EDITOR’S NOTE: This is the final story in a three-part series on how Lewis & Clark Behavioral Health Services is expanding the mental health safety net in Yankton County to better serve mental health needs.
Lewis & Clark Behavioral Health Services (LCBHS) is helping those fighting opioid addiction with both in-patient and out-patient services, and now, with targeted medications.
Though LCBHS has provided alcohol and drug addiction treatment for some time, that treatment is now able to be honed specifically towards opioid dependency, which is on the rise around the country.
In addition to comprehensive therapy and support, Medication Assisted Treatment (MAT) for opioids includes the use of specific drugs that reduce cravings or the effect of opioids to facilitate with withdrawal and help prevent relapses.
In November 2018, LCBHS received a grant through the state Department of Social Services to include MAT as part of its existing program in order to better face the reality of the national opioid epidemic.
“Statistically, there’s about 115 persons a day dying from unintentional overdose related to opioid use disorder in the nation,” said Pam VanMeeteren, the psychiatric mental health practitioner who manages the MAT program for LCBHS. “If we had people dying of any other cause, we would certainly be looking at and trying to figure out ways to remedy it.”
So far this fiscal year, which began in July for LCBHS, 4% of out-patients served had a diagnosis of opioid use disorder and 22% of clients entering in-patient care at the very least included a diagnosis of opioid use disorder, allowing them to be treated under the MAT program, she said.
Since the beginning of the MAT program, LCBHS has served 44 individuals, and is currently working with 16.
“The Medication Assisted Treatment (MAT) program is really woven into our drug and alcohol treatment program,” VanMeeteren said. “We opened our residential in-patient treatment unit now about three years ago. About two years ago, when the opioid crisis became a significant issue across the nation and awareness grew, we were able to receive some funding through the state to implement medication assisted treatment for opioid use disorder.”
At this time, there are three providers at LCBHS that have completed the MAT certification training associated with the grant: VanMeeteren, Alan Brabeck and John Gullickson.
MAT is based on research that supports the use of medication as one part of the tool for combating opioid addiction. The three main medications indicated for treatment of opioid addiction include: Methadone, Suboxone or Vivitrol.
Methadone has been used for decades to address opioid addiction, and though it provides a consistent, low, daily dose of opioid, it is itself addictive and is stringently controlled.
“Methadone is only prescribed through a specially licensed clinic and the only location for that is in Sioux Falls, and so that’s limiting,” VanMeeteren said. “It’s not an option we would highly recommend, but nevertheless it’s been out there for a long time as a way to treat opioid use.
The MAT program at LCBHS uses either Suboxone or Vivitrol to treat opioid abuse.
Both medications work on a specific receptor in the brain, the immune receptor which is where opioids render their effect, she said.
“Suboxone renders a partial effect on the receptor,” VanMeeteren said. “So Suboxone is still a combination of opioids, but it’s combined with a kind of blocker so that the individual gets enough of the opioid effect that it prevents cravings, but it prevents a desire to use more.”
The blocker in the medication prevents the high or euphoria normally associated with opioid use. It also has a protective factor preventing the side effects of opioid use, particularly respiratory depression, which is responsible for opioid deaths, she said.
“The other medication, Vivitrol, is what we would call an antagonist, so it actually completely blocks that receptor so that, if someone uses, they absolutely get no effect,” VanMeeteren said. “The overdose potential is significantly negated with the use of either.”
The decision of which medication would be appropriate for a client is done on a case-by-case basis, taking into account the amount of opioid in the person’s system.
“The biggest challenge to using the Vivitrol is that, to start the medication, the person needs to be at least seven days opioid free. It’s really hard when you’re addicted to opioids to remain clean for seven days in order to start the medication,” VanMeeteren said. “If you start it too soon, then what happens is, we throw that person into a nasty withdrawal, and that’s not good. “
Suboxone can be used safely on individuals in mild or moderate withdrawal, usually within about 12 hours, she said.
In the second year of the MAT grant, LCBHS expanded its MAT services to do distance outreach to patients in three other communities. Patients released into communities with no MAT support can visit with VanMeeteren via computer. Supported communities include Dakota Counseling in Mitchell; Capital Area Counseling in Pierre and Behavioral Management Services in Rapid City.
Individuals that have received treatment though the MAT program are seeing positive results.
“Clients that we’ve worked with — and several of them now we’ve been working with for over a year — have stayed out of jail, have maintained their employment, have maintained family relationships in a way that hadn’t been there before,” VanMeeteren said. “The difference is largely in the domains of their ability to function and enjoy their life without opioids.”
Dr. Tom Stanage, the administrative supervisor at LCBHS, is always trying to enhance mental health services in Yankton and the surrounding area, she said.
“If there is an opportunity to improve services, access and patient care, he will pursue it,” VanMeeteren said. “If we save one life, that life is worth doing what we’re doing.”
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