SISSONVILLE – White House drug policy officials visited Sissonville to meet with leaders and patients at a medication-assisted drug addiction treatment program Wednesday, in an effort to promote more of such programs.
Meanwhile, in an interview following, program leaders said that their program would cease to exist should the Trump administration succeed in its efforts to dismantle the Affordable Care Act, including the part of that law that expanded the low-income health insurance program, Medicaid, to about 150,000 more people in West Virginia.
"The program would collapse without Medicaid expansion," said Lois Vance, care manager for Cabin Creek Health System's medication-assisted-treatment program. "I mean it's just simple, and people would die."
More than one-quarter of West Virginia relies on Medicaid — sometimes referred to as a "medical card." And in 2018, the state Department of Health and Human Resources reported that in 2016, Medicaid recipients were among the those most susceptible to drug overdose in the state.
Dr. Ryan Morrison, medical director for the program, added that cash-only Suboxone clinics would survive, but that in order for low-income people without health insurance to afford those programs, cash-only clinics often provide them with an excess of Suboxone so that they can sell the excess supply to purchase more.
The federal Department of Justice is supporting a Texas lawsuit that would dismantle the entire Affordable Care Act, also including the part of that law which protects people with pre-existing conditions like substance use disorder from being denied insurance or charged more for it.
The administration has also promoted the use of short-term insurance plans, which aren't subject to the same restrictions as Affordable Care Act plans and can turn people away for pre-existing conditions.
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Deputy Director of the White House Office of Drug Control Policy Kendel Ehrlich and Director for Rural Engagement Anne Hazlett visited Cabin Creek Health System's Sissonville location on Wednesday afternoon. Program leaders and patients at the MAT program at Cabin Creek Health Systems, a community health center, told them about the success of their program.
Ehrlich said they visited because they want to promote more use of MAT programs.
"It's to come and see the work being done, but also we recognize that some communities aren't as strong on MAT and for the opiate user, it is really effective and really works," she said.
In response to a question about the effect of dismantling the Affordable Care Act, therefore cutting the Medicaid program, Ehrlich pointed to separate federal funding for the effort that Congress allocated toward the crisis, a waiver the federal government approved to let Medicaid be used for more substance abuse services, and the president's bringing attention to the crisis through the "bully pulpit."
She also said the president mandated that every agency in the federal government "have a role" in the addiction crisis.
Cabin Creek was one of the first providers in the state, in Kanawha City in 2016, to begin offering a medication-assisted-treatment program. Sissonville's program started in 2017, while the program in Dawes started July of this year.
Along with group and individual therapy and other health services, they provide buprenorphine, often called by the brand name Suboxone.
According to the federal Substance Abuse and Mental Health Administration, buprenorphine saves lives, reduces overdoses, eases cravings, and can help people kick the deadly street drug heroin, or the even more powerful fentanyl. As a "partial opioid agonist," it affects the same receptors in the brain as full opioids, but people reach a "ceiling" when they take it, meaning the effects don't intensify with higher dosages.
Cabin Creek program leaders said that while cash-only clinics may provide only the medication, Cabin Creek provides intensive services, including individual and group therapy and treatment for other problems that may be related to drug addiction, such as trauma, anxiety or grief. They also require participants to attend four 12-step meetings a month for the first 90 days, but if the program participant finds that 12-step programs are not for them, they may also count activities like volunteer work, exercise, church, or other activities that help keep them sober.
Josh Carter, MAT program director, said 27 patients haven't used illegal drugs in over a year.
"A lot of patients will say I've been to other sites and basically wasn't treated like a person," he said.
One day, hungry patients were rummaging through the kitchen cabinets. Staff then brought a spaghetti dinner for the MAT patients.
Carter said they hold patients accountable by requiring regular drug testing.
"I know if I use something during the week and I come in, I have to face him," one patient said.
Program leaders talked about the stigma in West Virginia that still exists surrounding medication-assisted treatment. Some proponents of abstinence-only recovery, including recovering addicts themselves, sometimes see the use of buprenorphine as trading one drug for another.
But Cabin Creek patients hold down jobs, they get their families back, and some who choose to decide to discontinue Suboxone.
One man said they'd all be dead if not for the MAT program.
"It's not about getting high anymore," he said. "It's about just trying be normal."
The federal officials also questioned several MAT program patients, and observed Carter talk with the group about strategies to overcome triggers and cravings, such as distraction, talking to someone, and keeping their hands and mind busy.
Carter said that a trigger – such as stress, seeing somewhere they used to use drugs, or people they used to use with, can turn into a thought, then a craving, and eventually a relapse. He compared the process to a growing snowball on top of a hill.
If they don't find ways to manage the trigger early on, the cravings get stronger – the snowball gets heavier, the relapse becomes more likely.
He noted that more people on board, such as Vance, or their NA sponsor, could help them keep the snowball from rolling down.
"That's why you need support because you can't do it alone," he said. "You've got to have people to help you stop your snowball."
Patients talked about how their families had given up on the them, but not the health workers at Cabin Creek.
"Looking back now, I wouldn't have been able to do it on my own," one woman said.
According to the Washington Post, a judge is scheduled to rule next month on whether the entire Affordable Care Act is overthrown.
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