In Action: One Community's Story
By Rebecca A. Clay
Nestled in central Pennsylvania, Lewistown used to be the kind
of place where people didn't lock their doors. That changed when
gangs brought heroin to town a couple of years ago. This rural area
was faced with a violent crime wave and a surge in addiction among
teenagers and young adults.
Lewistown started a grassroots effort to solve this problem. Working
as a team, a local hospital, a family health practice, and a substance
abuse treatment center developed an innovative protocol for providing
buprenorphine treatment. The team announced the new option's availability
during a "community day." Members held a press conference
at the local hospital and immediately started accepting patients.
While law enforcement targeted the gangs, local health care providers
tackled the addictions. Local physicians received special buprenorphine
training sponsored by the American Society of Addiction Medicine
and funded by SAMHSA's Center for Substance Abuse Treatment (CSAT)
as part of an initiative to educate physicians throughout the Nation
(SAMHSA News, Training Physicians).
The Lewistown program proved so successful, according to CSAT
senior public health analyst Nick Reuter, M.P.H., that CSAT sent
a team to Lewistown in November to see how the program operated,
visit with doctors and patients, and hear about local law enforcement
efforts and treatment options. The team included Arlene Stanton,
Ph.D., a social science analyst, and Ruth Hurtado, a public health
advisor.
What's special about the Lewistown approach, said Mr. Reuter,
is its use of a coordinator—a psychologist, in this instance—to
handle much of the time-intensive interaction and followup required
during the treatment's early phase.
"This model addresses two major concerns related to providing
buprenorphine treatment," added Dr. Stanton, "First, it
allows medical doctors to 'do business as usual.' That means it
relieves doctors of time-consuming startup procedures for their
patients on this treatment. Second, it ensures these patients receive
integrated care—both medical and psychosocial."
In Lewistown, the psychologist meets with patients and their families
to educate them about buprenorphine and do some preliminary assessments
before they see a physician. After a patient's initial dose of the
medication, she checks in to offer reassurance and see if dose adjustments
are needed. Later she makes sure patients are going to counseling
appointments and complying with the treatment regimens.
Without this kind of help, these physicians admit that taking
on more than a few patients at a time would be impossible.
With the nearest methadone clinic located hours away, the use
of buprenorphine has been a boon for this rural community, and it
offers the same potential for other underserved areas.
In Lewistown today, four physicians are prescribing buprenorphine
to their patients. Joe,*
25, is one of these patients. Trying to get his heroin and other
addictions under control has not been easy, but after years of addiction,
he found his cravings began to subside when he started buprenorphine
medication. "By the time the psychologist called him the night
after his first pill, he was already thinking more clearly,"
said Dr. Stanton, who sat in on the young man's induction. "Now
he is eager to begin his new life."
*Pseudonym
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