Hospi­tal ef­fort aims to re­duce over­dose risk for pa­tients with opi­oid ad­dic­tion

Chris­tus St. Vin­cent ad­min­is­ters Subox­one to ease with­drawal symp­toms while health prob­lems are treated, moves to fa­cil­i­tate suc­cess­ful tran­si­tion to clin­ics

By Scott Wy­land swyland@sfnewmex­i­can.com

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A former heroin addict recalls being more afraid of withdrawal than losing her arms.

A business owner and mother, Barbara, who asked that her full name not be used, injected heroin every day for years, causing the veins in her arms to collapse.

She kept shooting the drug into her arm muscles, creating an infection for which she refused to seek medical treatment, even as it worsened.

Then one day, her arm suddenly broke, so she went to the emergency room at Christus St. Vincent Regional Medical Center.

Doctors told her the infection had spread to her bones and that she would need surgery to save her arms. Even then, she asked to leave because she feared how sick she would feel if she didn’t get a heroin fix. But doctors persuaded her to stay.

When she awoke after the surgery, she felt no withdrawal symptoms or cravings because she’d been given Suboxone, a medication used to treat opioid addiction.

That turned out to be the first step in her recovery.

“It’s been almost a year since I stuck a needle in my arm,” she said.

Barbara was one of the first patients to receive an opioid treatment Christus St. Vincent began administering last year. Patients admitted to the hospital with health problems caused by opioid addiction are given medications such as Suboxone to suppress withdrawal symptoms and prevent overdoses before they’re referred to outpatient clinics for longer-term care.

It’s a way for Christus St. Vincent, the largest hospital in Northern New Mexico, to bridge what has been a critical gap in narcotics treatment between itself and the clinics, doctors say.

“In giving that treatment, it gives them [patients] a better shot at a better outcome,” said Dr. Ben Stricks, who spearheaded the program.

A matter of life and death

Previously, patients were given weaker opioids — not Suboxone — to ween them off drugs such as heroin, and then they were released from the hospital, said Dr. Theresa Ronan, Christus St. Vincent’s medical director of quality.

A hospital staff member would recommend outpatient clinics, such as the one at La Familia Medical Center, where patients could receive Suboxone treatments. The patients were left on their own to get there, often while in withdrawal.

The patients also weren’t guaranteed entry into clinics that typically would screen them first.

The disconnect between Christus St. Vincent and outpatient clinics led to many people relapsing, Ronan said. Even worse, many would fatally overdose because the week or so they spent in the hospital taking milder opioids lowered their body’s tolerance to stronger narcotics, she said.

There’s a dramatic rise in risk of death after discharge during the first 28 days, Stricks said, partly because patients are more prone to overdosing.

A sobering statistic shows the mortality rate is especially high in the Santa Fe area, said Kathy Armijo Etre, the hospital’s vice president of mission.

In Santa Fe County, there are 47 deaths for every 100,000 overdoses, surpassing the rate of 43 in New Mexico and the 39 nationally, she said.

No one is sure why fatal overdoses are higher in Santa Fe County, though one reason might be that people struggling with poverty and addiction often gravitate to Santa Fe because it has good social and health services, Armijo Etre said.

That’s why it was important to bring together the hospital and the clinics so they work cooperatively — it could literally save lives, Armijo Etre said.

Hospital staff now set up appointments so patients can go directly to the clinics, with no treatment gap in between, she said.

The hospital has six doctors certified to dispense Suboxone to patients during their stay, Stricks said.

Patients whose drug addictions put them in the hospital — perhaps with hepatitis C or organ failure or a severe infection — have “bottomed out” and are often open to remedies that can help them regain control of their lives, Armijo Etre said.

“We’re in the perfect position to be able to treat people when they’re the most vulnerable,” she said.

Easing withdrawal is key

Prescribing Suboxone helps prevent severe relapses, Stricks said.

Suboxone blends the medications buprenorphine and naloxone. The combination triggers opiate receptors in the body to blunt withdrawals and cravings. It also prevents the patient from feeling euphoria — which eliminates a payoff — and overdosing on opioids.

Suboxone allows patients to transition to a normal life while undergoing long-term treatment, Ronan said.

“They can return to work, they can spend time with their families,” Ronan said. “They are less likely to engage in higher-risk behaviors like IV [intravenous] drug injection.”

Because of patient privacy laws, it’s difficult to obtain data to determine how much the program has helped people kick their opioid addictions, Stricks said.

A report published in the Journal of the American Medical Association in 2015 said opioid-addicted patients who went to the emergency room and received buprenorphine before they were released were twice as likely to stick to a treatment program than those who received no such medication in the ER, Stricks said.

Barbara agreed it was important to kill the heroin craving before she left the hospital.

“If the Suboxone didn’t have the medicine that blocks the cravings, I honestly know I would’ve gone back to heroin,” Barbara said. “If they have you on the right dose, you don’t get no cravings, you don’t catch a high. It’s like you’re normal. That’s what I wanted.”

She was on methadone for eight months, but the treatment failed because she could still get high on heroin while she took it, she recalled.

Easing withdrawal is vital in getting patients to accept medical care for the health problems that put them in the hospital — otherwise, they’ll defy the doctors’ advice and leave, Stricks said.

“The patients will just jump up and say, ‘I’m out of here,’ no matter how dangerous their illness is and whether we say, ‘We think you just might die if you leave,’ ” Stricks said. “They will just leave.”

Hospitals have been slow to adopt Suboxone and buprenorphine treatments, even though it’s been known for a long time that they effectively counter opioid addiction, said Dr. Josh Leiderman, director of La Familia’s recovery program.

That’s because an “X waiver” has been required to administer opioid medications since Congress passed the 2000 Drug Addiction Treatment Act, Leiderman said. As a result, most hospitals haven’t wanted to hassle with getting their doctors certified, he said.

In recent years, programs that offer training and certifications have become more common, making it easier for hospitals like Christus St. Vincent to get on board, Leiderman said.

Leiderman said he’s certain Christus St. Vincent’s program has resulted in more of its patients being handed off successfully to La Familia.

“We get people coming from there that wouldn’t have come otherwise,” Leiderman said.

Barbara said she hopes people struggling with heroin addiction will seek help through the hospital’s program.

“Those who want to be sober but can’t because they’re afraid of withdrawals — this is the perfect program for them,” she said.