Tackling the epidemic

Since Ampla Health launched its first clinic offering opioid addiction treatment early this year in Oroville, site administrator Suzanne Dolan has “seen a huge transformation” in its patients.

“They’re not coming in seeking drugs. They’re seeking help and they’re appreciative, they’re grateful and they’re thankful,” she told the CN&R.

The clinic specializes in prescribing buprenorphine, also known by the brand name Suboxone, an opioid medication used to treat addiction. The service, offered via what Ampla calls an Alpha Recovery Center, is in such demand in Northern California that Ampla already is expanding it less than a year later, thanks to federal funding. Butte County has been a hot spot when it comes to the rate of painkillers prescribed per person, and has an above-average opioid-induced death rate in California.

With a $200,000 grant from the California Department of Health Care Services’ MAT Access Points program, Ampla will launch Suboxone services at its Lindhurst and Chico clinics and expand services in Oroville and Yuba City. Plus, four full-time opioid use disorder counselors are coming on board, splitting their time across the four locations.

Right now, there’s a small pool of patients in treatment at Ampla’s Yuba City clinic and 45 in Oroville, Dolan said. The three doctors at the latter can technically take up to 230 patients, based on their experience prescribing buprenorphine and federal requirements, but workload is a factor.

That’s part of why the expansion, which aims to have more Ampla doctors become certified prescribers, will be so beneficial, Dolan said. She’s also relieved because the patient load increased so rapidly the clinic has desperately needed more counseling services (it has one part-time counselor currently).

“The need is definitely here in Butte County,” she said. “When our patients were on these [pain] medications, we had no way to get them off of it besides weaning them off or cold-turkeying them, and that didn’t work. … We don’t want to push our patients away; we want to support and help them in any way we can.”

Dr. Lance Lee had already been prescribing buprenorphine to patients in Oregon a year before accepting a job with Ampla at its Oroville clinic. In fact, when they brought him on board about a year ago, he said, they specifically asked him to help launch their program. He said it took about six months to get the electronic system up and running and train staff, but “the program has steadily grown since then.”

Speaking to the need of the program, Lee said he has noticed several patients seek treatment after receiving Suboxone illegally from a friend during withdrawal.

“That’s what brought them in, and now they want to get clean and have been sticking with the program,” Lee said.

It’s also been an avenue to establish regular health care for these patients. In addition to opioid use disorder counseling, Lee said he likes to become his patients’ primary care provider as well.

Ampla doesn’t just provide Suboxone treatment for those with opioid dependency. It is a nonprofit community health center with medical, pediatrics, dental, behavioral health, chiropractic, social and specialty services offered at more than a dozen locations across Butte, Colusa, Glenn, Sutter, Tehama and Yuba counties.

The physician team’s approach, Lee said, is geared toward accepting patients as they are and reducing stigma.

“We make it pretty easy to access care in a nonjudgmental environment, offering them other support services,” he said. “Drug addiction is a disease, not a weakness of character.”

More people in Butte County still die from opioids at a higher rate than much of the state. The opioid-induced death rate is 6.55 per 100,000 residents, the 22nd highest in California, according to preliminary 2018 data from the California Department of Public Health’s California Opioid Overdose Surveillance Dashboard. The state average is 5.54 per 100,000.

There is a silver lining, however: Local efforts seem to be working. The death rate hasn’t been that low since 2014, when it was 5.79, per the state dashboard. Buprenorphine prescribing efforts increased 28 percent from 2015 to 2017.

Chet P. Hewitt, president and CEO of Sierra Health Foundation and The Center, which manages the MAT Access Points Project, said that while medication-assisted treatment is “the gold standard of care” for those suffering from opioid use disorder, barriers hinder its implementation and availability throughout California, such as stigma and shortage of providers.

Ampla recognized these obstacles and the need for more access to such care in the North State, Hewitt said.

“By strengthening the region’s access to MAT services and education, this funding will ensure that the delivery of MAT facilitates positive treatment outcomes, safe management of care transitions and long-term recovery for people with opioid and other substance use disorders,” he wrote via email.

Lee said the overprescribing epidemic “has greatly improved,” and, with it, access to illegally obtained painkillers has declined. But he recognizes that there’s still more work to be done, and that as folks transition from painkillers, some may turn to heroin or other street drugs.

“[The epidemic] is huge. It’s not just our county, it’s all across America,” he said. “We’re just trying to get the most help for the most people in the safest way possible.”