Opioid recovery: Medication use becoming more accepted

Washington County drug court allows for the option

A survey taken at a time when the drug treatment court concept was beginning to catch hold and the opioid crisis had begun to capture public attention – 2010 – showed that only 56 percent of the drug courts in the nation offered its clients medically assisted treatment – the option to use medication to ease withdrawal symptoms while undergoing a program of treatment to stabilize their lives.

Although comparable surveys have not been cited more recently, drug treatment courts are being consistently steered toward making MAT available for their clients. That pressure includes an increasing body of research showing the effectiveness of MAT in suppressing relapse among people with opioid use disorder, and it also includes altered rules for federal financial support requiring MAT as an option, added in 2015 under the terms of the Affordable Care Act.

In the recently launched drug treatment court in Washington County, that option is available when it is deemed medically safe and appropriate and when the client agrees to it, the clinical coordinator for Rigel Recovery Services said.

Coda Kyle is the Marietta clinical coordinator for Rigel.

“It’s part of the diagnostic assessment, part of the screening process,” she said.

Clients referred to the treatment court through a screening process are assessed by a team of experts and a course of treatment tailored to the individual, with the client’s input, she said. Rigel, she said, offers Vivitrol treatment, using an extended release form of naltrexone, a compound that suppresses withdrawal symptoms without the narcotic high.

“It’s a medical treatment, appropriate, for example, for someone with severe opioid use disorder,” she said. The recommendation would come from a medical professional such as a nurse practitioner, she said.

“My role is telling them what their options are, determining their preferences,” she said.

Medically assisted treatment is just one option in a complex array of requirements faced by drug treatment court clients.

“It’s very individualized, with best practices you can’t have a cookie cutter approach,” said Aleisha Roberson, program coordinator for the drug treatment court, which is named Compass. “We follow the (Ohio) Supreme Court standard. There’s a screening process, a referral from a judge, probation office, a defense attorney.”

Caseworkers discuss the plan and determine high-need areas for the client.

“We do a lot based on what the client wants to work on,” she said. “Their buy-in is important. We want them to be a participant in their treatment. After all that, I take the information from the screening, the recommendation, take it to the judge, everyone gets input, and then the judge makes the decision. It’s the judge’s call at the end of the day.”

Washington County Commons Pleas Judge Mark Kerenyi said he generally defers to the service providers on matters concerning medically assisted treatment.

“The court doesn’t make that decision because we’re not qualified on medical issues. The court will allow medically assisted treatment, and the (Ohio) Supreme Court encourages it,” he said. “I respect the providers’ ability to make that determination, they’re the experts.”

That plan may or may not include medically assisted treatment, Roberson said. If the plan calls for abstinence, then the client will also have that option, she said, and is taken under care by one of the court’s three treatment providers – Hopewell, Rigel or Life & Purpose Services.

“It’s very intensive. For example, intensive outpatient treatment at Rigel is four days a week with group sessions, individual sessions,” Roberson said. “They need to show up, develop coping skills, maintain sobriety. It’s all about hitting that reset button.”

The program is a minimum 14 months, she said, scheduled in five phases, from most restrictive to least restrictive, including a 12-step program similar to AA, seeking ways to reconnect the client into the community and overcome the sense of stigma, guilt and shame that most of them feel. Most clients take longer than that, she said. Relapses are taken into account as part of the recovery process.

“This is not punitive, it is a nonadversarial approach, very treatment focused,” she said.

Medically assisted treatment had a lot of perception problems to overcome.

“There has been public kickback because it appears that the court is giving hardened criminals a slap on the wrist,” Roberson said. “But people heal best in their communities. This is saving money, saving lives. You see those mortality rates from opioids, it’s a sobering fact that it’s so real, happening in our home town. These are people, not just a faceless junkie, as people think. Everyone deserves help.”

MAT has also sometimes been controversial among some who believe one drug shouldn’t be used to treat addiction to another or that behavioral therapy alone is the best approach.

However, the scientific and medical community has endorsed MAT, saying it is often necessary for opioid addiction treatment, which can have a relapse rate of about 90 percent, according to the American Addiction Centers, much higher than with other drugs due to the intense cravings and withdrawal symptoms associated with it. The American Society of Addiction considers opioid addiction to be a chronic brain disease.

Kyle said in her experience the use of medically assisted treatment has spread.

“I think it has increased for sure,” she said. “Years ago there was an emphasis on abstinence, but as the epidemic got more attention, and more research was done, the evidence showed that MAT generally has better outcomes, and public perception of it is shifting into more positive perspective. It’s being viewed as a diagnosis, a disease, and it makes sense to treat it medically.”

Medically Assisted Treatment in drug treatment courts

•Medications: methadone, buprenorphine, naltrexone (or Vivitrol, extended release formula).

•Availability to clients in Washington County treatment courts: Yes, on recommendation from clinician and agreement of client and judge.

•Number of drug courts nationwide: More than 3,100.

•Percentage that offered medically assisted treatment in 2010: 56 percent.

Source: Times research.

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