Medication-assisted treatment has become a widely accepted approach to opioid addiction. But with just four physicians licensed to prescribe buprenorphine-based medication in Hancock County, local addicts seeking recovery sit on long waiting lists for the treatment. PHOTO BY JACQUELINE WEAVER

Is medication-assisted treatment substituting one addiction for another?

ELLSWORTH — For Jade, 26, the thin, medicated film she slides under her tongue each day is what allows her to function, go to work and raise her 4-year-old daughter.

Without her daily dose of Bunavail, Jade would spend the majority of her day searching for heroin, pills or any other opioid she could get her hands on. Not for a high, but to stave off painful opioid withdrawal symptoms.

“It’s extremely isolating and lonely,” she said.

Jade (not her real name) had used OxyContin and heroin off-and-on for several years after being introduced to it by a former boyfriend.

Suboxone film wrapper“I was always so anti-drug,” said Jade, who agreed to tell her story on the condition of anonymity due to the stigma attached to opioid addiction. “It was a constant source of conflict for us. So one day I just decided to join him because I thought it would be easier.”

During the periods she was using drugs, Jade stole thousands of dollars from her parents to support her habit. She bounced between sobriety and using for years.

One night, after months of sobriety, she overdosed in the bathroom at her parents’ house.

“It was like I was sober for so long that I felt like I deserved” to get high, said Jade. “If my mom had not been there that night, I might not be here today.”

Since last September, when a doctor prescribed Bunavail, a buprenorphine-based medication used to treat opioid addiction, Jade has been drug-free.

The bubbly brunette works a full-time job at a local health care facility, attends college, raises her daughter and is in a healthy relationship with a man who has never used drugs and is supportive of her recovery.

Jade is one of hundreds of opioid users in Hancock County who use bupenorphine to manage their addiction.

Buprenorphine treatments

Buprenorphine is the key chemical in the name brand medications used to treat opioid addiction.

It was introduced as an opioid replacement therapy more than 30 years ago, but only in recent years has it become a widely accepted medication.

Before buprenorphine, the only two options for recovering opioid addicts were methadone and abstinence.

Methadone, like heroin and oxycodone, is a full opioid agonist, meaning opioid receptors fully enter the brain, which can give the user a “high.”

Buprenorphine is what is called a partial opioid agonist. It has a ceiling effect: it blocks the brain’s opioid receptors from giving the user a high. Just enough of the opioid enters the brain to squelch painful withdrawal symptoms.

The most common buprenorphine medications are Suboxone, Subutex and Bunavail, which are thin strips placed under the tongue and dissolved in 10 to 15 minutes.

It is technically possible, but difficult, to get a “high” from taking a derivative of buprenorphine.

Buprenorphine “success stories”

Acadia Family Center in Southwest Harbor started a buprenorphine program last year. Executive Director Dan Johnson worked at Acadia Hospital in Bangor for over 20 years and served as clinical supervisor for the Narcotics Treatment Program there for three.

Since starting the buprenorphine program last year, Johnson has “seen several success stories.”

Johnson says buprenorphine treatment is ideal for some opioid abusers because of its ceiling effect and its low overdose risk.

Methadone can work better for long-time intravenous drug users who may require a higher dose of the opioid to successfully recover.

In the past year since the center started the buprenorphine program, Johnson has seen positive changes in the center’s 30-something patients, including one man who recently celebrated a year of sobriety.

Before buprenorphine, the patient was without a permanent home, job or relationship.

Now, he owns a truck, has a full-time job and a supportive girlfriend.

“He did a complete 180,” Johnson said.

But Johnson, who has a Ph.D. in counseling from the University of Maine, says medication isn’t a cure-all.

“Medication alone doesn’t cure addiction,” he said. “The counseling is crucial.”

Johnson said center patients are required to attend a one-hour counseling session every week for six months. After that, the patient has the option of attending counseling every other week for the next six months.

The goal of Acadia Family Center’s program is to wean patients off of buprenorphine after one year of treatment. But patients will not be kicked out of the program if that goal is not met.

For some addicts in recovery, Johnson said, the need for a daily medication is a mental thing. A patient may be on the lowest possible dose of Suboxone, but not feel ready to give it up all together.

“Part of it is fear,” he said. “They remember their worst opiate withdrawal and never want that to happen again.”

Other treatment options

For some addiction specialists, buprenorphine treatment is not the path to recovery.

According to Barbara Royal, a licensed alcohol and drug counselor and clinical supervisor of Open Door Recovery Center in Ellsworth, abstinence is the only way to rid oneself of addiction.

For several years in the mid-2000s, Open Door prescribed Suboxone, but stopped that treatment in 2007.

