Grant boosts access to addiction treatment at Heartland Community Health Center

For more than a decade, Eden lived each day trapped in a vicious cycle. What began as a need for prescription pain relief escalated to a heroin addiction. Today, however, Eden has something to celebrate: 28 months of recovery with the help of medication-assisted treatment at Heartland Community Health Center.

When Eden looks back on her late teens, she sees an overachiever — someone who took the “hardcore” classes, started college early and was working her way toward medical school.

But during a break, she was drugged at a party. She fell down some stairs, injured her back and needed surgery. Prescription pain pills and a successful surgery put her on the mend.

“I got off the medication. I remember feeling some withdrawals, remembered kind of liking the feeling of being on the medications, but I got off it OK,” said Eden, a pseudonym used on the condition we wouldn’t reveal her real name.

Eden returned to college and work, but within a year, she endured a severe on-the-job assault that culminated in a botched surgery and even worse pain.

“I was on bedrest for about seven years, and that’s when the addiction took over,” Eden said. “I was on these pain medications. Doctors eventually put PICC lines in my arms and ordered IV medication for me.”

Powerful combinations containing Dilaudid, Benadryl, Phenergan, Valium and Opana were all available to Eden, and within arm’s reach.

“I’d pass out and then I’d wake back up and just put more in my PICC line,” Eden said. “It was like the only thing I could do to hold on and not to kill myself. You know, it was the only thing that would take away my anxiety and my feelings of loneliness.”

When she could no longer access prescription medications, Eden turned to illicit drugs, including heroin. Eventually she connected with a surgeon who helped alleviate some of her physical pain, but she continued using heroin.

Then Suboxone came into Eden’s life via a clinic offering medication-assisted treatment (MAT) for addiction. The sublingual medication — a tiny patch that dissolves under the tongue — gave Eden a taste of what recovery could offer: a life free from the cravings and painful withdrawals of opioid addiction.

Eden went to rehab, where she continued treatment with Suboxone, participated in therapy, and “did a lot of healing.” Twenty-nine days later, she left Lawrence’s First Step at Lake View, a residential treatment center for women. 

Now more than two years later, Eden stands atop a recovery base that includes her faith in God, a 12-step recovery program, a support network of friends and family, regular behavioral therapy and ongoing medication-assisted treatment with Suboxone through Heartland Community Health Center (HCHC).

Eden said she could think clearly and has regained her “sanity” after feeling trapped in “that vicious cycle” of addiction for 11 years. The result, Eden refers to as gifts. A specialized career awaits her when she’s ready. And for the first time since her injury, she’s held down a job.

“You know, my family relationships are on the mend, like we’re doing so great. They trust me. I am a reliable person today. I’m a happy person. I have gotten wrinkles to the side of my eyes since being in recovery,” Eden said.

Focusing on healing her mind through therapy and a 12-step program while also concentrating on healing physically and spiritually have been very important to her success in MAT, she said.

Kansas Fights Addiction grants

In October, HCHC announced it was the recipient of two grants totaling $400,000 from the Kansas Fights Addiction program through the Sunflower Foundation — a statewide health philanthropy organization established as part of a $75 million settlement between Blue Cross Blue Shield and the state of Kansas.

Half of the grant money focuses on strengthening addiction prevention initiatives while the other half will be directed toward expansion of HCHC’s addiction treatment services and the cost of MAT, according to a news release.

Lisa Russell, chief clinical officer for Heartland, said the demand for substance use treatment has increased at the nonprofit community health center, 1312 W. Sixth St. Since 2017, she’s been involved in developing the center’s medication-assisted treatment program.

So far in 2023, Heartland has treated 1,084 patients using medication-assisted therapies. That’s up from 790 in 2022 and 920 in 2021. Russell attributed the dip in numbers in 2022 to a reduced number of providers licensed to prescribe MAT compared to 2021.

Russell acknowledged some patients have endured long wait times at the safety-net health clinic; however, the clinic has nearly doubled its capacity for primary care in 2023 with the addition of family-planning health care (known as Title X services) and a deeper pool of employee applicants.

Elizabeth Keever, chief development officer at HCHC, said more same-day appointments for urgent needs were available now than when she joined the organization in summer 2022. Three nurse practitioners have been added to the staff in the last year. The clinic served 20,000 patients in 2022, with the most common diagnoses by primary providers being anxiety and depression.

MAT options at Heartland

Unless a new or existing patient calls late in the afternoon or immediately before a holiday or weekend, same-day appointments are typically available for those interested in MAT, Russell said. That doesn’t necessarily mean patients would receive same-day treatment, but they could start the intake process for opioid or alcohol dependency.

Walk-in patients in crisis who need urgent evaluation or treatment won’t be turned away, Russell said. They can also be seen around the clock at the Douglas County Treatment and Recovery Center or LMH Health and receive a subsequent followup referral to Heartland.

MAT intake at Heartland involves a medication discussion and lab workup. Typically the patient returns in one to two days while experiencing mild withdrawal symptoms. With Suboxone, for example, an induction procedure takes place over a several-hour period at the clinic, where the patient receives small amounts of the medication until they no longer feel the effects of withdrawal. Until stable, they visit the clinic weekly or every other week, then monthly, and eventually every three months.

