St. Paul clinic’s fight against the opioid menace shows promise

St. Paul clinic’s fight against the opioid menace shows promiseBy RUBÉN ROSARIO | rrosario@pioneerpress.com | Pioneer Press
PUBLISHED: May 5, 2018 at 9:00 am | UPDATED: May 6, 2018 at 10:30 am

David Moyer does not look like the type of person one first thinks of when one hears the words “opioid addict.”

Sure, the 62-year-old former circuit-board factory worker from St. Paul dabbled with alcohol, pot and other illicit drugs during his rebellious-high-school and then partying-young-adult days until a DWI arrest at age 30 sobered him up.

“I had a young family then and I needed to think about people other than myself,” Moyer told me during a recent chat.

What followed were 28 years of work, raising a son and sobriety. Then came a painful back injury at work four years ago. He dipped into his wife’s prescription Vicodin to ease the pain.

“She has health issues and is very responsible with it, and I know I should have stayed away, but just thought I would take a couple,” Moyer recalled. “I remember, ‘Wow, it really does the job’ and then boom, I was right back in it.”

Compared with the drugs in his younger days, “this does not only get rid of the pain but also got me high,” Moyer added. “Back then, I was addicted to the experience of getting high. This is a worse addiction – I have to have that drug, not like back in the day.”

His abuse extended at times to stealing his wife’s fentanyl patches, opening them up, scooping the contents with a cotton swab and sucking on it. If most Americans don’t already know some of the sobering factoids about the opioid and overall drug crisis, here’s a sampling:

  • Drug overdose is now the leading cause of death among Americans under age 50.
  • Of the 20.5 million Americans 12 or older who had a substance-use disorder in 2015, 2 million disorders involved prescription pain relievers, and 591,000 involved heroin.
  • There were 20,101 overdose deaths related to prescription pain relievers and 12,990 overdose deaths related to heroin in 2015.
  • More than 1,000 Minnesotans are treated daily in emergency rooms for prescription opioid misuse, and 700 die annually from drug overdoses.

A Hennepin County inmate survey released May 1 disclosed that 64 percent of 173 inmates with a history of opioid abuse had overdosed. This is a drug crisis that arose at the beginning of the century with the overprescription of legal drugs. It has morphed in recent years to now include a lucrative street market for drug cartels and pushers peddling cheap heroin and synthetic opioids like fentanyl produced by drug labs in Mexico and China.

“This opioid crisis no longer sits on our doorstep, it is already in our homes,” Hennepin County Sheriff Rich Stanek said in releasing the survey. “Our family, friends, neighbors, and colleagues are all being affected … too many people are overdosing and far too many people are dying.”

Dr. Jonathan Dickman, one of Moyer’s physicians at the United Family Medicine clinic on St. Paul’s West Seventh Street, has seen up close the human toll and continuing struggle with this epidemic.

“It’s like a school shooting every couple of hours,” Dickman said of the estimated average of seven people an hour who die of a drug overdose. “There are three or four states that have more (opioid) prescriptions than people.” In 2013, West Virginia providers wrote out 110 opioid prescriptions for every 100 state residents.

Dickman and colleagues at the clinic, including Dr. Timothy Rumsey, Moyer’s family doc and a longtime clinic residency program director, embarked on a wraparound treatment initiative well over a year ago in response to the plight of the opioid clientele.

The goal: Train and certify the staff at the nonprofit, community clinic in prescribing Suboxone as part of a medication-assisted treatment protocol. Suboxone is a designer narcotic that can significantly reduce cravings and also stunts the side effects of withdrawal.

“Suboxone is safer (than methadone), well-regulated and allows you to wake up in the morning and go to work, go to school, be a dad, a mom,” Rumsey explained.

Mental health services are another major and critical component. Patients see in-house clinic therapists and psychologists instead of having to go elsewhere to address behavioral and other mental health needs. There’s also what Dickman calls a clinic within a clinic – an opioid safety clinic to help educate both patients and physicians about the addictive narcotics.

“There’s a stigma surrounding this, even among the physician community,” Dickman told me. “There’s still a feeling that this is a personal failing. But now we know that this is a personal failing as much as diabetes. It changes the brain chemistry and it changes the way people think.”

Rumsey began his medical career working at “free” clinics in the Saintly City during the sex, drugs and roll ‘n’ roll days of the 1970s. He believes doctors like himself, in their desire to help patients in chronic pain, were duped by the pill-pushing pharmaceutical industry into thinking opioid painkillers were relatively safe as prescribed.

Now he and other doctors are ramping down such medications and looking for medical and non-medical ways to better treat patients who become addicted.

The clinic staff have committed to prescribing opioids less often and at recommended lower doses and for shorter periods of time. Moyer was the first of a handful of clinic patients who underwent the multipronged treatment. The first meeting takes about three hours as patient and physician try to find the right dose to prescribe. There are frequent check-in visits and drug-monitoring tests.

“They watch you very closely,” Moyer recalled. He remembers the feeling he got shortly after he stuck as directed a small film strip of Suboxone under his tongue.

“Something dinged in my brain,” said Moyer, who agreed to share his story to encourage those struggling with drugs to get proper help. “It reduced the craving. It was that quick. I knew I would be OK.”

Moyer’s Suboxone prescription contains Naxolone, better known as Narcan, the synthetic drug that blocks the effects of opioids and is used by cops, paramedics and other first-responders to reverse overdoses. Rumsey carries a small spray bottle of it in his pocket.

“This is rescue stuff,” Rumsey said as he showed me the bottle recently. “It saves lives.”

Moyer has been opioid-addiction-free nearly 18 months now. Although his wife was instructed to place her medications in a secure lockbox as a precaution, Moyer said he goes to the pharmacy to pick up her meds without a problem.

On disability following heart surgery two years ago, he has occasionally taken up Tai Chi and yoga. He raves about his therapist. Although there may come a time when he will have to wean off the Suboxone, he is confident that he will never go back to opioids.

“That opiate thing felt good, but it comes with very severe consequences,” he explained, adding that it almost wrecked his marriage and led to health problems. “That clinic, these doctors, I feel like they probably saved my life because I don’t know where that was going, if it was going to continue to spiral.”

United Family Medicine

United Family Medicine