Juneau doctors add new approach to opiate addiction treatment

Juneau and Alaska as a whole have not been able to escape the nationwide opiate epidemic, and opiates appear to only be increasing their hold on Alaskans.

The age-adjusted rate of opioid deaths in Alaska is currently four times what it was in 2005, prompting Gov. Bill Walker to declare a public health disaster in February of this year. Seventy-four percent (95 of 128) of drug overdose deaths in Alaska in 2016 were due to opioid overdoses, according to preliminary statistics in the most recent State of Alaska Epidemiology Bulletin.

Juneau in particular has been hit hard. In 2015, there were 112 emergency room visits in Alaska due to heroin overdoses, and 10 of them were in Juneau, according to the Alaska Department of Health and Social Services. In the same year, 5 percent of the state’s prescription opioid emergency room visits (72 of 1,456) were in Juneau.

The country as a whole is facing an opioid crisis, and medical professionals are still seeking answers to the complex issue. There’s not one root cause for the epidemic, so there’s not one cure-all treatment that can work for every person working through recovery either.

Doctors at the Rainforest Recovery Center (RRC) have expanded their repertoire for treating opiate addiction, adding a treatment style this spring that they believe will be a vital step to helping addicts back to health.

The new approach, known as medically-assisted treatment or office-based opioid treatment, employs the use of a medication called Buprenorphine (the brand name, Suboxone, is more recognizable) that helps stabilize brain chemistry as addicts are trying to remain sober.

Craig Smith, the Lead Behavioral Clinical Therapist at RRC, said Suboxone helps clear the mind so that recovering addicts can focus on the second aspect of their treatment — on-site counseling at RRC.

“It’s a paradigm shift, really,” Smith said of this new approach. “If you look at it historically, Juneau has just been a total abstinence, 12-step-based model. That’s beneficial, it helps a lot of people, but it doesn’t help everyone.”

Medically-assisted treatment also won’t help everyone, Smith said. It will, however, fill a void in Southeast Alaska.

Easier access to treatment

Prior to this approach beginning in Juneau in mid-April, Jenna Hiestand found it difficult to keep patients in treatment.

Hiestand, the Medical Director of Behavioral Health at Bartlett Regional Hospital in Juneau, said patients in recovery would enter intensive residential treatment at RRC and “find it difficult to remain focused” because of cravings or withdrawal.

Only a few physicians in the area were prescribing Suboxone, while some patients left Juneau in order to get to a facility that offered medically-assisted treatment. Hiestand, along with Chief Behavioral Health Officer Sally Anne Schneider, saw the success that medically-assisted treatment had elsewhere, and wanted to bring it to Juneau in force.

On its surface, the treatment might look somewhat similar to methadone, which is a medication that replaces cravings for opiates with a craving for methadone (which is also an opioid), but Schneider explained that unlike methadone, Suboxone doesn’t cause any kind of high.

“I think there’s been the belief that, ‘Oh, it’s just replacing one drug with another,’” Schneider said, “but in reality, this is replacing a drug with something that helps the brain not need the drug, and also giving people the counseling for the coping skills to be able to change your life.”

Another difference between Suboxone and methadone is that methadone is highly regulated and only available at methadone clinics. Therefore, patients have to come to the clinic every day, at least for the first 90 days, Smith explained.

That’s just not practical for patients in Southeast Alaska who might live on a different island or in a remote location. Being able to get a prescription for Suboxone makes it easier to take the medication while continuing to have a job and carry on with life as normal, Smith said.

Bartlett (which runs RRC) applied for and received a Medication Assisted Treatment Expansion Grant from the Alaska Department of Health &Social Services, and will receive $175,000 during the 2017 fiscal year and $350,000 in the 2018 fiscal year. With these funds, the hospital can employ another counselor for patients, expand training for prescribing Suboxone and more.

The first patient began the program in mid-April, and RRC has treated seven people so far. The goal, Schneider said, is to treat 45 people by the end of the summer. There’s no limit on how many people can be in the program at any given time.

At the outset of the program starting, Hiestand reached out to Rachel Solotaroff, the Medical Director at Central City Concern in Portland, Oregon. At Central City Concern — an organization that helps relieve homelessness in Portland — Solotaroff has been instituting medically-assisted treatment for about five years, and has seen it work.

All it takes for doctors to be able to prescribe Suboxone — which comes both in the form of a pill and a small film that is place on the tongue — is an eight-hour training course.

“This is our best tool for expanding access to medication treatment,” Solotaroff said, “but I take that term of medically assisted treatment very literally, meaning that the medication clears your head enough to then be able to then engage in the hard work of treatment and recovery.”

Success stories

Solotaroff came up to Juneau in early May to give a presentation on the treatment and to help local physicians clear up any misconceptions they might have had about Suboxone or the treatment itself. She spoke about everything from cellular biology to psychological factors in addiction, but one of the more meaningful aspects of her talk was about a man named Arthur M.

Arthur had struggled with alcohol and opiate addiction for years in Portland, and treatment after treatment had failed. After months of homelessness and repeated hospitalizations, Arthur switched to the medically-assisted treatment program, using Buprenorphine and enrolling in a behavioral health clinic.

He hasn’t been in the hospital since then, and serves as Solotaroff’s favorite success story. Hiestand and those at RRC are already starting to experience successes from the program.

One of the requirements of the grant RRC received is that it must supply one “positive success story” per month, Schneider said. Hiestand said she is “definitely” seeing progress with a couple of the current patients, mentioning one in particular who is enrolled in classes and getting back on track.

For those looking for help, RRC now offers same-day treatment where someone can walk in and immediately enter the program. RRC is also accepting referrals from local organizations as well, hoping to involve all parts of the community in this effort.

Not only do they hope to change the community with medically-assisted treatment, but they hope to serve as an example for the rest of the state, one that has struggled to slow its opioid emergency.

“If we can really get something working well here,” Schneider said, “it can go to other Alaska communities and be individualized for those communities as well and work well there.”

• Contact reporter Alex McCarthy at alex.mccarthy@juneauempire.com or 523-2271.

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