Peoples Community Health Clinic in Waterloo, Iowa, sees nearly 300 patients daily who have a wide range of medical conditions, including opioid addiction. But the best options to treat opioid use disorders have been limited in Waterloo, particularly for uninsured patients who rely on the nonprofit clinic.

Now a new program that trains clinicians in medication-assisted treatment (MAT)—the gold standard for opioid use disorders—is available through the University of Iowa Department of Psychiatry. Training focuses on the proper use of buprenorphine, an approved medication used to treat opioid addiction, more commonly known by the brand name Suboxone. The drug targets the same brain receptors related to pleasure and memory that opioids, such as heroin, also target. Buprenorphine blocks cravings and prevents withdrawal symptoms.

“We want to provide a good, viable alternative that can potentially stabilize (our patients’) lives,” says Sharon Duclos, MD, co-medical director of the Waterloo clinic, who participated in MAT training. “It’s a great opportunity that will really benefit some people.”

Duclos recently started a MAT clinic with a team of advanced practice providers. She says it’s important to integrate addiction treatment into a primary care setting.

“I’m just ready to get it started. I’m ready to write my first prescription,” Duclos says. “When you can go to your doctor and get most of your needs met, it makes all the difference in the world.”

Duclos joins a growing number of providers in eastern Iowa working to bring lifesaving treatment to their communities. 

Scarce resources for a growing problem in Iowa

Currently, access to treatment for opioid addiction is scarce in the state even as the number of people with opioid use disorders is climbing, according to a report by Stephan Arndt, PhD, UI professor of psychiatry and biostatistics, and Suzy Hedden, an evaluator for the Iowa Consortium for Substance Abuse Research and Evaluation.

MAT providers tend to be clustered in the most populated counties, while Iowa’s rural areas, especially in the corners of the state, have few or no professionals trained to administer buprenorphine. In December 2018, there were 127 providers approved to administer the drug in Iowa, and a conservative estimate of 12,104 residents with opioid use disorder, according to the report.

Of Iowa’s 99 counties, 15 have no trained providers and 23 have just one. Iowans who live in counties with no access to treatment have to travel an average of nearly 40 miles to get appropriate care, according to the report.

In September 2018, Alison Lynch (98MD, 03R), UI clinical professor of psychiatry and director of addictions medicine in the department, was awarded a three-year, $1.5 million grant from the Substance Abuse and Mental Health Services Administration to train clinicians in MAT. As of April 2019, she and her team had trained 89 providers, primarily in eastern Iowa. More training is being scheduled, including sessions in Mason City and at UI Hospitals & Clinics.

Lynch’s project not only aims to increase treatment availability in rural clinics across the state, but also in prisons and jails. The training is available to physicians, nurse practitioners, and physician assistants in a number of different specialties, including primary care and emergency medicine.

“It is great to see so many clinicians signing up for our training sessions,” Lynch says. “People who have taken our course tell us that they have a better understanding of opioid addiction and feel more prepared to treat it.”

Another important component of the training is reducing the stigma that surrounds addiction by identifying it as a chronic condition that can be managed with the right treatment, she adds.

Treatment helps patients ‘get their life back’

Lynch started an opioid clinic at UI Hospitals & Clinics in 2017 with Jill Liesveld (86MD, 92R), clinical associate professor of psychiatry, and has been treating patients using buprenorphine combined with counseling and behavioral therapies.

Many of the clinic’s patients have either survived an overdose or know someone who has. These individuals worry about overdosing or even dying if the drugs they use are contaminated with fentanyl or other dangerous substances. They also face concerns about financial problems, being tested for drugs at work, or getting arrested.

“We get them on Suboxone and they just feel better,” Lynch says. “They have guaranteed access to a medication that’s coming out of a pharmacy, so they can trust it’s safe. They don’t have withdrawal. It’s so satisfying to see someone get their life back. I think it’s really empowering, yet there are still not very many trained providers.”