Cascade Community Healthcare’s Substance Use Department is now offering medication-assisted treatment (MAT) as an option to those recovering from opiate and alcohol use disorders.
The new program, which uses medication to reduce patients’ cravings and other symptoms associated with withdrawal from a substance, is intended to work in conjunction with Cascade’s existing substance use disorder (SUD) behavioral therapy programs to create a holistic approach to treating substance use disorders.
MAT clients meet with Angelina Chavez, a registered nurse practitioner (ARNP), who matches them with medication to best suit their needs.
Chavez was hired to lead the MAT program in late April after the Substance Use Department received a federal Certified Community Behavioral Health Clinic (CCBHC) expansion grant to enhance its services.
“It fills in those gaps that we don’t have the money to actually do, so with that money I was able to hire Angelina on full time and we get to build this program,” said Substance Use Program Administrator Mindy Greenwood.
Clients interested in the MAT program are required to do an initial assessment for traditional SUD treatment, but whether they pursue further behavioral treatment from there is up to them.
“The reason being, it gives her (Chavez) a really good history of what’s going on with the client and from there if treatment recommendations are made, we can help the client,” Greenwood said.
Since Chavez started seeing patients in May, the MAT program has seen 10 patients — one for alcohol and nine for opiates — and each at a different point in their recovery with different medication needs.
“Depending on the needs of the patient or what they want, short-term, long-term, we do a lot of Suboxone for opiates but we have the option of not doing Suboxone if they want to do supplemental medications instead … It's more about meeting with them, interviewing them, seeing what they want out of this and trying to come up with a plan together that will help them be successful,” Chavez said.
Suboxone is a combination of buprenorphine and naloxone that’s commonly used to treat opiate addictions.
“We use it for opiates, whether it’s withdrawal, addiction, cravings; we can use it for many different things,” Chavez said.
“What’s nice with Suboxone is it can be either a short-term or a long-term medication, so whether they want to use it short-term just to get over cravings or to get over the withdrawal from opiates and to transition, we can always wean them off later,” Chavez said. “There are some people who don’t want to be on it long-term, but yet there are some people who are like ‘no, this works for me, this is what’s going to maintain my sobriety, I want to be on it forever,’ and that works too.”
The inclusion of naloxone, the medication used to treat drug overdoses, is one of the reasons why Chavez prefers Suboxone to alternate MAT drugs such as buprenorphine, commonly known as Subutex, and methadone.
“The difference between the Suboxone and the methadone, is Suboxone is a partial antagonist so while they’re on it, if they happen to use opiates, they’re not going to get high. Whereas with methadone, they will,” Greenwood said.
Due to the high risks of misuse and overdoses associated with methadone, both Greenwood and Chavez agreed early on that they didn’t want to prescribe methadone to patients.
Suboxone comes with its own risks, which Chavez is carefully monitoring with each patient she prescribes the medication to.
Greenwood and Chavez have additionally been working with Lewis County District Court staff and local law enforcement to alleviate their concerns about patients potentially diverting medication to resell in the community.
“We’re pretty strict about, we’re not giving out more than a week’s worth of medication right now, because we want to eliminate any concerns that law enforcement had with diverting medication,” Greenwood said.
“We’ve gotten good feedback from them … and they’re really happy with what we’re doing so far.”
Cascade does monitor patients with regular urine testing, but “it’s not to be adversarial, we’re checking to make sure they’re at therapy levels,” Greenwood said.
The SUD program’s ultimate goal is abstinence — with the understanding that getting there is a personal journey for each client.
“I’ve had a few clients ask me ‘what happens if I pee dirty, are you going to kick me out?’ No, we’re not going to kick you out, we’re going to figure out what went wrong, what we can help you with what we can do better,” Chavez said. “We just want them to be successful, that’s our goal, so whatever we have to do to get there.”
The SUD Department anticipates a full reopening on July 1, with all in-person adult and youth programs resuming.
Clients are currently accepted on a walk-in basis from 8 a.m. to 5:30 p.m. Monday through Thursday. On extremely busy days, the wait to be seen is 10 to 20 minutes, “but you’re going to get in,” Greenwood said. “It might not be immediately when they walk through the door, but they’ll get them in.”
All insurance policies are accepted, but even if you’re uninsured, Greenwood encourages potential clients to come in anyways: odds are, Cascade staff can figure something out.
“We have ways for people to get what they need,” Greenwood said.
The entrance to the SUD clinic is located on the side of Cascade Community Healthcare's building in Chehalis, at 135 W. Main St. Visit cascadecommunityhealthcare.org or call 360-748-4339 for more information.
