Med­i­cal clin­ics of­fer op­tion for opi­ate addicts

Mid-At­lantic Ad­dic­tion Medicine has nine clin­ics around Mary­land

Maryland Independent - - Business - By DAR­WIN WEIGEL dweigel@somd­ Twit­ter: @somd_bized­i­tor

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.

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