John Clark Jr. traces the start of his battle with opioid addiction back to when he was 23 and working at a group home for persons with cognitive disabilities.
One day a coworker gave him $30 and a little blue pill as repayment for covering a shift. The pill was oxycodone. Soon he began taking 1-2 pills a day, a rate that accelerated after a 6-year relationship ended. Paul's use spiraled out of control. He switched to heroin when pills were too expensive to source.
“I tried to overdose towards the end, I kept trying to because I hated myself,” he said. “I hated my life, I hated waking up and just doing it all over again. I hated what I was doing; I hated stealing stuff; I hated panhandling; I hated losing all my jobs; I have a son and I hated not being a good dad. I hated myself so I wanted to not wake up. I would get as much money as I could together and buy as much [heroin] as I could, put it all in one shot every now and then when I hated myself at the worst times, and just shoot up everything I had. And pray that I could either not wake up or get some help – something, I didn't know what to do, I didn't know where to go. I had no idea where to go.
“It's upsetting because I was 27 at the time, 28, and I didn't have any insurance,” he said. “When I was ready to change I didn't have insurance. I was tired of living the same thing every day: I wake up, use, try and find money to go pick up to use. It was all about picking up to getting my drug otherwise I would be sick.”
Clark Jr. says when you're a drug user you think nothing of yourself, he said. You think, “This is all my fault, I brought this on myself. What's wrong with me? Why can't I stop? Why can everyone else live a good life and I can't? Why can't I stop using? I always believed that people came up with 'It's a disease' as an excuse. And a lot of people believe that it's an excuse, it's a cop out. I've always been somebody who if I start something I am going to finish it. If you want something bad enough you can get it – all you got to do is work towards it. For using, for being an addict, it was not like that at all. You know I wanted to quit. But I needed help to do this. I needed help because I couldn't do it on my own.”
Clark found it in a pilot project part of Intermountain Healthcare's opioid community collaborative, which funds projects in Weber and Davis counties that connect people with medication-assisted treatment. The program provides access to medications like methadone or buprenorphine that lessen withdrawal symptoms and opioid cravings in combination with behavioral therapy to address the underlying issues of addiction. More than 300 people are enrolled in the pilot programs. In October, Intermountain announced it would donate another $2 million in 2018 to continue the MAT demonstration projects.
“It was a clinic where I would go and medically-assisted treatment,” Clark Jr. said. “They would give me medicine to get me through. I decided to take methadone and it was seriously the best decision I've made in my life. That was a redefining moment. That was the beginning of my life. While going to Weber Human Services and talking to all these people – my therapist, my counselor, and going to these classes and finding out skills that I could use to stay clean just reshaped the way I was.”
Clark Jr. says everything combined paved the way for him to be successful and stay sober. “You have people who encourage you and tell you that 'You're doing really good. You're doing good in life. You look healthy. You work two jobs, you go to school. You still do all this other stuff,'" he said. "And that's what I do now. That's what my life is. I love being busy. I love waking up. I love having the day to do something. I love my life now. I am happy to wake up.”
Clark Jr. has been enrolled for more than 8 months. This is common and expected in MAT programs. While there is some risk of abuse of maintenance medications like methadone and buprenorphine, typically, studies have found that participants in long-term MAT programs have better outcomes than in short-term detox only therapies. Research has also found that MAT outperforms behavioral therapies alone, as well.
Despite the recommendations in the Surgeon General's report on substance abuse for MAT programs, they remain under-utilized across the country, and one the major barriers to providing MAT to opioid-addicted individuals remains stigma. For Jed Burton the clinical director at Weber Human Health, overcoming the stigma of both prescribing MAT and using MAT is critical for getting people on the path to recovery.
“One thing I'd like to mention for those who need treatment or are seeking treatment is these are not folks who are bad people,” he said. “These are folks who have an illness. There may have been a choice at one point in their lives that they took that led them down this road that many other people may have taken that same choice but it didn't lead them down this road because of their physical make up, their predisposition to this type of thing. But, at this point, this is an illness and we often compare it to diabetes.”
“When people take a pill for diabetes and they take it every day for years and years and years nobody says anything,” Burton said. “But, we provide somebody medication-assisted treatment and they can get a job and they can maintain a family even though they are taking another medication, people are critical of that. Critical of starting and critical of them being on that for long-term. And this is a disease that is just as deadly and dangerous as many physical ailments.”
In Utah, the bulk of MAT programs for individuals without health insurance exist along the Wasatch Front. But there is a shift happening. When CEO Lori Wright brought forth the idea of expanding clinic services to include MAT, for Sue Wilkey, a registered nurse and the quality director, it just felt right.
“Like a no brainer,” Wilkey said. “Because we recognize that a community health center is a safety net program. And it's really the last stop for many people. So we said we should do this, we can do this. It feels late coming in because we all know so many people that have been affected by overdoses and the loss of relationship and function that have presented. But then when we looked around we were actually kind of early for the medically-assisted treatment process.”
This summer, Family Healthcare in St. George became one of the first to start offering MAT in their community clinic. In August, the program had nine participants. Wilkey says the organization is moving slowly to expand services to ensure they can scale up effectively.
“We've dealt with patients that are on opioids and other kinds of use disorders but to pull it all together to actually put a program in that will help them withdraw and maintain that withdrawal is pretty complex,” she said. “Because it includes behavioral health, it includes our medical providers being waivered and becoming comfortable with that process with their patients, and case management, care coordination – it takes a lot of work to do that well. And to do it according to the current guidelines, the best dosing practices, the best alternative pain management practices, and social support as well.”
Implementing the MAT program at Family Healthcare also requires that patients are actively involved in their recovery. Because MAT isn't a matter of showing up and getting fixed; it's a long-term process.
Zolman and Ari Mendez provide the behavioral health counseling portion of the MAT program. They say the MAT program offers low-cost treatment to individuals with opioid abuse disorders – but most importantly, it offers hope.
“Some of those first appointments are some of the most meaningful because they realize they are at that point where they need help,” Zolman said. “They've gone through this addiction cycle over and over again with very little success and then they come here, say 'This is what I am going through' and we can offer them those resources when they are sometimes at rock bottom where they don't know what else to do. But it's so great to give them that hope: We have this MAT program, which can definitely give the lasting results that so many people going through that opioid use disorder are going through.”
“It's never too late to start [treatment],” Zolman said. “If anybody that is listening is going through this type of issue – who do I call, what do I do? – Family Healthcare we are one of those agencies that is more than happy to help. And the more you listen, the more you think about the life you're living and thinking okay maybe I do need help, our arms are wide open. We are happy to help anyone that walks through our doors.”
This series is brought to you in part by the Association for Utah Community Health, providing training and technical assistance to health centers and affiliates across Utah. More information available here.