[New post] ‘It’s OK to not feel OK’: Front Range Clinic prioritizes patient functionality through medication-assisted treatment
Morgan McKenzie posted: "Substance abuse addiction has several similarities to diabetes — both are considered chronic relapsing medical conditions, and treatment is the best solution. A difference lies in some attitudes toward treatment for the two conditions: those living wit" Greeley Tribune
Substance abuse addiction has several similarities to diabetes — both are considered chronic relapsing medical conditions, and treatment is the best solution.
A difference lies in some attitudes toward treatment for the two conditions: those living with addiction face stigma when seeking treatment. Medication-assisted treatment, or MAT, however, is an effective way to reduce relapses and overdoses, according to experts.
MAT is an evidence-based treatment for addiction that fills the receptors in the brain to get rid of withdrawal symptoms, according to the Front Range Clinic website. This helps reduce the likelihood of engaging in dangerous drug-seeking behavior.
The treatment doesn't cure addiction but grants people a functional life through medication, counseling and behavioral health services, the website said.
In honor of Overdose Awareness Week, Chief Medical Officer Dr. Jeremy Dubin at Front Range Clinic, Colorado's largest network of outpatient treatment centers, is highlighting the clinic's life-saving approach to treatment that prioritizes MAT, along with harm-reduction care that is "high access, low barrier."
Front Range Clinic has more than 35 medical providers to more than 60 points of care across Colorado, including Greeley, Loveland, Fort Collins and Longmont. Along with 20 in-person facilities across the state, one in Greeley, there are also four mobile units funded by the state that tend to rural parts of Colorado.
A poll indicated 66% of American adults have a personal or familial experience with alcohol or drug addiction, according to Axios. Nearly 645,000 people died between 1999-2021 from an opioid overdose, the Centers for Disease Control and Prevention reported.
Dubin credited a few factors of the epidemic that have created the "perfect storm" of demographics that include all types of people.
"The soccer mom, the homeless person, the oil rig guy, the teacher, the doctor, the journalist … everybody," Dubin said about those dealing with addiction.
An initial factor, according to Dubin, is the crisis conception in the 1990s starting with prescription painkillers and opioids because physicians were told they were under-treating pain — a national trend the state followed.
Adding to that, addiction has always been plagued with stigma: people who abuse drugs and alcohol are viewed as "bad." This stigma is also seen in people seeking help because there is misinformation about how treatment doesn't work, Dubin said.
Those who are vulnerable to addiction make up about 10-15% of the population, according to Dubin. He compared it to diabetes: if 10 people ate chocolate cake for one month, only one or two of them would develop diabetes.
The same goes for consuming opioids. Only 80-85% of people placed on Percocet due to chronic pain would become vulnerable to addiction.
When the epidemic became evident in society, physicians changed how they prescribed prescription opioids. But this ignored a whole generation of people who were now grappling with addiction, according to Dubin. Many of those who fall into that demographic, even those one would never expect to have an addiction, began turning to heroin because they couldn't access their medicines.
"It's like saying to somebody with diabetes, 'OK, now I'm not going to give you your insulin. Good luck,'" Dubin said.
In the past decade, heroin has since been replaced with fentanyl, which is much more deadly and has a higher potency, Dubin added. He said COVID-19 has only magnified this issue — causing a 30% increase in overdose, mortality and relapse nationwide, statewide and in Weld and Larimer counties.
The pandemic that caused isolation or desolation only added to the condition described as a disease of isolation and desolation.
Front Range Clinic's fight for treatment, prevention
Prevention and challenging stigma are needed to see real change, Dubin said, which includes letting people know it's OK to ask for help, that treatment works and that communities are behind them during their recovery journey.
"We're trying to clean up the water from a broken dam," Dubin said. "It's OK to not feel OK."
Front Range Clinic at 8223 W 20th St. Suite 100A in Greeley. (Courtesy/Front Range Clinic)
Getting people started on a treatment path is a forte for Front Range Clinic because they are high access and low barrier, meaning they're quick at getting people in and open to all insurance types. Unlike other treatment centers, which can sometimes have up to six-month waiting times and increase the risk of an overdose, there are no waiting lists at Front Range Clinic.
"That is a very important piece, and that's secondary to the stigma," Dubin said. "We have to see people when the iron is hot."
As for the low barrier promises, the clinics take all insurances and are about 70-80% Medicaid, according to Dubin. Experts even work with people who don't have insurance.
"Our porch light is always on, and our doors are always open," Dubin added. "We take it as a badge of honor."
Addiction professionals at Front Range Clinic identify the vulnerable people in society: adolescents, seniors, marginalized people suffering from chronic pain and people with co-occurring mental health issues.
Dubin explained that alcohol and drugs seem to work for people suffering from pain or mental health issues, such as depression or anxiety, but the list of consequences is long: legal and criminal issues, families falling apart and health dangers such as heart attacks, strokes and other severe and deadly issues.
