For those in recovery, suboxone can be silver bullet

By ADAM DRAPCHO, LACONIA DAILY SUN

LACONIA — As opioid addiction has grown in the Lakes Region, so too has the number of practitioners who offer medication-assisted treatment. Recovery professionals say that the use of medication can be a game-changer for people seeking to escape the trap of substance use disorder.

The most commonly prescribed drug in medication-assisted treatment is suboxone, which combines buprenorphine and naloxone. The buprenorphine soothes withdrawal symptoms for an addicted person abstaining from opioids, while the naloxone blocks opioid receptors in the brain, preventing the patient from getting high on heroin or fentanyl while the suboxone is in his or her system.

A person gripped by an opioid addiction might desperately want a way out, but the path to sobriety is intimidating, especially the promise of withdrawal symptoms, which can be severe, and which include anxiety, depression, agitation, nausea, vomiting and pain.

Feelings of illness begin as early as six hours after the last dose of opioid, then peak, along with feelings of craving, after 72 hours. The use of medication can greatly reduce those symptoms and give a patient enough time to begin the process of recovery.

The medication is only part of medication-assisted treatment. Patients are also required to engage with a drug counselor.

“The fear of withdrawal is huge, and the use of suboxone can ease that transition,” said Daisy Pierce, director of Navigating Recovery, one of the counseling agencies that works with the Recovery Clinic operated by LRGHealthcare.

Some have taken a disapproving view of medications such as suboxone. Patients who are prescribed suboxone will become dependent, and will require months or even years of gradually decreased dosages before they can stop taking the medication. But to Corey Gately, clinical director for LRGHealthcare’s Recovery Clinic, medication is less of a crutch and more of a springboard – it gets patients through a critical few days, during which they realize that a life without heroin or fentanyl is possible.

“When you see someone on the first day, and then you see them a week later, it’s miraculous,” Gately said. “They don’t even look like the same person.”

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Dr. Margaret Bahder, a psychiatrist, has operated a practice in the Lakes Region since 2000. She was one of the first private practitioners in New Hampshire to acquire the special waiver from the Drug Enforcement Agency to allow her to prescribe suboxone.

She started prescribing suboxone 12 years ago. Then, patients mostly sought medication-assisted treatment to address an addiction to prescription painkillers. That changed two or three years, when her suboxone clients walked in not with a pill problem, but with an addiction to heroin or fentanyl.

More and more, her practice is specializing in medication-assisted treatment for substance use. About half of her patients currently have a diagnosis for substance use disorder.

“There is such a need for substance abuse treatment,” said Bahder. Her waiver initially allowed her to prescribe suboxone to up to 30 patients. Then that limit was raised to 100, and now Bahder Behavioral Services can have as many as 275 suboxone patients at any time. Those patients must simultaneously participate in traditional talk therapy.

She finds it rewarding to treat people for substance abuse, and is looking to expand her practice so that she can help more people.

“I do look for expanding and hiring more people who do what I do, prescribing, and to hire a couple of therapists, because there is a need,” Bahder said. “I think it would be nice to have a group practice.”

She treats patients from all over the state – from Berlin to Manchester to Portsmouth – because the demand for medication-assisted treatment is more than what providers in those cities can currently serve. Bahder Behavioral Services, in Gilford, can get new patients into treatment within a couple of weeks, while they might wait for months for a program in Manchester.

“People who are very motivated will go anywhere,” she said.

Treatment using suboxone, she said, is “very effective.”

Statistically, talk-only treatment for opioid addiction has a poor likelihood for success, as the patient is likely to succumb to cravings within a short period of time. But, with suboxone, those results flip, said Bahder.

“This addiction is so insane. You can tell them, you could die tomorrow. They don’t care. It’s not a choice,” she said. “Quickly, with suboxone, within a week, they can see incredible results... They can feel very good quickly, but their life needs to change. That becomes work.”

As a parent as well as a provider, Bahder has seen addiction damage or destroy lives throughout the community. The crisis should be addressed in the same way as any other epidemic, she said.

“As a psychiatrist, my obligation is to the individual I see. But also, I live in this community, I see how many people are addicted, how many young people are addicted. I think we should come together to help people who are addicted.”

Education should be a part of the solution, she said, as young people often don’t understand the nature of addiction until it’s too late. She also called for more treatment providers.

“Addiction is a disease. If that’s how we look at it, there has to be more treatment.”