New clinic in Cloquet tackles mental illness, substance abuse
People with opioid use disorder can start receiving medication-assisted treatment paired with psychiatric services out of Cloquet's Community Memorial Hospital starting in March.
Tim Weber, a nurse practitioner in the emergency department at CMH, is leading the program called WebMed Mental Health Services.
Ultimately, he wants to tackle the mental illness component that drives a lot of chemical dependency.
"I don't feel comfortable offering medication-assisted treatment without tackling the mental health portion that's going along with it," Weber said. "I think it's inappropriate, to be honest. I really do."
In August, Weber finished school to become a psychiatric nurse practitioner and received certification to provide psychiatric assessments and pre-psychotherapy.
Weber will use psychotherapy at his clinic to support patients in managing how they fill voids in their lives that mental illness can leave behind. Patients will be able to choose from a tiered program what kind of services they want to receive.
Weber said Tier 1 will include psychiatry services and adult rehabilitative mental health services, otherwise known as ARMHS, which is a service funded by Minnesota Medicaid to help people with mental illness establish healthy housing, employment and other living skills.
"(Often) people leave patient treatment centers and go back to the same house and same situation they were in before and it's inevitable relapse is going to occur," Weber said. "If we don't change these things and get people set up on a different path when they're out of these rehab facilities, we don't get this ball rolling."
Patients will also have access to a peer support specialist, or PSS, which is an extension of ARMHS. These are people who have been in recovery and can provide patients the support they need, like tagging along to meetings, Weber said.
"You bring people to meetings — they're afraid," Weber said. "It's nerve-wracking going into a meeting where you don't know anybody."
Tier 2 would use medication-assisted treatment along with the psychiatry services, as well as ARMHS and PSS.
Tier 3, the most vital piece of the program for Weber, would be available for anyone, but especially recommended for people in the criminal justice system.
At this level in the program, patients would receive the medication-assisted treatment and psychiatric services along with mandatory use of ARMHS workers once a week and use of a PSS four hours per week for six months.
A series of monetary incentives would hopefully encourage patients to follow through with their treatment, Weber said. Ideally, those would be funded with grants.
Tier 3 is not yet guaranteed for the immediate future because it's dependent on a grant or funding help from local agencies, Weber said. It could be delayed for over a year if he doesn't receive the grant he applied for.
WebMed will also have patients on suboxone treatment use an app called reSET-O that contains over 60 modules of continued therapy. Patients will be required to complete at least one a week, Weber said, and users of the app can also log what triggered them if a relapse occurs.
In December, the U.S. Food and Drug Administration approved the Pear Therapeutics, Inc. app, which is only available with a prescription.
His mission with the clinic centers around brining a holistic approach to treating opioid use disorder — managing the patient's substance use, mental illness and life situation all at once — and removing barriers for people in Carlton County who want treatment.
Currently, Raiter Clinic offers medication-assisted treatment, but can't take on new patients. The Fond du Lac Band of Lake Superior Chippewa's Min No Aya Win Human Services Center also provides treatment for band members.
In his work, Weber said he noticed a serious need for services for pregnant women, who otherwise have to drive to Duluth if they want to receive their daily dose of suboxone, which is a medication to treat opioid dependency.
"My goal is to remove that barrier of distance and time for them to have appropriate services," he said.
WebMed Mental Health Services will also offer vivitrol, another medication to treat opioid dependency. With vivitrol, instead of a daily dosages, patients receive an injection that lasts 30 days.
However, Weber said he wants patients to have extensive education prior to injection because chances of overdose increase for people who use again after the 30-day treatment period. People's tolerance for opioids have decreased during that time, he said, but they'll often still use as much as they used before.
Rick Breuer, CEO and administrator of Community Memorial Hospital, said the need for opioid use disorder treatment far outnumbers supply in the community.
"He's going to be helping address that shortage with his presence in town and I think he'll be busy very quickly," Breuer said. "We're excited to have him here and happy to support that practice."
Between January 2017 and mid-December 2018, nine people in Carlton County died of drug related overdose, most of which involved some sort of opioid, according to Midwest Medical Examiner reports.
The Carlton County Sheriff's Office recorded at least 11 instances of drug overdose during that same time period, according to records the Pine Journal requested.
Weber compares what his practice strives to prevent to a piece of Swiss cheese. Think of just offering medication-assisted treatment, without any of the other services, as a single slice of Swiss cheese, he said. People are going to fall through those holes in the cheese.
"But you add all these different services on top and start layering different pieces of Swiss cheese, blocking up those holes, you start having these different layers of accountability," Weber said. "It's going to reduce the amount of holes and relapse."
For more information about WebMed services, visit webmedmn.com. Forms required before intake will be available online.