By MICHAEL KITCH, LACONIA DAILY SUN
FRANKLIN — "I am seeing results I didn't expect when we started in October," said Dr. Paul Racicot.
With his colleague Dr. Paul Friend of Horizons Counseling Center, Racicot provides medically assisted treatment for opioid addiction at the Lakes Region General Hospital Recovery Center, which operates in a suite of offices and exam rooms in the basement of Franklin Regional Hospital. "I'm very excited to see people becoming productive again."
The program, undertaken in collaboration with Horizons Counseling Center of Gilford, combines prescribing suboxone, a formulation of buprenorphine, which eases then stifles the craving without causing either withdrawal symptoms or euphoric highs, with counseling and therapy. Prescription of suboxone is contingent on participation in a counseling program.
"It is not the whole solution," Racicot said, "but it is a piece of the solution. You can't do one without the other."
Likewise, Jacqui Abikoff, executive director of Horizons Counseling Center, stressed "assisted," explaining that medication is "not a substitute for counseling." She said that patients taking suboxone, who are not obsessed by cravings, are more open to counseling as well as making the changes in their lifestyle required to sustain their recovery from addiction.
The president of the medical staff at LRGHealthcare,who has treated alcohol and drug abuse for 25 years, Racicot said that five years ago he was skeptical of medically assisted treatment, which was dominated by methadone clinics. He said it was difficult to set the dosage at the appropriate level not to cause either euphoria or withdrawal. But, above all, he was troubled that addicts taking methadone could continue to use illicit opioids drugs by "piggybacking" and too often used methadone as a maintenance drug for prolonged periods — even lifetimes.
Racicot said that after reviewing the medical literature and attending a number of conferences, he was persuaded that coupled with counseling, suboxone offers a an effective mode of treatment. He noted that physicians at Dartmouth Hitchcock Medical Center are strong advocates of medically assisted treatment. He anticipates that in five years medically assisted treatment will become the preferred regimen for opioid addiction as new medical products, including an implantable, longer-acting form suboxone, became available.
However, Abikoff acknowledged that medically assisted treatment remains "controversial" as many who treat addiction with various forms of counseling and therapy question the quality of recovery that falls short of total abstinence by incorporating a medication in the the treatment regimen.
Racicot said that he and Friend opened the recovery center on discovering that "a lot of the patients are kids we know. We've treated their parents and know their families." Any qualified physician can prescribe suboxone, but initially they are limited to treating 30 patients, which provides Racicot and Friend capacity for 30 patients apiece until May when they each will be able to care for 100 patients. Friend said that some 30 patients are currently being treated at the center.
Patients begin with weekly prescriptions for a daily dose of suboxone, taken as strip under the tongue, for a month and then begin to be weaned off the medication according to their progress. Friend said that "there is no define length of treatment." At the same time, Racicot added that studies indicated that unlike methadone, 95 percent of those treated with suboxone stop taking it within a year. Likewise, he noted that children born to mothers taking methadone spend twice as long in hospital as those born to patients taking suboxone.
All the while patients are closely monitored to ensure their participation in counseling by case manager Corey Gately, a master's level licensed alcohol and drug counselor with 15 years of experience, including a spell at Horizons Counseling Center. "When we say coordinated care, we mean coordinated care," she said, stressing that she ensures patients fulfill the counseling component of the program. When patients leave here, I call Horizons and tell them when to expect them for their counseling session," she said. "We are in tight with Horizons and speak with them every day." She said that more than 90 percent of the patients who have enrolled in the program have done "very well."
Racicot emphasized that medically assisted treatment is cost effective. Suboxone, he said, costs $30 or $40 per week while studies suggest a heroin addict, who "steals and deals" $1,000 a week to support his habit, can cost the community $65,000 a year in property crime, police, legal, medical and other costs. Moreover, he pointed out that while addicts are "the most unhealthy young people you will ever see, "the general health of those in recovery markedly improves. It thrills me to see them get better."
The New Hampshire Health Protection Program, known as expanded Medicaid, Racicot said was essential to expanding the capacity to treat substance abuse. "Without this program, which treats both the medication and the treatment, most of our patients would not be covered," he said.
Nearly two years ago, when the New Hampshire Center for Excellence took stock of the resources in the state to treat substance abuse disorders no provider of medication assisted treatment was reported in the Winnipesaukee region, one of 13 regional public health networks which includes the city of Laconia and 10 towns of Belknap County and the city of Franklin and three towns in Merrimack County.
Apart from the LRGH Recovery Center, HealthFirst in Laconia also provides medically assisted treatment to its primary care patients. Executive director Rick Silverberg said patients undergo a "substance abuse brief referral intervention and treatment " (ESBRIT) screening and full physical exam before being prescribed suboxone by a qualified physician and treated by two in-house counselors.
The team of the LRGH Recovery Center, a medically assistance substance program at Franklin Regional Hospital, which is undertaken in collaboration with Horizons Counseling Center of Gilford, from left, consists of Dr. Paul Racicot, president of the medical staff at LRGH; Deb Fish, RN; Corey Gately, a master's level licensed alcohol and drug counselor; and Dr. Paul Friend. (Laconia Daily Sun photograph/Michael Kitch)
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