Health

Cedar Rapids opioid-use treatment program sees first-year success

Katie McCullough
Katie McCullough
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CEDAR RAPIDS — Katie McCullough has been through nine different treatment programs for her opioid and meth addictions, and has relapsed eight times.

But on the ninth try, it seems to have stuck.

The 41-year-old Cedar Falls resident has been sober for 14 months, which she attributes to a substance-use disorders treatment program that has “changed my life,” she said.

Through a partnership between Cedar Rapids-based health organizations, McCullough entered a program that offered medication-assisted treatment for individuals like her who have been struggling.

“This is the first time I’ve been successful in being sober for this long,” McCullough said.

Medication-assisted treatment, or MAT, uses medications in combination with behavioral therapy to treat opioid-use disorder.

Eastern Iowa Health Center — Cedar Rapids’ federally qualified health center — and the Area Substance Abuse Council — ASAC, the nonprofit substance-abuse provider — have partnered since early 2018 to offer this treatment program in response to rising opioid-use rates across the state. The partnership has been funded through a federal grant received last year.

“We started doing it because we knew the research was pretty solid saying that (medication-assisted treatment) really was going to help patients with opioid addictions, but also really strong evidence in helping patients with alcohol addiction,” said Barb Gay, ASAC executive director. “We didn’t have huge opioid numbers at that time, but we continue to have a lot of patients with alcohol addictions.”

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Since 2005, the number of deaths related to opioids in Iowa has more than tripled, according to the Iowa Department of Public Health.

Public health officials report 206 individuals died from opioid-related causes in 2017. Sixty-seven deaths were reported in 2005, only two years earlier.

Medications typically used to treat opioid-use disorder include methadone and buprenorphine. McCullough has been using Suboxone, the brand name for buprenorphine, for about 11 months.

Through the program, patients receive the medication from waivered providers at Eastern Iowa Health Center. These patients also are required to meet with providers at ASAC for cognitive-behavioral therapy, a necessary piece to treatment programs to ensure long-term success, research has shown.

Eastern Iowa Health Center has 11 providers with federal approval to administer the treatment across its clinics. Joe Lock, president and chief executive officer of the clinic, said the initial goal was to treat 25 patients.

“We built our program very purposely here,” said Amy Wilson, nurse practitioner and one of the 11 approved providers. “We started out very slow because it is a whole other realm.”

However, officials said the program exceeded expectations. As of this month, 42 individual patients have been treated early last year, Lock said.

ASAC and Eastern Iowa Health officials denounced the stigma sometimes associated with programs that aim to help individuals with substance-use disorder, saying more providers should take on this treatment option for their patients.

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“It’s like you treat diabetes or it’s like you treat (high) blood pressure,” ASAC’s Gay said. “There are drugs you use to treat them — you wouldn’t deny someone insulin if they need that for their diabetes.”

McCullough joined the program nearly a year ago while living in Hightower Place in Clinton, ASAC’s transitional housing for women recovering from alcohol and drug-use disorders.

She said she decided to try treatment again last year when her relationship with her 14-year-old daughter became strained.

“I love my daughter,” McCullough said. “Seeing that relationship deteriorate really pushed me to want to do better.”

McCullough, who since has moved to Cedar Falls, drives once a month for her medication. She also obtains counseling with a private therapist in Cedar Falls, who helps her address adverse experiences from her childhood that drove her to substance use.

“My goals (in treatment) were to stay sober and be a responsible, productive adult and move forward with my life in a positive way and take care of my daughter,” she said. “It’s all been coming true.”

ACCESS

Admissions to health care providers for opioid-use disorders reached more than 2,200 admissions in 2017, according to the Iowa Department of Public Health.

However, an Iowa Department of Public Health work group, directed to review substance-use disorder services statewide by lawmakers, found access to providers “is not sufficient.”

According to a study published by the University of Iowa, as of December 2018 there were 127 providers in Iowa registered with federal officials as buprenorphine-treatment practitioners.

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“Since much of Iowa is rural, access to (medication-assisted treatment) may be a challenge for residents in many counties,” according to the study. “... Adequate coverage often requires having more than one local provider.”

The study states that among Iowa’s 99 counties:

• 15 counties’ residents do not have access to buprenorphine treatment.

• 23 counties have limited access.

• 61 counties have two or more providers.

For those 15 counties, no access means a resident might have to travel more than 30 miles to obtain this treatment. In Emmet County, residents have to drive nearly 57 miles to reach a provider.

The study, which was published in January, states Linn County has 32 providers and Johnson County has 34 providers.

A challenge for prescribers offering medication-assisted treatment is obtaining prior authorization from Medicaid insurers, Eastern Iowa Health Center’s Wilson said.

Wilson documented eight hours of phone time with a managed-care organization while obtaining a patient’s prior authorization for the treatment in the early days of the program’s existence.

“It’s like all these barriers of paperwork, and then you’ll get random denials for reasons that it doesn’t make sense,” Wilson said. “There’s never consistencies. It’s just it’s very, very challenging.”

State lawmakers recently passed legislation that would remove the requirement for a prior authorization for five treatment types — methadone, buprenorphine, naloxone, buprenorphine and naloxone combination and naltrexone.

It was sent to Gov. Kim Reynolds on April 11 for her signature.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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