Medical clinics offer option for opiate addicts
Mid-Atlantic Addiction Medicine has nine clinics around Maryland
A St. Mary’s woman walked into a Waldorf addiction clinic last summer and set her life on a new path, ending 12 years of opiate abuse.
“My son is 12 years old now and it started from a sciatica injur y from having him,” the woman, who wished to remain anonymous, said while sitting in one of the clinic’s exam rooms in early January. “They started me on Vicodin and it progressed to Percocet.
“I’m on Suboxone now, but starting the first month coming here I was stable within the first month — no longer taking any kind of opiates [to get high]. It was a big life change, big life change — huge. And I’m telling you, my kids are loving it — absolutely loving it. It’s good to feel halfway normal. Actually, pretty normal, really, compared to what I was doing.”
Mid-Atlantic Addiction Medicine, a private treatment organization started by two pain management doctors, has part-time outpatient clinics in Waldorf and Leonardtown and is adding clinics in Prince Frederick and Fort Washington. Those clinics join five others in Mar yland under the same banner.
Doctors Ehsan Abdeshahian and Damean Freas launched Addiction Medicine in 2014 with the goal of bringing another avenue of opioid abuse treatment to areas that don’t have many options, or where addicts only have methadone clinics available.
The clinics, which are usually only one or two days a week, operate outside the normal operating hours of their host medical offices and are located to cover the state, especially where help is needed most with the burgeoning opioid addiction epidemic: Annapolis, Cumberland, Easton, Fort Washington, Glen Burnie, Leonardtown, Millersville, Prince Frederick and Waldorf. Two of the clinics — Annapolis and Cumberland — are located within existing drug treatment programs.
“We saw a huge need for it. We were seeing a lot of patients in our pain clinics that weren’t getting the proper care they deserved, and they were on higher dose narcotics. We felt like we were kind of abandoning some of these patients: There’s no place for them to go,” said Abdeshahian, a native Oklahoman who practices at the KURE Pain Management clinic in Waldorf. His friend and colleague Dr. Freas is KURE’s chief executive officer.
“I wasn’t comfortable prescribing the dose of narcotics they were on, and neither was anyone else in Southern Maryland. We were kind of leaving them out there to their own resources, to whatever they can find.”
For the St. Mar y’s woman, that meant first hitting up a methadone clinic in what would be the first of many attempts to sober up — and then shopping around for other doctors to prescribe increasing amounts of opiates as her addiction intensified. Methadone itself is an opiate meant to supply a decreased high, but a high nonetheless, according to Abdeshahian.
“There for a while, I was eating 40 10-milligram Percocets in a day — easy. It was bad. It’s a lot. A normal person? It’d probably kill them. But I would have no problem doing it,” she said. “It was Percocet, then I started at a methadone clinic [around 2007]. So it was Percocet and methadone when I came in here.
“I was going there for a couple of years, then I started getting the methadone from a pain management place,” she added. “They were giving me 240 methadone a month and 90 15-milligram Percocet a month. There’s no reason for somebody getting that many pills, honestly. It’s crazy.”
Abdeshahian said he prefers not to use methadone precisely because the high essentially feeds the addiction. For weaning off drugs, he and the Addiction Medicine clinics prefer Suboxone, which is a combination of naloxone — an opiate blocker — and buprenorphine, which helps fill the opiate need without producing the high. Suboxone, while normally prescribed in pill form, is also available as an under-the-skin implant that works for six weeks, giving the patient an even dose over that time.
“Methadone is an opiate. With methadone [unlike Suboxone], you actually do get a high sensation, which is the reason I prefer not to use it,” Abdeshahian said.
“This is the one phrase my patients always tell me when they come in and they’re on Suboxone: I feel normal,” he added. “I can’t tell you how many times I’ve heard that from patients. When you hear them say that, you know they’re on their way to recover y and are doing better.”