Though it makes sense that substance use gets a bad rap due to the long list of consequences, Dubin said the perspective has to change to eliminate stigma for the people who use the substances and encourage people down a treatment path.
"I've never met someone who wants to be addicted," he said. "I've never met someone that wants to maintain their mental illness. But if we can step back and challenge our cultural perception of drugs and alcohol, then we can really harness our resources to the folks that need it the most with treatment and access to treatment."
Treatment may not always be perfect, but just like for diabetes, it includes developing a relationship with someone and creating a "trajectory of functionality." Front Range Clinic uses functionality, a recommended approach by the American Society of Addiction Medicine and the National Institute of Drug Abuse.
Experts, of course, want to see patients' trajectory result in them not using anymore, Dubin explained. But the care team cares more about functionality, such as if a person goes from injecting to smoking, and doing so once per week instead of once per day.
Progress is seen in that example as significantly decreasing the patient's chances of HIV or hepatitis and their chances of overdose, as well as establishing a relationship between the patient and team.
To reach functionality, Front Range Clinic has enforced a harm-reduction approach and institutionalized non-judgmental, empathy care, Dubin said. Harm-reduction care includes using the proper language without using any non-stigmatizing wording and creating therapeutic relationships. This also means providing individualized care depending on the severity of conditions.
"The opposite of addiction is not sobriety. It's connection," Dubin said.
Empathy is especially critical among those who need drugs and alcohol to treat their mental health disorder. He cited the example of a soccer mom using opioids to help with her depression because nothing else worked.
"Nothing works as good as drugs and alcohol," he said. "That's why they're so attractive. It's not like people just want to get high, a lot of folks are using it to treat their co-occurring mental health disorders."
After a while, these people develop a separate condition because their brains get kindled to the drugs they are addicted to. Stopping the use of that drug can create withdrawal symptoms that "feel like the flu times 20," Dubin said.
This is why MAT is life-saving.
MAT has shown results
Front Range clinics look at the "biochemical" part of addiction. Patients have genetic vulnerability, and there are actual brain changes from drug use and withdrawals.
However, access to medicine can quickly decrease the risks of overdose and get people off their rollercoaster of going back and forth between using and non-using, according to Dubin.
"These medications are tools to help patients level the playing field so they can engage in treatment," Dubin said. "The idea sets a foundation."
Front Range Clinic uses two of the three MAT options that can be used to treat opioid addiction — buprenorphine/Suboxone and naltrexone/Vivitrol.
Buprenorphine replaces opioids to prevent cravings and lessens the intensity of withdrawals from opioids, according to the clinic's website. Patients on the medication report feeling normal and functional all day long. The medication is also combined with counseling and other forms of support.
Naltrexone is injected monthly to treat opioid addiction and alcohol addiction. Vivitrol has been clinically proven to reduce the probability of relapse, according to the website. The medication binds to receptors in the brain and prevents patients from feeling the pleasant effects of opioids and alcohol.
Several nationwide organizations also endorse MAT, including the CDC, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration and the National Institute for Health, Front Range Clinic's website said.
"Treatment without MAT is often incomplete because it ignores the biochemical piece," Dubin said, citing the American Society of Addiction Medicine. "It doesn't mean everybody needs it, but everyone should have the opportunity to have access to it."
All Colorado jails, as of July 1, are now required to offer MAT to inmates who need it to combat overdoses, relapsing and retention, according to Dubin. He reported inmates will overdose almost 5 to 1, sometimes 10 to 1, coming out of jail.
Throughout his career, Dubin has seen patients do better and live longer when medicine is offered to play a role in their treatment. He cited data on severe opioid use disorder that shows about 9% of people in jail have negative urine drug screens over the course of one year.
About 9-10% of patients receiving counseling alone have negative urine drug screens, while counseling followed by a strategy sits at 10-15%.
As for MAT, Dubin said that number is more than 50% and increases when combining medication with behavioral and counseling help.
"Those numbers might not sound great, but coming from a place where we don't have a cure like diabetes, we are moving forward," Dubin said.
Dubin encourages people to keep fentanyl testing strips and naloxone, or Narcan, on their person. Narcan is a nasal spray that can reverse an opioid overdose and is available as an over-the-counter treatment.
A box of Narcan and a Kloxxado training device are seen at the Evans Police Department in Evans Oct. 21, 2022. The two products are used to reverse opioid overdoses. (Alex McIntyre/Staff Photographer)
Overdose signs include a pale and clammy face, limp body, fingernails and lips turning blue or purple, vomiting or gurgling, being unarousable and unresponsive and shallow or slowing heart rate, Dubin said.
If you expect someone is experiencing a drug overdose, call 911 and administer Narcan, if possible.
For more information about Front Range Clinic, or to get help, call (866) 568-8344 or go to www.frontrangeclinics.com.
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