Carie Canterbury / Daily Record)
Courtesy Photo / Daily Record)
There will always be a need for pain management, but some insurers put stringent guidelines on what providers can and can't prescribe their patients, and not a lot of therapies are covered by insurance.
Dr. Lisa Pearson, owner of Metamorphosis Pain Clinic and also a nurse anesthetist who is board certified in Pain Management and Anesthesia, said it's unfair the demands put on providers by insurers and the government.
Addiction always has existed, Pearson said. Following the Civil War, two percent of the U.S. population was addicted to morphine, and heroin was created by Bayer to treat morphine addiction.
"The next big addiction problem was after the Vietnam War and then it was heroin," she said. "They treated it with methadone — now we are back to heroin again."
Heroin addiction is being treated with Methadone, Suboxone and Vivitrol.
While there is an over-use and addiction issue in rich countries, Pearson said, people are dying in significant pain in countries where no medication is available.
"You get burned, you die in agony, you have a horrible cancer, you get nothing for it," she said. "There is a place for opioids, and there is a place for pain management that is well managed — where you are managing for your addictions, you are making sure that pain is taken care of and you are treating it for things other than just opioids."
However, nearly all insurers require providers use morphine, methadone or fentanyl first for long-acting medications, Pearson said.
"I can not get another long-acting medication unless I try at least two of those," she said. "If I want to get a long-acting (medication) which has less of a risk for addiction, has a comparable pain relief as an abuse deterrent drug, I have to try morphine, methadone or fentanyl first — so you use a highly potent drug, then expect the patient to come down to a less potent drug, that's a set up for failure."
Several insurance companies won't cover a lot of non-opioid therapies for pain, and patients can't always afford to pay out of pocket.
"Providers and physicians feel quite attacked in the whole over-prescribing thing when they were really set up by lawyers, government and regulations that said they had better treat pain and treat it well or they would be dinged in their payment or be taken to court," Pearson said. "From my little piece of the world, what I can do is manage patients on low doses of opioids with multiple other therapies, include the cognitive/ behavioral, heavy physical therapy, medications, interventional therapy and monitor closely for signs of addiction and manage that as needed — that's what I can do, as well as get Narcan into the community."
Metamorphosis Pain Clinic provides medication management and medication assisted treatment for addiction with suboxone or vivitrol in coordination with Solvista and Gateway for behavioral health, and they offer a variety of interventional procedures. For more information, visit www.metamorphosispain.com.
This is the final installment in a four-part series examining the impacts of heroin on individuals and on the community.
Megan Hamilton was on the verge of death when Fremont County Sheriff's deputies administered Narcan, a reversal agent for heroin and prescription opioid overdoses, which saved her life.
At age 18 and weighing only 90 pounds, Hamilton had shot up about a gram of heroin literally moments before her arrest Jan. 17. She had been wanted on numerous warrants including failure to appear on possession of dangerous drugs.
Hamilton said she was mad at the time that deputies Jeremy Amendola and Greg Owen didn't simply let her die, but now, five months later, she is grateful.
Hamilton was in custody and about to be transported to jail when Amendola noticed her slump over in the patrol car and appearing unresponsive.
"We pulled her out of the car and laid her on the ground — she was limp, she wasn't breathing and didn't have a pulse," Owen said. "We gave her the Narcan and she came back; when she came back she was fighting mad."
She later told her mom it would have been easier to have her "put in the ground" than having her fail again.
"I knew what I was doing was wrong, I guess I didn't want to disappoint my family and myself again," Hamilton said. "Now I seek validation from (Amendola and Owen) and my family, and I hold myself to a higher standard than I ever had."
Hamilton spent 40 days in jail following her arrest and then seven weeks in a rehabilitation center. She has been clean five months, and she has plans for a bright future. She recently became engaged and she hopes to attend school to become a certified addiction counselor.
"I am actually happy and I am at peace with myself," Hamilton said. "I have not been in this position for four or five years."
She started getting high when she was 16-years old. As a homeless teenager, she slept in cars, outside, and at crack houses in Cañon City and Florence.
She said she never wants to return to her former lifestyle.
"Heroin scares the hell out of me," she said. "I will cut my hand off before I ever touch that again. I hold on to that fear of going back to it because I know what it will do — not what it 'can' do, but what it 'will' do. I literally lost everything."
Her message to the deputies today is, "I am very thankful," she said.
"I never saw myself getting sober, I never wanted to get sober, but it's definitely a blessing," she said. "It does get better."
Cañon City woman Michaellia Weber, 31, tried heroin twice, but decided it wasn't for her. However, she has battled other demons.
"Heroin is really scary, I thought I was going to die for sure," she said. "I was seeing silhouettes and I could barely move."
Shortly after Weber was born, her mom died by suicide. She was five when she moved from Arizona to Colorado with her sister and their dad.
Weber's criminal history began at age 11 for burglary, and she dropped out of school in eighth grade. She began smoking marijuana and was in and out of detention settings a number of times. She later moved to Washington where she was introduced to the needle.
"Six months into shooting up I had a mental break," Weber said. "I started hearing voices, I ended up stealing a car, but I finally made it back home."
She stayed clean for nearly three years before she got back into the same familiar life-style of drinking, using methamphetamines and again, stealing a car. She spent time in a Las Vegas jail and prison.
Life is different now for Weber. She is a secretary at First Christian Church, and she and her husband, Joe, have four children and bright plans for their future.
