grants and hopes recent moves by the Legislature will signal additional funding for medication-assisted treatment programs throughout the state.
“I feel like we finally have an engaged Legislature, whether Democrat or Republican, finally willing to take this on,” Keck said.
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