Sarver
On top of the COVID-19 pandemic, America in the midst of an opiate use epidemic.
Dr. Ryan Sarver, a family physician with Schneck Primary Care in Seymour, said the Centers for Disease Control and Prevention has reported overdose deaths are at a record pace of 70,000 people a year, and opiates are responsible for more people dying than car accidents.
“We’ve been called upon now by a lot of the professional boards to have a comprehensive program for taking care of those are affected by this epidemic,” he told the Schneck Medical Center board of trustees during a recent meeting.
Six months ago, the suboxone medication-assisted treatment became fully operational in his office.
Suboxone is a prescription medicine used to treat adults who are addicted to opioid drugs (either prescription or illegal), including oxycodone, OxyContin, morphine, MSContin, Percocet, codeine and heroin.
The treatment is a whole-patient approach that uses medications in combination with counseling and behavioral therapies to treat substance use disorders.
Sarver said he initially proposed the idea to offer suboxone to patients in Jackson County, and Schneck leadership has been very supportive of the initiative.
Discussions started in August 2020, agreements to procure medical equipment and contracts for testing were finalized in late fall 2020 and the program was opened to the public the first part of January 2021, he said.
Currently, his office has 25 patients on buprenorphine, a medication to treat opioid use disorder and methamphetamine use disorder. Sarver said the latter is huge in this area.
“It’s extremely hard to treat. In fact, most of my MUD patients are still using meth, but they are stable in the clinic, so they will come in dirty almost every single time,” he said. “The neat thing about suboxone is it does have a ceiling effect on respiratory depression, so if they do use meth that happens to have fentanyl or heroin in it, they are actually slightly protected against an overdose from an opiate if they are on medication.”
Sarver said there is a huge increase from Mexican cartels and Chinese triads who have a lot of fake pills on the market that have fentanyl and meth in them. Philadelphia, Pennsylvania, is one of the major ports, he said. Some even have carfentanyl, which is 100 times more potent than fentanyl and up to 10,000 times more potent than morphine.
In terms of the suboxone treatment program, patients must agree to the contract, guidelines and counseling and establish care in Sarver’s office.
The first office visit includes an extensive history of their opiate use disorder, a full physical exam, a urine drug screen, an INSPECT report, blood work, an explanation of the program and contract and referrals.
Sarver said the initial visit typically lasts 20 to 30 minutes, depending on how extensive the person’s medical history is.
Subsequent visits involve a review of how the patient is doing in the program, a pill count, a urine drug screen, a clinical opiate withdrawal scale assessment and a follow-up on any additional patient needs. Those typically last 10 to 15 minutes.
The office visits go from weekly to monthly over time, and Sarver said the cost of the medication is covered by insurance or Medicaid.
The ultimate goal of the program is full recovery. The treatment approach has been shown to improve patient survival, increase retention in treatment, decrease illicit opiate use and other criminal activity among people with substance use disorders, increase patients’ ability to gain and maintain employment and improve birth outcomes for pregnant women with substance use disorders.
“Once they are on this medicine, they feel more normal. They feel like they can return to their normal lives,” Sarver said. “They get back in with their family members. They start finding employment.”
He currently has an 87% success rate with the program, which is slightly higher than the 85% national average.
The program also can help people with chronic pain. Being prescribed a low dose of suboxone to take three times a day is a pretty decent analgesic, Sarver said.
“It’s not a catchall, universal thing that’s going to get rid of all chronic pain because they tried that with pain centers before and it didn’t really work, but I have about a 60% success rate currently with chronic pain,” he said. “It’s not great, but those are 60% of the people who already failed out of everything else, so at least we recaptured some of these people and gave them a better quality of life.”
Between OUD, MUD and chronic pain, Sarver said he has 33 patients receiving treatment, and he recently received a waiver to go up to 100.
“Our success is good,” he said of the program. “Patient volume is as high as I could have had it up until about September, so now, we can go up to 100, so we’ll keep growing. I’m trying to keep it lower than the max because I want to be able to take emergency patients and things like that. Then next year, I will go up to 275.”
Since he’s not looking for that to be his entire practice, Sarver said he would like other physicians to come on board with him. Schneck Primary Care Nurse Practitioner Velvet Schmidt also is qualified to offer the OUD treatment.
Sarver said a physician assistant and another nurse practitioner have expressed interest in getting trained, too.
“That’s really going to be the key going forward with the program is getting other people to take care of patients,” he said.
The big thing they are trying to do is get an emergency room warm handoff program started at Schneck.
“People who overdose, if they are stable to go home, they call a peer recovery coach, the peer recovery coach comes and meets them in the emergency department, they get a prescription for suboxone, they induce themselves at home and see me the next day or the day after, so that’s like the gold standard of what we’re looking to do,” Sarver said. “I think that’s really the next step for us in being able to make a difference for our community.”
The coaches are people who are fully addicted and have recovered and go through a special training to guide someone through the recovery process.
Sarver also said he is working with hospital officials to apply for grant money from the Indiana Rural Opioid Consortium to increase access to overdose resources.