The exam room at Salud Family Health Center in Fort Collins is pretty standard – medical table, cabinets with a sink and a couple chairs. Here, a female patient in her 50s finishes up appointments with Dr. Amelia Vitrosko and Cynthina Conner, a behavior health counselor. She meets with both providers to receive buprenorphine, a type of medication-assisted treatment.
Medication-assisted treatment, or MAT, combines therapy, social services and medications to treat opioid addiction. Experts says it’s the gold-standard of treatment.
Vitrosko and Conner work together to address a patient’s physical and social needs.
“Dr. Vitrosko and I collaborate extensively,” said Conner. “We share clinical impressions with each other and then formulate treatment plans based on that.”
There are three types of MAT, and they are defined by the drugs are the core of their treatment: naltrexone, methadone and buprenorphine. Naltrexone blocks the opioid receptors, so a person can’t get high, while methadone and buprenorphine are long-action opioids that reduce cravings and withdrawal symptoms.
In the early 1970s methadone maintenance programs became a major public health initiative to treat opioid addiction. The drug is heavily regulated and by law can only be dispensed at an opioid treatment program (OTP) which has been certified by the federal government. In methadone programs, patients typically go to an OTP every day to receive a liquid dose of methadone which must be drunk in front of a nurse. This daily routine can be a deterrent for people who want to treatment.
Buprenorphine was approved by the Federal Drug Agency in 2002 as a less potent and more accessible alternative to methadone. The drug is prescribed by a health care provider and picked up at a pharmacy. Buprenorphine can be administered at several locations including hospitals, correctional facilities or clinics like Salud Family Health Center.
The health center has 20 MAT patients in their program, which is currently available at only three of its locations – Fort Collins, Longmont and Commerce City. Salud provides integrated primary care which includes an array of services including dental, pharmacy, behavioral health, medical, care managers, transitions of care staff and onsite digital xray.
Yajaira Johnson-Esparza, director of the MAT program, said Salud’s model reduces barriers to treatment because patients are not referred to another program to receive addiction treatment.
“The approach that we kind of take, instead of sending someone to go somewhere and detox, let’s get them started on this medication,” said Johnson-Esparza. “Try to set them up for some kind of success.”
Despite evidence proving the success of MAT programs, it’s not readily accessible in Colorado. According to a report released by the Colorado Health Institute, 31 of the state’s 64 counties do not have a MAT location and an additional 15 counties only have one. This means more than half a million Coloradoans have no or few treatment options for opioid addiction.
“I think the important thing to remember when we’re talking about opioid dependence, is that recovery is possible,” said Teresa Manocchio who authored the report. “And to get people into long-term recovery, we do need to get them into treatment.”
The barriers extend beyond having specific locations. To prescribe buprenorphine, health care providers must complete a training course and receive a waiver from the federal government.
At Salud, only 12 percent of their providers have the waiver. Across Colorado, less than 400 providers are licensed.
The state is working to bridge the treatment gap. In September, Colorado received a $2.9 million federal grantto expand opioid addiction treatment to 17 health centers around the state.
A bi-partisan group of state lawmakers are addressing the lack of MAT through a group of bills planned for the 2018 legislative session. One of the bills would create and fund training for MAT programs, while the another improves prior authorization standards for addiction treatment, making it easier for individuals to get care.
Democratic State Sen. Irene Aguilar said the latter bill will allow an opioid user, who comes to the emergency room, to get buprenorphine for five days without consent from an insurance company.
“Prior authorization in connection with counseling would be set up so that if people came in, say after an overdose, and were ready to quit,” said Aguilar. “They could be started on treatment immediately.”
Medication-assisted treatment is a long-term treatment, so Conner and Vitrosko don’t rush their Salud patients into the program. Patients need to be aware of the requirements and how the medication works before starting buprenorphine.
“(We) make sure that they’re in that stage of change where they’re ready to commit to a program like this,” said Conner.
