The before-and-after contrast was stark.
“She’s a totally different person,” said Danielle Jones, a registered nurse at the Fairview Mesaba Clinic in Hibbing. “She’s just stunning. She’s doing absolutely fantastic.”
Jones was talking during a teleconference Wednesday about a 27-year-old woman who came to her last May after struggling with substance use disorder for more than half of her life.
“She’d actually started using opioids when she was 14 or 15 to cope with the loss of her mother who died of an overdose,” Jones said from Hibbing during the conference that originated in Little Falls, Minnesota, and involved more than 130 medical providers from throughout the state.
“Then she got into the harder things — methamphetamine. In 2014, she started with IV heroin.”
Jones is the care coordinator in Hibbing for Project ECHO (Extension Community Healthcare Outcomes), which originated in New Mexico in 2003 as a method for sharing medical knowledge between specialists in a central location and community-based providers. It now has 650 programs in at least 37 countries, including the program in Little Falls, which began just over two years ago.
It was initiated in Little Falls by Kurt DeVine and Heather Bell, family medicine doctors at CHI St. Gabriel’s Health Family Medical Center. In a phone interview, Bell and DeVine said their work started in January 2015 when they received a state grant focused on opioids, and they originally looked at opioid prescribing.
At the time, 100,000 opioid pills were being dispensed every month in Morrison County, which has a population of 33,000, Bell said. The No. 1 reason people went to the emergency room at St. Gabriel’s Hospital in Little Falls, the county seat, was to get pain medication.
Bell and DeVine convened a controlled substance care team at their clinic, monitored prescriptions and managed to cut the opioids being prescribed by 65%. Getting opioids “is not in the top 20 reasons why people come to the ER or anymore, because they can’t,” Bell said.
“So the state asked: If you’ve done this in Little Falls, can you do it outside of Little Falls?” she continued. “Can you mentor people on how to do your thing?”
In the meantime, the two were learning about medication-assisted therapy for substance use disorder and went from being skeptics to being advocates, they said.
The state Legislature awarded them $1.2 million to be used in eight communities, including Hibbing and Aitkin, to help them get their own programs started. Officially known as the "CHI St. Gabriel’s Health Family Medical Center Community Pilot Project," it has become one of the largest Project ECHO outlets in the country, DeVine said.
The participants in Wednesday’s teleconference spoke out of cubicles, conference rooms and lunchrooms from clinics in Hibbing, Aitkin, Fergus Falls, Alexandria and elsewhere. They were there to share success stories about using medication-assisted therapy, specifically Suboxone, to help individuals break out of the substance disorder cycle.
As with Jones’ story, every one of them talked of a dramatic transformation.
Jessica Schwartz, a registered nurse with Essentia Health in Baxter, Minnesota, told of a 50-year-old woman who had become addicted to pain pills after being treated for a back injury.
“She came to us very, very, very thin and unable to basically care for herself,” Schwartz said. “She has only been on (Suboxone) for less than two months, and she has gained 20 pounds. … And like Danielle was saying — Danielle is so right. She looks like a different human.”
Bell described a patient who was being treated with Suboxone at the same time as her mother and grandmother. Under Bell’s care, the patient delivered a healthy baby in Little Falls.
“The grandma commented that they were all our patients and they were all in the room and how awesome it was because they were all happy and mentally stable and healthy," she said.
The Hibbing patient came to Fairview Mesaba after relapsing in March, Jones said. The young woman had lost custody of her 6-year-old son, was in an abusive relationship and wasn’t working or going to school.
“Her day was based on how can I find heroin and meth?” Jones said.
The prescribing doctor started the patient on Suboxone that day, Jones said, and she entered outpatient treatment — doing so well that she graduated early. She now has custody of her son, is in a safe relationship, is involved in her church and going to school and working full time.
Jones and the doctor and nurse practitioner who comprise the Hibbing team have “knocked it out of the park,” DeVine said.
Medication-assisted therapy doesn’t work for everyone. Of the 211 patients who have been treated in Little Falls beginning in June 2016, 111 are still in “active treatment,” according to Bell. That doesn’t necessarily mean the others were failures. Six have died, but 10 have transferred to other clinics.
Among the 84 others, some are using drugs, but others have chosen abstinence-based treatment with no medication, she said.
Bell and DeVine said they think smaller communities have an advantage when it comes to treatment.
“It’s easier to find people if they fall off,” DeVine said.
“And law enforcement, they know them, too,” Bell said. “So if they’re struggling, they’ll pick the patients up and rather than bringing them to jail they’ll bring them to us.”