Printer-friendly format

Ray Huber is one of the counselors at Quapaw House, Inc., a Hot Springs-based center providing Suboxone therapies for opioid addicts. Quapaw House, Inc. treats a full range of substance addictions at several regional facilities.

In recent months, U.S. officials have begun paying close attention to the rise in abuse of buprenorphine, the prescription drug that has been considered by many to be a major breakthrough in the treatment of opiate addiction. Most commonly sold as SuboxoneTM, buprenorphine has been slow to take hold in Arkansas. The manufacturer’s Web site lists only 15 doctors in Arkansas who are licensed to prescribe the drug, the vast majority of which reside in the Little Rock metro area. In Hot Springs, however, at least one substance abuse program has found Suboxone to be an almost unqualified success.

Quapaw House, Inc. began treating opiate addicts with Suboxone in mid-2007. “We did a lot of research into the treatment before deciding to go with it,” said Bob O’Dowd, executive director for Quapaw House. “We feel that was a good decision, because the medically assisted opiate therapy has been highly successful for our patients.”

Suboxone works by occupying the opioid receptors. Buprenorphine is a partial opioid agonist, so its opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin. Suboxone also contains naloxone, an opioid antagonist, which is designed to prevent abuse by denying the user a high.

The drug was developed as a joint project by the National Institute on Drug Abuse and Reckitt Benckiser Pharmaceuticals Inc. of Richmond, Va. Nationally, an estimated 170,000 addicts are receiving treatment with Suboxone.

O’Dowd said that the organization’s interest in Suboxone coincided with that of its new medical director, Dr. Kevin Hale of Hot Springs. “Dr. Hale became very interested in the phenomenon of addiction to pain meds,” O’Dowd explained. “He kept seeing it increasingly with children of his patients as well as in patients who legitimately needed pain medication.”

Hale went to a Drug Enforcement Agency (DEA) workshop to become licensed to prescribe buprenorphine and Quapaw House decided to build an outpatient clinic to support the program. O’Dowd said Hale decides after at least one initial consultation with the patient whether to prescribe Suboxone for them, and then the patients return for monthly outpatient evaluation.

An at least equal component of any substance abuse treatment is counseling. O’Dowd said that research shows that Suboxone alone is not enough, that it must be coupled with professional counseling and life skills training to be of lasting use.

“We don’t allow patients to come in and just see the doctor, just get the pills,” he said. “They have to sign up for the whole program.” Quapaw House patients must go through a program of group and individual counseling sessions in conjunction with the medical therapy.

The beauty of buprenorphine is that it removes two of the biggest obstacles in early sobriety and withdrawal, the pain of withdrawal and then the cravings, said Quapaw House therapist Ray Huber. He said the development of buprenorphine has done for substance abuse counseling what the development of antidepressants did for depression counseling.

“Once that consuming pain and craving for the drug is removed, patients are more stable,” Huber explained. “They stick better and quicker in the counseling. You’ve got a more stable and steady person sitting in front of you to work with. You don’t have to gut out this 30 to 60 day period of withdrawal before they return to themselves.”

Huber said Quapaw House’s current census of patients on Suboxone is around 30, and that all are doing “marvelously.”

“To date, I don’t know of one person we’ve lost to relapse,” he said, “which is unusual because the relapse for opiate-dependent people has been near 100 percent unless they are in some sort of facility for a while.”

He said Suboxone gives the counseling sessions, which focus on life skills and coping skills, a chance to work. “Many of these people have kind of burned their lives to the ground at some point. We rebuild that, and they learn how to cope with life issues that are usually a trigger to go back to the drugs,” Huber explained. “So we get that stabilized and they walk out now able to function, go to work and do all the things that people who are not dependent on drugs do.”

Quapaw House has several specialty facilities in Hot Springs, Arkadelphia and Mount Ida, though not all provide the medically assisted opiate recovery. Much of the program is outpatient, but the institution does have a detoxification unit and a residential facility for patients who need intensive monitoring.

O’Dowd said the residential facility is particularly counseling-intensive, with patients getting an average of 27 hours of therapy per week until they are ready to transition to outpatient treatment.

O’Dowd said that besides heroin and prescription painkiller addicts, the center has seen quite a few patients who want to wean off of methadone using Suboxone. “They don’t get that same high from the Suboxone, they just feel normal and able to function,” he said.

Huber added that some patients might stay on limited levels of Suboxone for six months or more, but that it is really a matter of the patient’s own psychological need, not physical. “The main reason for the maintenance program is for patients who are so concerned they are going to go back to their old way and are so happy with their result of taking the Suboxone. It’s like a boon to them,” he said. “The idea of not taking it at all and just going on their own recognizance kind of scares them a little.”

The University of Arkansas for Medical Sciences (UAMS) recently began its own outpatient drug addiction program using Suboxone and similar dependency-blunting drugs with counseling therapies. Offered by the Department of Psychiatry, the Chemical Dependency Outpatient Program is available for any drug addiction, but director Dr. Chris Cargile said he expects it to be particularly helpful for patients who have become addicted to prescription pain medications.

“We have determined that there’s a fairly substantial need for this in Arkansas,” said Dr. Chris Cargile, director of the service. “It’s our hope that even patients of modest means can be served by the program.”

Despite the need, such treatment has been lacking because it is often not covered by private insurance, Medicaid or Medicare. Cargile said that at UAMS, patients will be charged fees that are as low as possible but that will sustain the program.

O’Dowd said that so far, Quapaw House, Inc. has not dealt much with insurance plans in the Suboxone therapy.

An investigative series in late 2007 by the Baltimore Sun details the rise in abuse of Suboxone, a drug that was supposed to be impossible to abuse. Some addicts have found ways around the high-inhibitors such as crushing and injecting Suboxone or Suboxet, or by combining them with other alcohol and other drugs. Other users have started buying it on the street as a stopgap until they can get their next heroin or other opioid fix.

In February, the Center for Substance Abuse Treatment, which oversees the federal government’s buprenorphine initiative, held a closed, two-day summit on buprenorphine abuse. The director, Dr. H. Westley Clark, told reporters afterwards that possible action on the problem included stronger warning labels, improved physician training and more precise detection protocols.

U.S. physicians who get certification from the DEA can prescribe a 30-day supply of Suboxone with five refills, for up to 100 patients.

O’Dowd indicated that Quapaw House has not seen any evidence of Suboxone being sold on the streets.



April 2008

Tags:

None

Login and voice your opinion!

Do you know someone else who would like to see this?
Your Email:
Their Email:
Comment:	(Will be included with e-mail)
Secret Code	In the box below, enter the Secret Code exactly as it appears above *