Riverwood Healthcare Center began offering Suboxone treatment last September to those who are addicted to opioid medications or other narcotic drugs. Suboxone is a combination of Buprenorphine, which helps eliminate narcotic cravings, and naxolone, which acts to prevent the person from getting high.
Currently, there is one Riverwood physician, Dr. Melissa Herbranson, who is certified to prescribe and oversee Suboxone treatment at Riverwood’s Aitkin and McGregor clinics. Treatment is completely confidential.
“Buprenorphine is a type of opioid included in the Suboxone. It does not cause overdose or significant respiratory depression. It has a ceiling effect, and about 24 mg a day does not have an increased effect on the patient. We don’t prescribe above that amount,” Herbranson said.
Registered Nurse Renee Senich is the first point of contact at Riverwood for anyone who wants to pursue treatment for substance abuse related to opiates or narcotics. She conducts the initial intake interview with the patient and assessments that are passed on for review by Herbranson.
“We are hoping to have more patients seek us for treatment. We know the need is high,” Herbranson said.
She treats a relatively small number of patients who suffer from opioid addiction, all who first started taking medically-prescribed opioids.
“I’ve also had patients who are getting Suboxone on the street and have gotten themselves off of the street drugs, such as heroin. They want to be in a program that keeps them accountable,” she said. “Individuals doing black market Suboxone are attempting to stay out of withdrawal, because by day three they’re dehydrated and miserable. This is true of prescription opioids and heroin.”
Those experiencing acute opioid withdrawal may have symptoms such as extreme gastrointestinal upset with pain all over the body, impaired vision and high levels of anxiety, she described.
“Everything that the medication suppresses is exaggerated when they are off of it,” Herbranson said. “It’s the kind of misery that makes you feel like you are going to die.”
She added, “Their life is scattered to pieces. A lot of times they don’t have custody of their children. Their life just revolves around the next fix. When patients come to us they are quite sick.”
The ultimate goal of Suboxone treatment is to taper the dose over time and get the person off the medication. Once treatment starts, the patient returns for follow-up visits at Riverwood.
Herbranson describes the treatment program as one of the most rewarding things she is doing right now. “It is pretty neat. After the first dose of Suboxone, the sickness goes away and patients start to have hope again,” she said.
However, Herbranson understands some patients need to undergo Suboxone treatment long-term.
“Suboxone treatment can be lifelong,” she said, adding that studies have shown higher success of treatment when the underlying issues of addiction are also addressed.
“There is a reason addiction happens, many reasons. A lot of it stems from childhood, traumas or mental health disorders,” Herbranson said. “Mental health and addiction are entangled.”
Suboxone is just one of the tools physicians utilize to help patients get their lives back on track. Another form of medically-assisted treatment is Vivitrol, a once-a-month injection that works by attaching and blocking opioid receptors, which prevents the release of dopamine. When dopamine is blocked, there is no pleasure associated with the use of these drugs.
“The problem with Vivitrol is that you have to be completely off opioids, which is really hard in this kind of addiction,” Herbranson said.
However, Riverwood has seen some good success with patients on Vivitrol who have failed using Suboxone. Follow-up care for these patients is with Janet Larson, a psychiatric mental health nurse practitioner who sees patients with behavioral health issues at Riverwood’s Aitkin and McGregor clinics.
Some patients who are candidates for treatment with Suboxone may also need inpatient care. Herbranson advocates the use of community resources to help treat the underlying issues of opioid addiction.
However, referrals to another provider for mental health treatment can prolong the process by nearly a month. In her experience, it is difficult to get patients to seek outside care with a provider they don’t know and trust.
“You have to be there to treat them at the time they present,” she explained. “There are limited resources in rural Minnesota. I have not been able to get anyone in a program that is affordable or that worked with their insurance or that was located within a reasonable traveling distance. A lot of our patients walk to treatment and don’t have transportation or income. It is not ideal for our treatment population.”
In addition to Suboxone treatment, Herbranson also offers mental health treatment to patients in acute withdrawal with other mental issues.
Additionally, Riverwood recently launched a program for a standardized system for prescribing chronic pain medications for all providers and patients to follow to eliminate the high risk of overprescribing. The surgical department also follows protocols regarding lengths of opioid prescriptions.
“We are in a culture change right now,” Herbranson said. “The education is different for the prescribing doctors. Legislation has eliminated the influence of the pharmaceutical industry on the education, and the bias that had poisoned the medical field.”
Anyone who wants information on the Suboxone treatment at Riverwood may contact Renee Senich at 218-429-3907. For help getting into a substance abuse treatment program, call Aitkin County Health and Human Services at 218-927-7200.