Leslie R. Dye, MD, FACMT
It is important to note the word “assisted” accompanying the word “medication.” Members of our quick-fix culture, particularly those with opioid use disorder, often want instant gratification. If pills or heroin caused the problem, maybe a pill or strip will solve it? But when treating opioid use disorder with buprenorphine, successful treatment involves much more than medication. Northland combines counseling, behavioral therapy, and other adjuncts to provide comprehensive treatment. Multifaceted interventions increase patient retention and the likelihood of positive outcomes.
The opioid epidemic is a result of various factors, but one contributing cause was the existence of “pill mills,” where patients could get prescriptions for large amounts of opioid tablets written and filled at a location owned by a doctor who was prescribing them, resulting in huge profits for the doctor and vast amounts of pills being distributed. While buprenorphine is an extremely useful tool in treating opioid use disorders, it can also be profitable to prescribe the medication, but it should not be the only tool used. Primary care physicians can prescribe buprenorphine in the office with the appropriate training and are required to provide access to all of the adjunctive treatment, but it is important that the same type of problem does not occur where buprenorphine is being prescribed without any other supportive care.
In addition to buprenorphine, outpatient care of opioid use disorders at Northland is combined with groups, case management, individual counseling, peer support, and drug testing. Patients receive a comprehensive psychosocial assessment and medical assessment, including laboratory testing. Co-occurring physical and psychological problems are identified, family problems are addressed, and referral for additional services is made as needed. All of these services are offered under one roof with close communication between all providers.
Attendance in the following groups is required for all patients receiving buprenorphine (also known as Suboxone) at Northland:
- Suboxone intensive outpatient (SIOP): This phase of treatment last 1 week (5 consecutive days M-F) and begins the following business day after a patient leaves detox. SIOP is specifically designed for patients to receive education about the biology of the disease, the importance of a sober environment, the management of triggers and cravings, the use of suboxone, and relapse prevention strategies.
- Intensive outpatient (IOP): This phase of treatment typically last 8-12 weeks (if patients have no relapse or attendance issues). Patients with all types of addiction come together and participate in a combination of group education and individual counseling sessions. During this phase, there is a heavy focus on education, family relationship building and integration back into society.
- After Care: This is the longest phase of treatment, but it is also the least intensive. This phase requires 52 weekly sessions for completion. During this phase, clients continue to meet regularly with their support system for encouragement as they face struggles of everyday life. When a patient relapses consistently or attendance is an issue, the patient can be returned to IOP for 4 to 12 weeks.
- Post continuing care (PCP): This monthly program monitors patients closely for relapse and other issues that may hinder their recovery.
Throughout their treatment at Northland, patients are encouraged to regularly attend 12 step meetings and to develop a sober support network in the community. Recovery is not about substituting one drug for another; it is about changing body, mind and spirit. Eventually, patients are weaned from buprenorphine and must rely on everything else they have learned and practiced during the course of treatment to remain drug-free. It is a process that requires multiple tools and multiple disciplines. Northland provides all of the resources necessary to support long-term recovery.
Dr. Dye is a board-certified medical toxicologist and emergency physician and staff physician at Northland. She is the immediate past president of the American College of Medical Toxicology.