Combatting the Crisis: Opioid Pilot Program Launched in Boise
Nationwide, overdoses and deaths from opioids have hit epidemic and crisis levels. On average, 130 people die every day in America from an opioid overdose. Deaths from natural opioids, such as oxycodone, synthetic opioids, including fentanyl, and illicit opioids like heroin, have skyrocketed to record levels, with no signs of the epidemic slowing.
In 2017, there were 103 opioid-related overdose deaths (https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/idaho-opioid-summary) in the state of Idaho. Of these, 63 involved prescription medications. Fentanyl was linked to 22 cases and heroin to 23. Leaders from Boise, Idaho's police department, along with the Treasure Valley Opioid Response Team, have taken steps to respond to this crisis by implementing a pilot diversion program for the city.
The program is still in its infancy stage, but it has already garnered attention due to its controversial use of the drug Suboxone. The drug, which is a combination of two opioid derivatives – naloxone and buprenorphine – are used to help reduce the symptoms of opioid withdrawal.
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While Suboxone is an opioid derivative and stimulates the same brain receptors as opioids like heroin and OxyContin, Suboxone can be safely absorbed in the bloodstream and is absorbed in a much slower rate than other opioids. This means that the brain doesn't associate Suboxone with the same high as the more addictive drugs. Suboxone's slow absorption also helps ease the symptoms of opioid withdrawal without producing its own withdrawal symptoms.
Boise's diversion program aims to promote substance abuse treatment rather than incarceration. Funded by a grant from the Idaho Department of Health and Welfare (https://healthandwelfare.idaho.gov), the pilot program allows for 10 candidates, who all must fit a strict set of criteria for admittance to the program. As of mid-April, four candidates were participating in the program, with successes being seen in all four cases.
In the diversion (https://www.nwrpca.org/news/390722/Opioid-Crisis-Treasure-Valley-Gets-it-Right-.htm), drug offenders participate in a yearlong Suboxone-assisted treatment program designed to end the candidate's drug addiction. If a candidate does not complete all requirements for the program, then the charges that the candidate was initially arrested on will be placed on his or her record. For many candidates, drug possession isn't the only charge made during the arrest.
An important component of this program is counseling. Amy Jeppesen, executive director of Recovery 4 Life, stated that she's noticed that many individuals with opioid addiction have an intrinsic motivation to recover and get clean. However, they often struggle with the initial withdrawal process, often wanting to rely on their current drug of choice until the Suboxone dosage has reached therapeutic levels.
This is why Boise's diversion program also includes a counseling component. This can help those in the program fight cravings, overcome withdrawal symptoms, learn coping techniques to deal with life stressors, and manage any pre-existing anxiety, depression, or other mental health issues.
Program Criteria:
The criteria to enter the diversion program are strict. First and foremost, the candidate must want help and be ready to change. If the candidate does not want help, then the program will not be the right fit. Those that want help recovering from addiction are referred to as Recovery 4 Life to begin counseling and Subuxone-assisted treatment.
Other criteria for the program include:
at least 18 years of age
not a registered sex offender
not on parole
not arrested for a violent crime
no previous arrests for drug trafficking or possession with intent to deliver
A previous criminal history does not exclude the candidate from eligibility as long as the previous crime was non-violent and not related to drug trafficking. Candidates can also be on probation and still be eligible.
Expanding the Program:
While this current pilot program is only in Boise, it is hoped that the techniques and successes can expand beyond the city, and eventually beyond Idaho. The Idaho Board of Correction (https://www.idoc.idaho.gov/content/directors_office/board_of_correction) has begun partnering with another organization, Terry Reilly Health Services, to offer a second pilot program.
This pilot program is also medication-assisted but is available to those with opioid addiction outside of Ada County. In this program, Suboxone-assisted treatment is provided through Terry Reilly, with counseling offered through Recovery 4 Life.
This pilot program is larger than Boise's, with 70 candidates entering the program thus far and 27 still receive treatment as of mid-April.
A Whole-Person Approach:
These opioid addiction treatment pilot programs have thus far been successful, in large part due to the whole-person approach used. Rather than punishing drug use or treating only addiction, candidates receive counseling and assistance with other important needs.
Suboxone-assisted treatment (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992357/) through these pilot programs is considered outpatient. This means that the candidates take the medication themselves and do not require hospitalization. This allows candidates to continue to work, raise a family, and attend to their daily responsibilities. Therefore, in order to be a successful candidate, he or she must have safe and reliable housing, employment, and a social system.
About six months into the program, once the initial withdrawal period has ended and the candidate is stabilized, counseling efforts begin to focus on helping the candidate overcome previous trauma. This helps reduce the risk of he or she relapsing because of PTSD (https://pcssnow.org/resource/opioid-abuse-u-s-military/) or other mental health symptoms.
While the Suboxone-assisted treatment program remains controversial and isn't the right option for everyone, Boise officials continue to monitor the outcomes of the program and educate the public on medication-assisted addiction treatment. In addition to reducing the number of overdoses in the city, the officials' goal is to work towards destigmatization of Suboxone-assisted treatment and educate the public about this treatment model.
As I continue to write for Sunshine Behavioral Health (https://www.facebook.com/SunshineBehavi1/), passing on information like this is essential. If you like this post, make sure to share it.