The current opioid epidemic is the deadliest drug crisis in American history. Overdoses, fueled by opioids, are the leading cause of death for Americans under 50 years old — killing roughly 64,000 people last year, more than guns or car accidents, and doing so at a pace faster than the H.I.V. epidemic did at its peak. Alarmingly, a person can become addicted to opioids in as little as one week.

In Idaho, 1 out of 5 high school students have used a prescription drug without having a prescription, and Idaho’s rate of drug overdoses is double what it was in 1999. The Idaho Press reports that the Substance Abuse and Mental Health Services Administration believes that the abuse of illegal, prescription, or over-the-counter drugs takes the life of an Idaho resident every 45 hours. Between 2014 and 2015, the amount of heroin seized by Idaho State Police jumped 800%.

More than 900,000 U.S. physicians can write prescriptions for painkillers such as OxyContin, Percocet and Vicodin. On the flip side, just over 43,000 are licensed to prescribe the medicine to help. Each is limited by federal restrictions to treat no more than 30 patients at a time, and half the counties in the U.S. don’t have a single buprenorphine prescriber. This means that in the U.S. only 49 percent of people with an opioid dependence can potentially receive treatment.

In short, opioid overdoses are killing Americans at an alarming rate. Yet most of the more than two million people addicted to opioid painkillers, heroin, and synthetic fentanyl get little to no treatment. Kaniksu Health Services is helping residents of Bonner and Boundry counties by folding addiction treatment into their everyday practice. With two providers currently licensed to prescribe Buprenorphine and Suboxone, medications that help suppress the cravings and withdrawal symptoms that plague people addicted to opioids, Kaniksu has joined rank with a small cadre of primary care doctors in the nation who are working to curb the opioid epidemic (there are four total in Bonner and Boundary counties).

Science proves that medications like buprenorphine and Suboxone work. Most people cannot just walk away from opioid addiction. They need help to change their thinking, behavior, and environment. Unfortunately, “quitting cold turkey” has a poor success rate – fewer than 25 percent of patients are able to remain abstinent for a full year. A substantial body of research has found that medication-assisted treatment options benefit patients in staying sober while reducing the side effects of withdrawal and curbing cravings which can lead to relapse. Buprenorphine is an opioid itself but relatively weak. It works by activating the brain’s opioid receptors enough to ease cravings, yet not enough to provide a high in people accustomed to stronger drugs.

Suboxone is the commercial name for Buprenorphine combined with naloxone, an opioid antagonist. Suboxone was developed in response to a need to discourage users from abusing Buprenorphine by injecting or snorting the drug to get high. Naloxone was added to the Buprenorphine to keep the user from feeling the effects of the drug if Suboxone is injected. When Suboxone is taken sublingually, you won’t feel the effects of naloxone. However, if you crush the drug and try to inject or snort it, the naloxone will block the pleasurable sensations that high doses of Buprenorphine can produce. Suboxone has recently become available as a film, which reduces the potential for abuse even more.

Getting help

Before patients are admitted to the Kaniksu treatment program, they must be evaluated by a member of the behavioral health team using a standardized assessment. If passed by behavioral health, the Kaniksu Controlled Substances Committee reviews the application and refers all viable candidates to one of the two Kaniksu doctors licensed to treat opioid addiction, Dr. Jade Dardine and Dr. Peter Kelterborn, for a medical evaluation to see if they are medically fit to undergo treatment.

Dr. Jade Dardine is no stranger to addiction treatment. In 2014 she did an addiction medicine rotation at Kaiser Permanente in Los Angeles, along with working in a homeless clinic on Skid Row. Kaiser’s intensive program — in which patients are required to come in every day from 8 a.m. to 5 p.m. for the first two weeks of the program and undergo a medical exam as well as two group therapy sessions and individual therapy sessions per day – gave her a perfect frame of reference for what starting a treatment program at Kaniksu would entail.

Once a patient is formally accepted into phase 1 of the program, their next step is induction at home. On the third day of the program, they see the Kaniksu clinical pharmacist to make sure there are no adverse side effects from the medication, as well as a visit with their behavioral health specialist. The following week they start attending weekly appointments with Dr. Dardine or Dr. Kelterborn at which they are written a prescription for Suboxone or Buprenorphine to get them through another week, and are additionally required to attend an individual and a group behavioral health appointment weekly as well. Additionally, each patient must submit to urine toxicology at every appointment, and can also be tested at random. After approximately 12 weeks, the interdisciplinary, controlled substances committee determines the next step which can vary anywhere from continued phase I requirements to every two week visits and the program advances as determined by the team based on the patient’s needs.

Pitfalls of the program

Of all the patients Kaniksu has treated for opioid addiction, only about 20 percent have successfully completed the program. The rest are considered “inactive” at this point, generally meaning they relapsed, found another treatment provider, or simply disappeared.

The process is hard — and the majority of those who fail will do so in the first week. But considering the national average for relapsing, even when prescribed Buprenorphine or Suboxone, is 92 percent, a 20 percent success rate is pretty good. “When the program works, it really works,” states Dr. Dardine, “This is a harm reduction model. Patients need to move past the idea that you are trading one substance for another. It is really rewarding to see the patient make a successful transition. And it is always disappointing to see a patient unable to be successful.”

It takes work to stay in the program. There is zero tolerance for any controlled or uncontrolled substance use on the program. And prescriptions for the medication are written weekly. Why? Although Buprenorphine and Suboxone are primarily used to help people who are in recovery for an opioid addiction, some experts said there is a street market for the drug. Most often the individual buying them ‘off the streets’ is someone who struggles with an opiate addiction themselves, but either don’t want to get involved in treatment and follow treatment plan or maybe they don’t have the finances or resources to get involved in treatment.

Who is likely to succeed? The patients that are committed to engaging and utilizing the mandatory medical and behavioral health components of the program do very well. These are patients who communicate their feelings, thoughts, and needs directly with the team. Success is also highly determined by access to transportation, insurance coverage, and an employee situation that allows for treatment attendance.

Looking forward

Though all the successes, and failures, Kaniksu is committed to being a resource for residents in North Idaho in the fight against opioid addiction. One patient, who successfully made it through the program commented, “KHS was there for me when I was at rock bottom. I had no choices left and was on a path of destruction. My addiction consumed my entire life and affected those of everybody around me. I called KHS and within an hour I was starting down the road to recovery. Everybody is super supportive and encouraging to me, and without them I would not be where I am today. I have been drug-free for almost two years. I couldn’t have done it without the tools I have learned from the staff in the Kaniksu Behavioral Health department. My life has done a complete 180 and I am now living a life I only dreamed existed for myself.”

“I’m totally inspired and invigorated by the success and potential of this program,” comments Adam Kusler, LCSW, ACADC, Director of Behavioral Health for Kaniksu Health Services, “We have a hand full of patients who have expressed that this program has saved their life and has given their life back to them. Seeing this change from an individual who I initially see in a place of despair, hopelessness, and ruin, to an individual whose life has value and meaning, is amazingly rewarding.”

Olivia Luther is the director of community relations for Kaniksu Health Services. She can be reached at 208-263-7101, ext. 2211; or via email at oluther@kaniksuhealthservices.org.