Another medication the clinic uses is Vivitrol, which is a long-lasting, controlled-release version of naltrexone. The medication, which is not an opiate, is injected into a muscle and prevents narcotic cravings for a month. The patient has to be free of opiates for up to 10 days before the injection and can’t take any opiates in the ensuing month.
“Vivitrol’s great,” Abdeshahian said. “I didn’t start using Vivitrol until recently, probably within the last year. It’s a great drug because it’s not an opiate. At the point that a patient’s gotten on Vivitrol, they’re no longer using opiate medications; they’re no longer dependent on the medications.
“If they’re on the injection, one, they have no craving; two, if they use [an opiate] they get really sick. It would shoot them into severe withdrawals, basically.”
The Mid-Atlantic Addic- tion’s administrator Molly Owens called Vivitrol a “miracle drug” when it comes to addiction.
“When a person is going through the whole addictive process and trying to straighten their life out, they have a battle in their brain that’s just ridiculous as to whether they’re going to use or not,” Owens said. “What Vivitrol does is it stops the battle.”
And Owens should know: she was the coordinator for Anne Arundel County’s District Court Adult Drug and DUI Treatment Court for eight years before teaming up with Calvert County Circuit Court Judge Mark Chandlee back in 2014 to start a drug court in Prince Frederick. She left that post a little more than a year ago to help Mid-Atlantic Addiction expand.
“My goal was if we can do these clinics and reach more people than what I was reaching inside the courts, and they were done properly, I was all there,” Owens said. “I went in and looked at the clinics and watched what was going on and just fell in love with what they were doing.” The clinics currently have 330 patients spread among six doctors on a rolling basis.
The addiction clinics are $150 for the first visit, $100 for a required twoweek checkup and then $195 a month for ongoing care. Owens said the clinics currently can’t accept insurance for the office visits but she and her assistance go out of their way to get the medications covered under a patient’s insurance plan.
“We’ve been fortunate that people have been able to do it [financially],” Owens said. “They either have family members helping them or they’re working. If we can get a person sober, then they can go back to work, and family then wants to get engaged.”
Abdeshahian said another component of the addiction clinics is counseling.
“The physical dependency is something you can fight. The mental component is very difficult for them. That’s why we think counseling and therapy are a very integral part of it,” he said. “The counselors and therapists actually play a bigger role than I do to get them off [drugs], basically.”
Abdeshahian said the normal treatment time is between six and 12 months, though patients who have been addicts for 12 years like the St. Mary’s woman sometimes need help beyond that timeframe. He said he has patients that have been seeing him regularly for two years.
“A lot of people would scrutinize that and say that’s not the right way to practice, but I would argue and say, ‘I’ve seen what this person is capable of and I know what the alternative is,’” he said.
“I would rather them be safe and comfortable in my practice, seeing me, having me monitor them and doing counseling, as opposed to on the street using street drugs and ruining their lives.”
Owens concurred and said it’s her experience that the treatment standards have been trending toward longer doctor/ counselor involvement.
“The tendency now in all of treatment is moving towards leaving people on medicated, assisted treatment for a longer period of time,” she said.
The St. Mary’s woman has been on Suboxone for a little over six months now and is going to start tapering off of that soon in hopes of becoming normal again — something that has eluded her for 12 years. She’s tried cold turkey as many as 20 times over the years.
“It would be so nice to not to have to take anything every day. It would be amazing. That’s my ultimate goal, and this place is making it possible, for sure,” she said.
“Coming here, they have you go to counseling, too,” she added. “That also helps you — just dealing with the mental part of it. That definitely helps a lot. Believe me, it’s taught me a lot of coping mechanisms. I handle myself so much differently now than I did, say, two years ago — so differently.”
For anyone seeking addiction treatment, the clinics have one telephone number to set up an appointment: 410-8004466.
“We’re here to help,” Abdeshahian said. “The first step is making it in here.”
Dr. Ehsan Abdeshahian and Molly Owens pose for a picture at the KURE Pain Management clinic in Waldorf. Abdeshahian also treats drug addicts there after normal clinic hours.