Dr. Raghuram Bhat will begin prescribing Suboxone to patients in just a few weeks.
Bhat, who serves as chief medical officer for Columbia River Mental Health Services, said that as soon as his organization clears some internal red tape, it’ll accomplish its yearslong goal of treating patients with Suboxone. It’s a medication that’s being embraced nationally as a promising way to address the country’s opioid addiction crisis that’s killed nearly half a million Americans between 1999 and 2014, according to the Centers for Disease Control and Prevention.
The Clark County Sheriff’s Office has also hatched plans to treat some opioid-dependent inmates with Suboxone, making it just one of a few correctional institutions in the state to use the medication. Both organizations have high hopes that Suboxone will help people recover and even save lives.
“Opioid overdose is a major cause of death in Washington,” said Dr. Alan Melnick, Clark County health officer. “It’s causing more deaths than car wrecks.”
According to numbers from the University of Washington’s Alcohol and Drug Abuse Institute, the number of deaths in Clark County attributed to either heroin or prescription opioids rose 58 percent between 2002 and 2013. Numbers from the state Department of Health show that 197 people in Clark County died from opioids between 2011 and 2015 alone.
Suboxone is an increasingly used commercial brand of buprenorphine, a medication that was first approved for use by the U.S. Food and Drug Administration in 2002 to treat opioid addiction and has generated billions in sales, according to some estimates. Last year, the Obama administration announced a series of executive orders seeking to overhaul how the country treats opioid addiction that would increase the number of doctors authorized to prescribe the medication.
Suboxone is similar to methadone, another synthetic opioid that’s been used since the 1960s to help addicts keep cravings in check while undergoing treatment. Methadone typically comes in liquid form and is administered in a clinical setting, which can be stigmatizing and a barrier for a patient who lives far away. Suboxone, which comes in the form of a pill or strip, has less potential for misuse or overdose and can be prescribed and taken at home while a patient undergoes addiction therapy. Numerous studies have found it to aid treatment.
“The advantage for the client with Suboxone is it’s safer and they don’t have to come to the clinic every day,” said Bhat. “It’s more of an opportunity for them to recover in their lives.”
Suboxone is used at a relatively lower rate in Clark County than the rest of the state, according to the Alcohol and Drug Abuse Institute. Of the 451 physicians in Washington authorized to prescribe the medication listed on the Substance Abuse and Mental Health Services Administration’s website, only six are in Clark County.
Approval expected
Craig Pridemore, CEO of Columbia River Mental Health Services, said that offering Suboxone as a treatment option has been on his organization’s to-do list for about five years. He said he currently has 350 clients (who are predominantly on Medicaid) who are prescribed methadone.
In August, Columbia River Mental Health hired Bhat who is authorized to prescribe the medication. Pridemore is confident his organization’s board will approve prescribing Suboxone to patients next week.
Bhat said that he can prescribe Suboxone to up to 275 patients at a time. Deciding which patients to prescribe the medication to depends on various factors such as their medical history, other medications they’re taking and their psychological condition said Bhat. He said an 8-milligram tab, which needs to be taken once or twice a day, of Suboxone costs about $10 out of pocket, but Medicaid patients are covered.
Jared Sanford, CEO of mental health and addiction treatment provider Lifeline Connections, said his organization is currently the largest provider of Suboxone in Southwest Washington with about 95 patients receiving some form of medication-assisted treatment for opioid addiction. He said that policy makers and treatment providers are realizing that opioid addiction is a chronic illness that can be treated with medication, not unlike a diabetic needing insulin.
“The old idea that this is a moral failing and people need to pull themselves up by their bootstraps is antiquated,” said Sanford.
Melnick said that if a patient receiving Suboxone treatment is taken off their medication while incarcerated, they’ll go through withdrawls. Once they’re released, he said, they could relapse and be at a higher risk of overdosing after their tolerance levels dropped while being incarcerated.
Training for deputies
Earlier this year, the sheriff’s office began training deputies to use naloxone, an opioid antagonist that can halt overdoses. Clark County Undersheriff Mike Cooke said he’s had discussions with Melnick and others in the medical community about inmates being cut off from their medication.
“It’s a shame that when they go into jail, it breaks their treatment,” said Cooke. “For many of those people, it puts them right back into the throes of their addiction.”
Cooke said he wants Suboxone to be treated like any other medication in the jail and allow inmates to continue treatment. He said the sheriff’s office is still working out details to allow inmates to be prescribed Suboxone such as staff training and who will write the prescription. He isn’t sure how much it’ll cost but he hopes inmates can receive the treatment next year.
Corrections Chief Ric Bishop said that while he didn’t have numbers on how many inmates have addiction issues, he believes the percentage is high. He said that Grays Harbor County is the only other county in Washington that allows the use of Suboxone in its jail.
Jeremy Barclay, communications director for the state Department of Corrections, said that of the department’s 12 prisons the Corrections Center for Women in Gig Harbor is the only one that allows inmates to be prescribed Suboxone. He said more facilities don’t use it because of the training and certifications staff are required to undergo and also because it can be costly.
Mike Anderson, a commander in the Clark County sheriff’s office, said that Suboxone is already one of the top substances smuggled into the jail that inmates use to catch a buzz, a problem that correctional facilities in other states have also encountered.
But Cooke remains optimistic.
“Right now I’m not seeing any obstacles that are insurmountable,” he said. “It’s just a matter of checking the boxes to get it done.”
