Wednesday, April 24, 2019 1:00 am
Range of options
Treatments increasing for opioid patients
Lack of training, resources and understanding of its potential have hampered the use of one important strategy in the fight against opioid addiction – medication-assisted treatment. There are signs that is changing.
Indiana's prisons and the Allen County justice system appear to be a bit ahead of the curve in implementing this addiction-fighting tool, though there is much more to be done within our region.
In Massachusetts, a recent law allows prisons to offer addicted inmates medications to relieve the symptoms of opioid withdrawal. Four prisons have begun to dispense buprenorphine, also known as Suboxone, one type of drug that can block pain and cravings. The Massachusetts prison system will eventually make two other medication-assisted treatment drugs – methadone and naltrexone – available along with other types of treatment. National media hailed Massachusetts' law as one of the few progressive state policies on medically assisted treatment in the nation.
But through its Recovery While Incarcerated program, the Indiana Department of Correction has offered “a full continuum of clinical care and medication assisted treatment (MAT) options in all adult correctional facilities” since September 2017, including detox, maintenance and reentry programs, according to Margaux Auxier, the department's communications director.
In response to changes in state law that mean more drug offenders who formerly would have gone to prison remain in local jails, a system has evolved in Allen County to identify those local drug and alcohol offenders who could benefit from medically assisted treatment. “The influx from state facilities and the sheer number of inmates” with substance-abuse problems meant “something had to be done,” Sheriff David Gladieux said Tuesday.
A key to identifying inmates who need medically assisted treatment has been Allen County's array of courts that deal with offenders who may have substance-abuse problems, said Tom Allman, vice president of addiction services for Park Center. “Allen County is fortunate to have as many problem-solving courts as we do,” he said Tuesday.
Park Center identifies those who need help through liaisons who monitor courts that focus on drug cases, veterans, mental health and DUI offenses, Allman said. Several times a week, center staffers assess inmates, and they arrange to transport those who could be helped to treatment facilities after their release from jail.
Before such transportation arrangements, Gladieux said, “many times they wouldn't even make it to the facility” before relapsing into substance abuse.
Outside of those identified through the justice system, however, it appears many substance abusers who could benefit from those medicines are not getting help. “These people generally aren't coming in unless someone else encourages them to – a family member, a friend, a pastor,” Allman said. “They generally aren't coming on their own.”
In a recent report, the Regional Mental Health Coalition of Northeast Indiana called for making medically assisted treatment “readily accessible to all patients with OUD (opioid-use disorders).” Those attempting to increase the use of anti-addiction medications are fighting a number of barriers and myths, the coalition reported, including a shortage of prescribers and providers, fear of legal consequences if those drugs aren't properly administered and the continuing reluctance to accept substance-use disorders as brain disorders that are more likely to respond to treatment than to “abstinence-only” programs.
“These barriers are very evident in northeast Indiana,” the coalition reported. “In Allen County, less than 3% of those diagnosed with an OUD are treated with medications and in the surrounding nine rural counties of northeast Indiana the rate is only 1.1%.” Allman said Park Center, which became part of Parkview Health last year, plans to use a federal grant to address those needs. “We are looking to expand treatment of addicts across our region, to Wabash, Huntington, Adams, Wells, Kosciusko, LaGrange, Noble and Whitley counties,” he said. Some addicts don't need medically assisted treatment to recover, Allman said, but many do.
“As things are today, the majority of individuals suffer in silence,” he said.