Sublingual medication, like the brand Suboxone that Eden is prescribed, contains buprenorphine and the opioid blocker naltrexone, also known as Narcan. Buprenorphine can produce euphoric effects and respiratory depression when used at low to moderate doses. But, Eden said, for someone with a high tolerance for opioids like herself, Suboxone just makes her feel normal. The combination of buprenorphine and naltrexone reduces misuse of the medication if it were crushed and injected.

For Eden, Medicare and Medicaid benefits cover the two daily doses of Suboxone she’s prescribed.

Russell said Heartland has an onsite pharmacy, River City Pharmacy, which offers Suboxone and other medications at discounted rates through GoodRx and the 340B pharmaceuticals pricing program for uninsured patients.

“And part of the grant is going to be used to help people pay for medications who can’t afford them otherwise,” Russell said.

Russell said Heartland also prescribes buprenorphine without naloxone for those who are pregnant and people who have severe liver disease. Heartland providers can treat patients as young as 13 with Suboxone, although they haven’t.

“We’ve never had anybody that young on it, but we have had some older teenagers,” Russell said.

She said Suboxone is well-tolerated by most patients but with a few side effects, including drowsiness. For Eden, constipation has occurred, so she uses Miralax daily.

To treat opioid and alcohol use disorders, Heartland offers daily oral naltrexone in pill form and in injectable form as the brand Vivitrol. Naltrexone samples are available at Heartland, and the drug manufacturer offers a patient financial assistance program, Russell said. While a patient can stop taking daily naltrexone and then consume alcohol, Vivitrol is a thick liquid that has to be injected in the hip and stays in a patient’s system for 28 days.

“And it’s really great because people, if they drink, they don’t feel drunk,” Russell said. “They don’t crave alcohol. So they really, they take that control factor out where they can’t mess it up.”

Vivitrol can cause pain and tenderness at the injection site, however.

“Most people are fine dealing with it,” Russell said. “I’ve never had anybody stop it for that reason. It can cause headaches and nausea the first few days. But again, I’ve maybe only had one person stop it because the headaches and nausea were too bad.”

“I would say the vast majority of people on MAT — even if they have side effects — they will stick with it just because it’s so helpful,” Russell said.

The common medication-assisted treatment oral Antabuse, or disulfiram, for treatment of alcoholism also is offered at Heartland. Methadone for opioid addiction is not available because it requires a special license to administer.

Russell said MAT is safe to use for months, years or for a lifetime, if necessary.

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Her job rewards her by letting her witness patients getting their lives back on track.

“It’s instant gratification,” she said. “Because when people come in when they’re in withdrawal … and they’re miserable, they’re vomiting, they’re sweaty, they just feel so awful. They walk out here a couple hours later, after they’ve had Suboxone, and they feel the best they have in years or decades. And you just can instantly see it makes a huge difference. And same thing with Vivitrol.”

Those who are interested in the MAT program through HCHC can phone the clinic at 785-841-7297 for more information.

Opposition to medication-assisted treatment

The 2021 National Survey on Drug Use and Health found 46.3 million (16.5%) U.S. residents 12 and older met the criteria for substance use disorder diagnosis, yet 94% of them didn’t receive any treatment.

Eden, Russell and Keever hope to educate the community about the availability of MAT at Heartland as well as the importance of pairing MAT with counseling and behavioral health services in order to be successful in recovery.

Treating addiction with medication is not without controversy, though. Some recovery advocates and communities disapprove of treating addiction with medications, Russell said. They point out the dangers, including overdose, of “trading one addiction” for another. One of the stigmas attached to MAT is that it isn’t “real recovery.”

Ed Lobdell, behavioral health program director for DCCCA, said in an email that First Step at Lakeview’s stance is that medications for addiction “can be an important part of someone’s recovery journey.”

The residential center for women will accept clients who’ve been prescribed medications for addiction treatment.

“Medications for opioid use disorder and alcohol use disorder are evidenced-based practices, FDA approved, and effective,” Lobdell said. “We are very lucky to have a partner in town like Heartland Community Health Center who has expertise in the treatment of addictions using physical health interventions.”

At Oxford houses, each sober-living, abstinence-based home is run democratically by its residents, said Stephanie Fillmore, executive director of Friends of Recovery Association.

Eight Oxford houses are spread across Lawrence. Individual homes vary on whether they will accept applicants who participate in MAT or MAR, medication-assisted recovery.

Fillmore said in an email, “There are many Oxford Houses that will accept MAT/MAR membership in which case we have safeguards set up.”

Protocol consists of a lock box for medications and at least two housemates monitoring pill counts alongside the MAT participant.

“Members of Oxford Houses are not physicians and will not conduct themselves as such. We can not tell a member how to take their medication nor can we tell them what to do with it,” Fillmore said.

Get mental health help in Lawrence

These resources are available 24/7 if you or someone you know needs immediate mental health help:

• Douglas County Treatment and Recovery Center: 785-843-9192; 1000 W. Second St. in Lawrence; trcdgks.org
• Bert Nash Community Mental Health Center: 785-843-9192; bertnash.org
• HeadQuarters Kansas: 785-841-2345; hqkansas.org
• National Suicide Prevention Lifeline: Dial 988; veterans, press 1
• SAMHSA Behavioral Health Treatment Services Locator and Helpline: 1-800-662-HELP (4357)

Tricia Masenthin (she/her), equity reporter, can be reached at tmasenthin (at) lawrencekstimes (dot) com. Read more of her work for the Times here. Check out her staff bio here.

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