Substance use treatment is about more than prescribing drugs
Editor’s note: This is the second in a two-part series of articles about substance abuse disorder treatment in Hubbard County. The first article was published on Wednesday, March 29.
Freeing people from the need to use opiates and other substances is a multi-faceted task, according to three Essentia Health care professionals who treat substance use disorders in the Park Rapids and Walker area.
Dr. Susan Bauer, a physician, and Chasity Phillips, a physician’s assistant (PA), both work out of the Park Rapids clinic, while nurse practitioner Kathy Nevins works out of Walker. All three are waivered to prescribe medications, such as suboxone (used to treat opiate use), naltrexone (for alcohol use), and more.
Besides prescribing medicines to control their cravings and protect them against overdoses, Bauer describes herself as aggressive in making sure her patients also receive treatment for medical and mental health issues and trauma.
The doctors noted that many substance use disorders begin with people self-treating for chronic pain, mental illness and trauma in their background.
“ADHD (attention deficit-hyperactivity disorder) is strongly linked to alcoholism and other substance-use problems,” said Bauer, adding that during initial substance use treatment visits, “we ask all these questions, including things like, ‘How much trauma have you had in your life? Have you had – we call it a high ACE score (adverse childhood experiences). Do you have a lot of trauma in your life?’ Because we know that trauma is strongly linked to substance use disorders.
“I ask about mental health things. ‘Do you have depression and anxiety that we’re not treating? If you do, why aren’t we treating it, and how can we better help your mental health?’ Because good mental health treatment is a necessity in substance abuse treatment.”
Phillips said it takes time to build a rapport with many patients because “most of them have exorbitant amounts of trauma.”
Sadly, she said, “I don’t think I have a single female patient that hasn’t had sexual trauma before the age of 22. And not just ‘things went too far.’ We’re talking multiple rapes, molestation by family members.
“When you can finally get through to those people and have them feel comfortable talking about how that’s affected their choices and how they’ve ended up where they’re at, that’s huge. Because then you can start getting them into the right people to talk about that and help that healing process.”
Medical, mental health, trauma, substance issues are often intertwined, Bauer said, so patients coming in for drug treatment are also screened for health issues and may be referred to trauma therapy, Alcoholics Anonymous, etc.
“We try to get them as many resources as we possibly can,” said Bauer, “so we can help them in every aspect of their life, not just the substance use.”
Since September 2022, Essentia Health’s west market has treated, or is treating, 761 patients for substance use disorders, including 114 in Detroit Lakes, 97 in Walker and 51 in the Park Rapids-Menahga area.
However, their work is far from over.
According to Nevins, 292 people die every day in America from a treatable illness – opioid use disorder. For perspective, she said, “That’s a full plane, every single day in this country, that crashes and everybody on it dies. That’s not OK.”
According to the Minnesota Department of Health, there were 978 substance use-related deaths in Minnesota in 2021 – a statistic Nevins believes is underreported because victims’ families fight having drugs mentioned on their death certificate.
For another statistic, only 10% of people with substance use disorders seek treatment.
“Where are the other 90%?” said Nevins. “We need to take care of them and not allow them to become one of those statistics.”
Bauer puts a lot of this gap down to the stigma of opiate use, which makes many who suffer from the disease hesitant to seek treatment. Even those who do benefit from suboxone therapy aren’t, for the most part, singing its praises.
“There’s people in town whose bosses don’t know that they’re on this stuff,” said Bauer. “They could lose their job. Some of these people are professionals that you would never suspect that they’re on suboxone or getting treatment for substance use.”
Going after the stigma
The stigma is real, Bauer says, citing people who say suboxone just replaces one narcotic for another, and even literally saying “they should just let them die.”
“We don’t say that about smokers, do we?” she said. “We don’t tell them, ‘Sorry you got lung cancer, I don’t care.’”
She questions why people don’t look at nicotine the same way, accusing those using lozenges, patches or gum to quit smoking of exchanging one form of nicotine for another. “Nobody says that,” she said. “They’re like, ‘Good for you for not smoking because you’re on a safer delivery method of that nicotine.’”
That’s despite nicotine being “probably the most addictive substance that we know,” said Bauer. “I have heroin addicts that tell me that heroin is easier to get off than nicotine.”
Like nicotine gum, with suboxone “we’re giving (opioid users) a much safer alternative that reduces their chance of overdose,” said Bauer. “Not only that, they are functional. They can get a job. They can work. They’re a functional parent. And those things allow our community to be a healthier, stronger community.”
All three doctors stressed the importance in their work of being non-judgmental and removing stigma from the treatment process.
“When I first started this, there were certain pharmacies that we didn’t use because of the way patients were treated, trying to pick up suboxone,” said Phillips. “I don’t get that anywhere anymore. I don’t feel like the patients struggle to get it. I feel like pharmacies reach out, trying to make sure this patient isn’t going without medications.”
That’s important, Phillips said, because that makes it easier to fill medical prescriptions than to maintain a high from drugs they’re buying elsewhere.
And as Nevins pointed out, buying street drugs laced with who-knows-what is “just Russian roulette.”
“I hear from patients all the time, ‘I wouldn’t be alive if I was still doing that,’” said Nevins.
Federal opioid settlement
Essentia Health is part of a cohort that has 11 physicians from across northern Minnesota working toward board certification in addiction medicine. One of them is Bauer, who upon completion, will be the only addiction-certified physician in all of northwest Minnesota.
“Dr. Bauer is going to be a strong asset for a long time,” said Nevins.
Another promising sign is that Minnesota will receive about $500 million in the next 18 years from the federal opioid settlement, 75% of which goes directly to the counties, based on population.
The other 25% is going to the state Opioid Epidemic Response Advisory Council, of which Nevins is currently the vice-chair.
With that money, she said, “we are able to do so much work to make a difference in treating opioid use disorder, everything from sober housing and treatment centers to things related to children who are affected by parents with substance use disorders. The opportunities are huge, and they’re now.”
Telehealth important for rural Minnesota
Being able to see virtually all of her patients via telehealth also helps, Nevins said.
“It’s insanely helpful for those people who can’t get out of their house,” Bauer agreed, “or they have car issues.”
Nevins is licensed in all four states where Essentia has a footprint, so telehealth enables her to see people wherever they are. “Transportation is a big barrier for people, because they’ve often lost their license and vehicles,” she said.
Bauer said the federal government was leery in the past about opiates being prescribed through virtual visits, but now telehealth seems to be here to stay.
“It’s very helpful for people in outlying areas,” she said. “Between here and International Falls, there’s some access (to treatment) in Bemidji, but truly, there’s not much. These people live very far away from these suboxone or substance use providers.”
‘I don’t know what I would’ve done’
The best testimony to the progress being made, may have to come from patients whose broken lives have been made whole again.
“Isn’t it just awful that people can’t say, ‘I have high blood pressure’ in the same breath that they can say, ‘I have a substance use disorder’?” said Nevins.
Nevins’ patient, David Szathmary of Wadena, is one exception. His advice for anybody suffering chronic pain, addicted to opiates or even stronger drugs, is that suboxone therapy works.
“Check into that,” he recommends. “Not only do they prescribe the drug, but you get the counseling that goes along with it. There’s no stigma or pressure on you” – like the threat of being rejected or kicked out of the program. “Your dignity is always going to be intact,” he said.
Szathmary described his care by Nevins and other doctors as a well-managed continuum that takes all his issues into account and even provides resources for services outside the health care setting.
“I don’t know what I would have done without this program,” he said.
To connect with Essentia’s 24/7 substance use disorders hotline, call 833-677-1262.