“We have found through experience that [Suboxone] is very often treated like every other opiate,” Royal said.

Suboxone, she said, is often a user’s drug of choice and that it is sold on the streets.

“It keeps that addictive thinking and gets people believing they are dependent on someone besides themselves,” Royal said.

The only exception is Subutex, which is allowed for pregnant women who have actively been using in order to protect the fetus from withdrawal symptoms.

Open Door’s addiction treatment program is not specific to opioid addicts. It requires intensive outpatient therapy 10 hours per week for 10 weeks, as well as a minimum of four 12-step sponsored meetings per week.

The initial treatment program is followed by a six-month relapse-prevention group that meets once a week.

“We say, ‘Let’s teach you how to feel and think, let’s teach you how to cope with life and do that safely and to do it in a healthy way,” Royal said.

Lack of local options

Buprenorphine treatments are hard to come by for addicts in Hancock County.

Physicians must have a special waiver in order to prescribe buprenorphine meds.

According to a Substance Abuse and Mental Heath Services Administration database, just four doctors in Hancock County are licensed to prescribe the medication.

Doctors new to prescribing buprenorphine can treat up to 30 patients. After two years, that number jumps to 100.

While just a handful of local doctors prescribe the medication, hundreds of area physicians are eligible to get the license.

The only requirement for a buprenorphine license is a daylong online course.

Johnson said many physicians don’t want to treat opiate addicts, either because they don’t have the time to commit to those patients’ needs, or because of the stigma associated with addiction.

“Doctors can’t say, ‘I won’t treat diabetes.’ They can’t do that,” Johnson said. “Addiction is a disease and we need to get away from that stigma.”

Hancock County doctors who do provide medication-based addiction treatment are at capacity and are running on waiting lists.

Acadia Family Center employs one licensed prescriber, Dr. Roger Wilson, who sets his patient limit at 30, but he treats 35 because it is difficult to say no to someone desperate for help, Johnson said.

Johnson said the center gets calls multiple times per day from people wanting buprenorphine treatment.

“If every doctor would prescribe to 100 or even 30 patients, we wouldn’t have a problem,” he said.

Some state officials are publicly throwing support behind the treatment.

In January, Maine Attorney General Janet Mills urged more physicians in the state to become prescribers of buprenorphine, citing the medication as “being one of the few modes of treatment known to wean addicts off drugs.”

Last December, every New England governor, including Maine Governor Paul LePage, signed a letter to the United States Congress urging the passage of a bill that would allow physician’s assistants to prescribe buprenorphine.

Nurses and physician’s assistants are licensed to prescribe opioids such as OxyContin, Vicodin and morphine, but not the drug that treats addiction to those medications.

Doing what it takes

With so few options for medication-assisted treatment in the area, many local addicts seeking buprenorphine have to devote a full day every month to getting their monthly prescription.

Jade drives to Manchester every month to see her prescribing physician. With her company’s health insurance plan, she pays $55 per month for the doctor visit and prescription.

But someone without health insurance can spend over $500 per month for the appointment, drug test, prescription and round-trip’s worth of gas.

Both the financial cost of treatment and time commitment can be prohibitive for some.

“Someone without a car will have to pay for someone to drive them to their doctor, pay for gas money, find childcare,” said Kip Young, a licensed alcohol and drug counselor with a practice in Ellsworth who is an advocate for buprenorphine treatment.

Mary, 28, used to go to Portland once per month before finding a doctor in Hancock County who would prescribe her Suboxone.

She has been able to maintain sobriety and keep her full-time health care job for the two years she has been on the medication. “It has made a huge difference in my life,” she said.

Young and others in the field say that buprenorphine is a sustainable treatment option for many recovering addicts.

“What Suboxone does is take a dangerous addiction and replaces it with a manageable dependency,” Young said.

Local addiction experts say abstinence is not always a sustainable treatment for opioid addicts. They note that opioids affect the brain in a way unlike alcohol or other drugs.

Buprenorphine, they say, helps recovering addicts function in their daily lives without having to drive to the methadone clinic daily or spend months in an in-patient rehab center.

Johnson says that since addiction is a disease, it should be treated with medication, just like any other illness.

“It drives me crazy when people say it is exchanging one addiction for another,” Johnson said. “This is a disease — an acquired disease, but a disease — and it needs to be treated as such.”

Part 1 of this series: “Treating drug addiction as a disease

Related: “The empathy alternative for addiction

Taylor Bigler Mace

Taylor Bigler Mace

Reporter at Mount Desert Islander
Taylor covers sports and maritimes for the Islander. As a native of Texas, she is an unapologetic Dallas Cowboys fan. [email protected]
Taylor Bigler Mace

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