MICHIGAN CITY — Some safety-net medical clinics in Northwest Indiana have started offering treatment for opioid addiction.
HealthLinc, a Valparaiso-based federally qualified health center, recently began providing medication-assisted treatment at some of its locations.
"Medication-assisted treatment is the gold standard for the treatment of opioid use disorder," Cara Jones, program manager of integrated behavioral health for HealthLinc, said at the company's annual conference last Friday at Blue Chip Hotel & Casino. (This reporter gave a presentation at the event on writing about the opioid epidemic.)
The development comes at a time when an estimated 130 Americans die every day from opioids like heroin and fentanyl. Last year, 215 people lost their lives to opioid overdoses in Lake, Porter and LaPorte counties.
But in Northwest Indiana, drug treatment can be difficult to access, particularly for people who don't have health coverage or are on government insurance like Medicaid. HealthLinc serves people regardless of their insurance status or ability to pay.
The nonprofit got into the medication-assisted treatment business in January when it acquired the South Bend clinic of Dr. Brandon Zabukovic, a family physician who had already been providing the medicine to Medicaid patients in his community.
HealthLinc has since expanded the service to its Knox location and plans to add it soon in Michigan City and eventually bring it to the rest of the HealthLinc clinics, including East Chicago and Valparaiso.
Medications used to treat opioid addiction include buprenorphine (Suboxone), naltrexone (Vivitrol) and methadone, though methadone has to be dispensed at specially regulated clinics. All are designed the block cravings for opioids.
"Everyone's journey is different. There's not one medication that magically fixes this for everybody," Zabukovic said at last week's conference.
Vivitrol is given in a monthly shot and can only be taken once a person is completely withdrawn from opioids. The drug is an opioid antagonist that blocks the effects of opioids.
Buprenorphine, an opioid itself, comes in a variety of forms, including sublingual strips, implants and abdominal injections. People who take that drug become physically dependent, so they are supposed to be weaned off when they discontinue use.
"Some experts say people should go on it for three days; some say forever," Zabukovic said of the drug, which comes with some potential for abuse. "We really don't know how long people should stay on it."
In his experience, he said, patients generally use buprenorphine for 1 1/2 to two years, about the time it takes the brain to heal from addiction.
He advised that people on the drug should have their pills counted at random to make sure they aren't selling them, be treated for co-occurring mental health conditions, given short-term prescriptions, be drug-tested regularly, followed on the state's INSPECT prescription-monitoring system, not be prescribed benzodiazepines like Xanax, and should be referred to counseling.
"Remember it's medication-assisted treatment, not medication treatment," he said.
Zabukovic noted that research has found that people who undergo medication-assisted treatment have a greater chance of staying engaged in treatment and a lower risk of dying from overdoses.
He advised HealthLinc employees to get patients in promptly when they call about seeking help for their drug use.
"Every single interaction we have with a person with addiction is an opportunity to get them into treatment," he said. "If we are not responsive, they're not going to wait eight weeks to get in. The obstacles in their lives are unfathomable: poverty, trauma. We've had patients who had to trade sex for the ride to the office."
He compared the medications used to treat opioid addiction to insulin; people take them in order to be productive citizens: go to work, raise kids. "We are treating a medical condition," he said.