PDT Staff Writer
Before people begin to believe that Suboxone is a cure for opiate addiction, they need to get the facts from Ed Hughes, director of the Scioto County Counseling Center, and Dr. Terry Johnson, the center’s medical director.
Suboxone contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication. Buprenorphine is similar to other opioids such as morphine, codeine and heroin.
“In many ways our knowledge and experience with Suboxone nationally is limited,” Hughes said. “What we at The Counseling Center see, the use of any type of medication-assisted treatment is that it is an assistance to treatment — that it’s not a replacement for treatment.”
Hughes said the majority of The Counseling Center’s patients are receiving intensive outpatient or residential treatment. Of those, less than 10 percent of the center’s clients will receive medication-assisted treatment, such as Suboxone.
Hughes describes Suboxone as a short-term treatment — no more than two weeks — mainly used to overcome withdrawal from opiates such as Oxycodone. Hughes emphasizes counseling and treatment as the main ingredients in the recovery process. He said the Center’s medical staff looks at the use of Suboxone on a “very limited” basis.
“Opiate withdrawal is very painful, very difficult,” Hughes said. “In addition to the physical discomfort there is a tremendous presence of craving for the drug. And if we can help somebody get through those first couple of weeks of detoxing from the opiate which would make them more likely to stay in treatment, to put them in a better position to be able to gain from what has happened to them in that first couple of weeks of treatment, we feel that is having a good use.”
Hughes and Johnson fear a new version of the former Oxycodone “pill mill,” with Suboxone as its product. At one time there were nine pain clinics or pill mills operating in Scioto County and selling Oxycodone, until a state law — sponsored by Johnson — outlawed the practice.
“What we’re seeing in some places is that Suboxone or Methadone is the course of treatment for some programs,” Hughes said. “It is being essentially marketed as a drug that is a kind of standalone treatment program, and it’s not.”
Hughes said The Counseling Center staff has a concern about Suboxone being prescribed and making its way to the street for sale or use, or inappropriate use by the patient that has had it prescribed for them.
“When you have perhaps a medical practice that is advertising Suboxone, giving Suboxone essentially to anybody who comes in and asks for it, and giving it to them in high doses and for an unlimited period of time, we just see all kinds of potential problems in the making for that,” Hughes said. “Some of these programs look similar to the pill mills that we were having to address in Scioto County. They are cash only. They do not take health insurance or Medicaid or Medicare.”
Hughes said he has moral issues when it comes to cash-only operations that essentially give prescriptions for money.
“Essentially, if somebody has medical coverage that they have earned in some way, then that medical coverage should be able to be used for medical services,” Hughes said. “Instead, you have somebody who maybe is poor, who has a medical card, and you are requiring them to pay $250 for their prescription. That’s money that is coming out of their children’s food or their utility bill, or whatever, in order to access that medication.”
He said the medication, in the absence of treatment, is “doomed to failure.”
Johnson, a state representative and osteopathic physician, says he has been trained to see people as the whole person, not just treating the parts of their bodies that are ailing.
“A person is obviously a body, a mind and a soul,” Johnson said. “For someone to be a healthy, happy, productive person, I can’t just look at their earlobe or their kneecap. I have to look at the whole person, and people have various social afflictions. They have various addictions. They have various problems. So the quintessential family physician should be looking at these things anyway.”
Johnson said the prescription drug epidemic is still far from over.
“We cleaned up the pill mills. That’s a huge accomplishment,” Johnson said. “Step two is to deal with the aftermath. I happen to have come over to a place (Counseling Center) that has a rich treatment environment, and this is a misconception that a lot of people have. They don’t know what treatment is. They think treatment is a pill. They think treatment is a regimen or a protocol. Treatment for a recovering addict is actually an infrastructure of counselors and support mechanisms that helps them change their lives. It doesn’t happen automatically. So, as an osteopathic physician, it’s an opportunity to get back with what I’m trained to do and what I like to do. I get to treat the whole person.”
Johnson said a lot of people do not need medication assistance at all.
“What I’m interested in, when we look at tools to help with treatment, if you look at a tool like Suboxone, it is a tool that only works for a certain sub-set of people. And you need to use it very appropriately, and you need to use it very responsibly,” Johnson said. “So I see it as a bridge, a short bridge between being opiate-addicted and on the street to getting clean and sober and starting a good pathway. So I want that bridge to be as short as possible. I want it to be less than two weeks. If someone fails, that does not mean they can’t get back on Suboxone, but they are less likely to, because maybe that was not the right treatment for them to begin with. So not only do I want a short bridge. I want as few bridges as possible.”
Frank Lewis may be reached at 740-353-3101, ext. 232, or email@example.com.