Heroin's hold: Fighting drugs with drugs

Iowa pushes for more doctors to administer Buprenorphine to fight symptoms, cravings

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The Iowa Department of Public Health is working to get more doctors trained to prescribe Buprenorphine — a drug that diminishes withdrawal symptoms and cravings — through the help of a $3 million federal grant.

In Iowa, those admitted for treatment with an opiate as their primary drug grew statewide from 677 people in 2007 to 1,707 in 2012 — a 152 percent increase. Fifty-two Iowans died from opioid overdoses in 2014, with 19 of those dying of heroin overdoses, according to state data.

Iowa currently only has about 40 doctors trained to administer Buprenorphine, also known by its brand name Suboxone. Experts believe increasing that number would boost access to Medication Assisted Treatment, also known as MAT. MAT is an effective way to treat heroin and opioid addiction through counseling and medications such as methadone or Buprenorphine.

Methadone is highly regulated and supervised, requiring daily trips to a clinic, whereas Buprenorphine can be prescribed and dispensed in a physician’s office. But a new report released June 23 by the National Safety Council — a not-for-profit that looks to prevent injuries and death — said all but three states are ill-equipped to sufficiently treat opioid addiction with Buprenorphine.

Herion's hold: Read the full series.

An analysis of national and state treatment capacity found that rates of opioid abuse or dependence (891.8 per 1,000,000 people) far exceeded the maximum buprenorphine treatment capacity (420.3), according to the report.

But there can be hesitation with MAT on the provider end, said Kevin Gabbert, Access to Recovery project director for the Iowa Department of Public Health.

“There’s some concern in regard to MAT” he said. “Once people learn the facts, they realize it’s just like any other treatment approach.”

To prescribe Buprenorphine, physicians must complete an eight-hour online course and apply for a waiver. Once granted the waiver, there are limitations on how many patients a doctor can work with, Gabbert said — about 30 patients the first year and 100 the second.

The state hopes to educate and train an additional 60 doctors — and has plans to hold educational sessions later this fall and reimburse providers for the fees associated with the necessary online training.

IDPH also gave funding to four Iowa providers in October to establish MAT programs — the Area Substance Abuse Council in Cedar Rapids, Jackson Recovery Center in Sioux City, United Community Services Inc. in Des Moines and Mercy Turning Point Treatment Center in Dubuque.

UnityPoint Health-St. Luke’s Hospital is holding an educational session in July for health care providers. It’s meant to give providers an overview on Medication Assisted Treatment, outcomes data and the benefit of MAT in treating opioid addiction, said Matt Rocca, program manager at the hospital’s chemical dependency unit.

“There are different schools of thought — sobriety from all substances, methadone, which has been around for decades,” Rocca said. “This is another option for those struggling with a serious health problem.”

Rocca said there are few MAT options in Cedar Rapids and all are outside the hospital.

“This is a good start, we’ll get information out to the community,” he said.

Dr. Charles Schauberger, an OB-GYN at Gundersen Lutheran Health System in La Crosse, Wis., and former chief medical officer at St. Luke’s, said the community needs more Buprenorphine options. Schauberger, who also works with residents at the Eastern Iowa Health Center, took the online course and has been able to prescribe the medication to his patients, which he says helps lower risk of neonatal abstinence syndrome — in which infants go through opioid withdrawal.

La Crosse is dealing with a similar situation, he said, and the community has worked to provide this comprehensive treatment with the help of doctors, social workers, nurses and care coordinators.

He believes addiction treatment eventually will become an aspect of family medicine, adding family doctors and hospitals need to step up efforts.

“We need someone who is committed to this population,” he said.

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