She was voted "Most Dedicated Student" at Pueblo Community College where she earned an associate's degree in office administration in 2012. She will graduate in July with a bachelor's degree in criminal justice and she plans to become a case manager for committed youth.
She and her husband went through the Family Treatment Drug Court program twice, which finally helped them to stay on the right track.
"At first, I hated it so much — I had dealt with it before and I was really, really embarrassed," Weber said. "They stuck it through with us and helped us along the way — I am really grateful for everything they did for us."
Family Treatment Drug Court is the most intense program offered for families through the Department of Human Services, which is aimed at parents who specifically are impacted by substance abuse issues. During its nine-year existence, the program has served 108 clients.
DHS reported in its last round of data, that in 55 percent of the typical dependency and neglect cases where substances were the primary cause, children were returned to the parents. That rate jumps to 85 percent when parents have taken part in FTDC.
"We see great success stories from family treatment drug court, as well as working with community partners on other dependency and neglect cases," Tonia Sutton, a child welfare supervisor for DHS said. "The program is intense, (and) the great part about it is we are able to get those children home quickly, and in some cases not even having to remove the children in the first place because we are able to build those safeguards and mitigate safety concerns."
In some cases, home visits are seven days a week to assess safety.
A similar program, Adult Treatment Court — based on the National Center for Drug Courts — was formed locally in 2012.
Mike O'Rourke, Chief Probation Officer for the 11th Judicial District, said 20 to 40 clients take part in the program, which is an individualized way to deal with the more high-risk, high-needs clients.
"We try to manage that with frequent reviews in front of a judge, they have frequent contact with their probation officer and they have a great level of treatment with the agencies that we have delivering whichever treatment that may be," he said. "That's shown to be one of the things that can really help in this fight against addiction and crime and how the two things go hand in hand."
The former Monitoring and Assessment program started in 1997 and evolved into what it is today, aimed at long-term reduced recidivism.
"Colorado is one of the leaders in this problem solving court," Fremont County Sheriff Jim Beicker said. "It's a very impressive effort, it's very manpower intensive, but we've seen some local success stories."
He said not all people facing drug charges truly belong in jail, but would better benefit in a treatment program.
Vivitrol now offered to offenders leaving jail
To help in treatment, the Fremont County Detention Center is kicking off a brand new program that offers Vivitrol to offenders leaving jail. Vivitrol is a non-opioid prescription injectable medicine for addiction that prevents opioids from getting on the receptors. It is used to prevent relapse to opioid dependence after opioid detox.
Beicker started a pilot program with parolees through the Department of Corrections a couple of years ago, which has proven to be a success, he said.
"This is in addition to psychological treatment," he said. "The beauty of this product is it helps them stay clean long enough that treatment modalities begin to work; they begin to understand the cycle they are in."
O'Rourke said the program is completely voluntary. Participants receive the first dose before they are released from jail, then they must receive a subsequent injection every 28 days. Medical staff from the jail have agreed to administer the injection to the participants at the Fremont County Department of Public Health and Environment.
"It has shown to make huge gains in their sobriety because they can use and they don't get high, and there is a low risk of overdose," O'Rourke said. "I see that as a big sword for us in the fight on opioid addiction, because you have to start with the cravings."
The cost for Vivitrol is about $1,000 per dose. The first shot will be paid for by offender treatment services budget through the Probation Department, which is paid for by the offenders through a monthly supervision fee, and subsequent shots will be paid for by Medicaid.
Offenders' ongoing treatment will be more closely managed following release thanks to a $7.8 million grant in federal funding to Colorado to help combat opioid addiction. The funding is part of $485 million in grants announced by the U.S. Department of Health and Human Services.
Beicker said Fremont County's share of the funding will go toward a case manager to help with continuity of care for offenders.
"We are starting with drug court participants — if they seek treatment, if they are on the treatment modality, then we will have a case manager making sure there is a pass off and a continuum of care to a treatment provider on the outside," he said.
In addition, State Representative Clarice Navarro, who represents a portion of Fremont County, recently was appointed to serve on Colorado's Opioid and Other Substance Use Disorders Interim Study Committee.
The policy issues to be studied include a review of data and statistics on the scope of the substance use disorder problem in Colorado, including trends in rates of substance abuse, treatment admissions, and deaths from substance use, an overview of the current prevention, intervention, harm reduction, treatment, and recovery resources and more.
"I'm looking forward to working on this committee to help address the issues Colorado, especially Southern Colorado, is facing regarding opioid and other substance abuse disorders," Navarro said in a media release. "I've seen firsthand what this is doing to our communities in Fremont, Otero and Pueblo Counties, and I know we can do more to ensure safe communities for our family, friends and neighbors."
Currently, Rocky Mountain Behavioral Health helps with the $500 co-pay for clients in need to get a bed at Resada Treatment Center in Las Animas County. Jenni Guentcheva, co-executive director for Rocky Mountain, said a community partnership fund is set up for donations for the co-pays.
Guentcheva said the inability to have funds for the co-pay should not be a barrier for people to receive treatment. Anyone wishing to make a tax-deductible donation may mail a check to Rocky Mountain Behavioral Health, 3239 Independence Road, Cañon City, CO 81212 or call Fran Birdsall, the office manager, at 710-275-7650.
Carie Canterbury: 719-276-7643, firstname.lastname@example.org
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