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Nation takes note of Little Falls anti-opioid abuse effort

CHI St. Gabriel's Health's Dr. Heather Bell (left), family practice physician; Kathy Lange, foundation director; Lee Boyles, president, and Dr. Kurt DeVine, family practice physician, pose for a photo with U.S. Sen Al Franken (center). Those behind the opioid project in Little Falls traveled to Washington in September to brief Congress on how to replicate the program elsewhere in the country. Submitted photo.

LITTLE FALLS, Minn. — A Little Falls hospital's program to curb opioid addiction drew the attention of Washington for its effectiveness in stopping opioids from hitting the streets, and users from hitting up the drugs.

Doctors from CHI St. Gabriel's Health went to Capitol Hill Sept. 27 to brief congressional staffers from the House and the Senate on their program.

Capitol Hill staffers want to know how their program can be replicated in other communities, and state lawmakers are willing to put big money on the line to see more programs like it in Minnesota.

The opioid program began first as an attempt by doctors and other health care providers to clamp down on the number of opioids they were prescribing, said Dr. Heather Bell of CHI St. Gabriel's. The hospital received government grant funding about three years ago, which kick-started an idea to have every patient being prescribed chronic pain medication to sign a pain contract if they wanted meds. That contract allows hospital staff to review charts, subject patients to drug tests and pill counts, and evaluate whether the patients should be prescribed opioid medication in the first place, Bell said.

The Controlled Substance Care Team has been monitoring opioid prescriptions at CHI St. Gabriel's since 2014. Reducing the number of opioids prescribed helps curb opioid abuse in two ways: It helps prevent patients from abusing pills themselves, and it helps prevent them from selling their medication—a practice known as "diversion."

All in all, the program tapered 324 patients off from opioid use and opioid audits kept an estimated $2.7 million in opioid pills off the street (based on hospital billing value).

The opioid effort at St. Gabriel's expanded in summer 2016 to work with people who already were addicted to opioids.

Health workers are so dedicated to the program they go inside the Morrison County Jail to make sure addicted inmates get access to their treatment medication.

The program's addiction treatment medication of choice—suboxone—helps it function more effectively than clinics that use methadone, said Dr. Kurt DeVine, an opioid program founder.

"All of the heroin-addicted patients that we've talked with, we've had quite a few that have tried methadone before, and most of them will tell you that being on methadone is really no different than being on heroin—that they still felt 'high,' " DeVine said. "We are really not methadone fans at all."

DeVine noted that the Brainerd methadone clinic was connected to a 2012 traffic collision that killed two people. Pinnacle Recovery Services settled for $8.55 million after being sued by the families of two Carlton County workers who were hit by Vanessa Brigan. Brigan was given methadone earlier in the day by the clinic.

In contrast to methadone, suboxone is a film placed under a patient's tongue. While still an opioid, suboxone is given to patients when mixed with other drugs in a way that prevents them from getting high, DeVine said. In addition, methadone patients need to come to a clinic every day, he said. However, suboxone has emerged as the go-to medication for treating heroin and opioid addiction, DeVine said.

There are about 60 addicts in the program and 30 patients on suboxone, Bell said.

"Two-thirds of them are back to their baseline—back to jobs, back to hanging with their families, back to doing their normal things—and not being addicted anymore," Bell said.

The anti-addiction medication forms only one part of the treatment program: Addicts are given access to mental health counseling, and social workers and nurses. They have to qualify before they can get suboxone, DeVine said.

There's also the question of how the patients pay for the addiction treatment. For the medication itself, most of the patients are on Medical Assistance (Minnesota's version of Medicaid), which requires a lengthy authorization process before they're cleared to get addiction treatment drugs, Bell said. However, the addiction meds are covered, she said. Some of the recent patients didn't have any insurance at all, so it was up to the opioid program's social worker to get them signed up, Bell said. Two of the patients opted to pay for the suboxone out of pocket ($500 a month) without waiting for insurance, she said.

"The cost is still far less than $80 of heroin in a needle in their arm every day," she said.

The response to the program has been profound, DeVine said.

"I think some of the most thankful people we take care of are the families of the heroin-addicted and opioid-addicted people," he said.

There are few programs people can turn to besides CHI St. Gabriel's, so they're working with the state of Minnesota to make sure other clinics can do the same thing. DeVine calls it "cloning ourselves," and hopes to get seven or eight other clinics to implement their own versions of the CHI St. Gabriel's program.

They were approved for $1 million from the state last week thanks to a law championed by Sen. Paul Gazelka, R-Fairview Township, and Rep. Ron Kresha, R-Little Falls. The doctors had their initial meeting with the state Wednesday, DeVine said.

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