Medication Assisted Treatment: Redefining Normalcy

“Can you take a drug and still be clean?” Proponents of medication assisted treatment, or MAT, strongly believe so.

MAT has become the standard of care for opioid use disorder. These medications work to relieve — and ultimately eliminate — the withdrawal symptoms and psychological cravings associated with opioid dependence. MAT, in combination with psychosocial treatments like counseling and therapy, is associated with greater adherence to treatment, decreased opioid use, and reduced likelihood of relapse and overdose fatalities. Methadone, buprenorphine, and oral/extended-release injectable naltrexone are among some of the FDA-approved medications used as MAT for opioid use disorder. 

Our MAT clinic primarily uses Suboxone, a combination of both buprenorphine and naltrexone. To provide flexibility to working patients, we began coordinating an evening clinic on Tuesdays. Our team includes a Substance Use Disorder Care Manager (SUD CM), two psychiatrists who check in with patients and prescribe the Suboxone, a medical assistant (MA) to record their vitals, and myself. I elected to stay after regular office hours to assist our SUD CM with this transition. I primarily set up appointments for patients to complete their physical, blood work, and initial drug screens. I also check in and register patients as they walk into clinic, organize the patient forms utilized by the MA and psychiatrist, and report any concerns consumers may have since their last appointment. After becoming more experienced in my role, our SUD CM would allow me to brief patients and support staff on MAT clinic expectations and protocol, complete patient contracts with consumers, and assist in the general workflow of the the clinic.

While there were many patients who have benefitted from enrolling in our Suboxone clinic, Katie’s story is nothing short of remarkable. Katie’s primary care doctor recently retired, so she came to PMFHC to seek a new provider. Katie is a 36 year old mother to two teenage children, the oldest being 16 years old. Katie has also struggled with ongoing use of cocaine and heroin for a few years prior to meeting with us. Due to her substance use, both of her children were removed from her home by the Office of Children, Youth and Families (CYF) for being suspected of providing an neglectful, unfit environment to minors. She was then quickly evicted from her house as a result of the legal charges from CYF. Her ongoing mental health symptoms were exacerbated due to the stress of these concurrent issues, leading her to find anxiety medication, like benzodiazepines, through illegitimate means in addition to the cocaine.

I distinctly recall Katie coming to our office in a frenzy on a Tuesday afternoon about two hours prior to Suboxone clinic starting. She had just been stripped of her purse, keys, and wallet on the bus. But instead of immediately filing a police report, she came to us because she was worried she would miss her scheduled appointment and thus not receive her weekly Suboxone strips. I believe it was this fierce determination and willingness to ask for help that helped Katie turn her life around for the better.

Within 6 months of enrolling in our MAT Suboxone Clinic, Katie had her children returned to her home with minimal ongoing CYF involvement. Her housing calamity was stabilized through the support of numerous social services, such as the Allegheny Link. She became actively engaged in individual therapy through Mercy Behavioral Health with appropriate management of mental health symptoms. She has also completely tapered off benzodiazepines, demonstrated clean drug screens for over 90 days, and has moved to monthly appointments for MAT (the most independent treatment plan reserved for our most stable consumers). Although not all our patients have been triumphant as her, Katie has proven to be a positive model of success in our clinic.

It is apparent that while there were several external factors that were out of Katie’s control during this period of adversity, she sought to take control of the one aspect that wasn’t: her health. MAT was not the quintessential solution to her distress, but it was certainly a good start on her path to recovery.

Among other crises, America’s opioid epidemic is no secret. Rising overdose fatality rates urgently require innovative solutions, not complacency. We can embrace the gravity of the situation through holistic education, opening up dialogues to combat stigma, and to encourage users to look into MAT and other structured, supportive recovery programs. Successful MAT patients like Katie have taught me that it is time to redefine the baseline that was once “normalcy.” Hopefully, the rest of our communities will catch on.
 

References

1. https://www.kff.org/medicaid/state-indicator/states-reporting-medicaid-c...

* Patient’s name was changed to Katie to protect privacy

This post was written by NPHC member Tobin Chemplavil.

Tobin serves at Pittsburgh Mercy Family Health Center as a Patient Navigator.