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Texas Doctors Strive to Help Patients With Opioid Issues

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    Texas Doctors Strive to Help Patients With Opioid Issues

    Stephanie McCurry, a 33-year-old Air Force veteran, had been using heroin steadily for about four years. She was the last person anyone expected to become addicted to the drug, she said.

    The Austin American-Statesman reports in December, she was having a hard time breathing and a fever that wouldn't go away. When she noticed she couldn't stand any longer, she called out for someone at the South Austin home where she's been staying to take her to the hospital.

    McCurry checked into the emergency room at Dell Seton Medical Center, where doctors told her she had bacterial pneumonia, fluid in her lungs and endocarditis, an infection of the heart that's common in intravenous drug users. They put her on antibiotics and a medication called buprenorphine, which is used to treat opioid addiction.

    While the medication has been on the market since the early 1980s and accessible to hospital clinicians, it's rarely been used in hospitals, despite its safety and low cost, said Richard Bottner, a physician assistant at Dell Seton and clinical professor at the University of Texas Dell Medical School. He's hoping to change that with the hospital's new "B Team," a first-of-its-kind group of clinicians who begin patients on the drug after they are admitted to the hospital for other conditions, with the hope that when they are discharged they will stay on it rather than go back to using opioids.

    McCurry remains on the medication today. She said it's the only thing that has worked to keep her off of heroin.

    "It just seems like nothing was working for me, as far as treatment, until when I got really sick and ended up at Dell Seton," she said. "I started seeing a difference in the way I was thinking. It was like I was becoming myself again."

    Buprenorphine, also known by the brand name Suboxone, blocks opioid receptors in the brain and curbs opioid cravings. Medical professionals have called it a wonder drug for treating opioid use disorder, but others have mixed opinions about it because it's still a narcotic.

    State lawmakers have been pushing for an expansion of programs offering the drug in Texas.

    Bottner said only a handful of the country's more than 6,000 hospitals offer formalized opioid addiction treatment for patients who are admitted to the hospital and that Dell Seton is the only one in Texas.

    "We have found that patients are more receptive to receiving treatment in that setting," he said.

    The B Team works like this: A person is admitted to the hospital for an infection or pneumonia, but the doctor recognizes signs of opioid addiction. The doctor then brings in the 10-member team, which includes a physician, a social worker, a psychiatrist and a chaplain. The team consults with the patient's doctors, then administers buprenorphine to the patient, who is able to detoxify and become stabilized in the hospital. When patients are discharged, they are transferred to the Travis County Integral Care/CommUnityCare Dove Springs clinic in Southeast Austin for continuing care or to their private doctor, so they can stay on the medication a recommended one to two years.

    The goal is to train all medical professionals in the hospital to treat opioid addiction so that the B Team will one day be obsolete. That starts by reducing stigma, Bottner said, because many doctors in medical school aren't taught about addiction, and most addicts say they aren't usually treated respectfully when they check into the hospital.

    "We are really trying to shift people's thinking," Bottner said.

    After being released from the hospital in late December, McCurry checked into a skilled nursing facility, where she is continuing to receive care for a lingering heart infection. She visits the Dove Springs clinic weekly for checkups and picks up her buprenorphine for free at a nearby pharmacy. She said she's used buprenorphine before and bought from dealers and other users on the street, but she's never been able to get the medication long term.

    "These doctors want thousands of dollars, and you have to pay out of pocket," she said. "People on the street don't have that luxury."

    The Dove Springs clinic is the only center in the region that provides buprenorphine treatment to the county's low-income Medical Access Program patients like McCurry. The clinic has been operating since September 2017 and gets calls every day from people seeking help, said Sara Young, who supervises the medication-assisted treatment program. It also provides case management and counseling that helps people shift from the hospital setting into the clinic.

    "When they are in the hospital, it's a pretty safe environment," Young said. "Once they discharge, a lot of the regular life stressors are present. Anyone in early recovery is very vulnerable to those, so it's key to have support, which is hopefully what we provide as a team."

    Since September, the B Team, a collaboration of Dell Medical School and Dell Seton, has consulted with 40 patients, 13 of whom were successfully started on buprenorphine.

    Bottner said his hope is to provide a model that can be mimicked in hospitals across the county, then to expand services into Dell Seton's emergency room. In Travis County, they'll first have to build the infrastructure to support that, because not enough doctors are certified to prescribe the medication, nor are there enough clinics to dispense it, Bottner said.

    "We are hoping to really build a case over time that this model of care works," he said. "There is more work to be done."

    Physicians, physician assistants and advanced practice nurses who want to prescribe buprenorphine have to obtain an "X waiver," which requires eight hours of Drug Enforcement Administration training. More than 80 medical professionals have signed up for X waiver training hosted by Dell Seton in March. Bottner said that number is far more than he expected when he opened up the course.

    "That says volumes to me about the thirst for this knowledge within the Austin community," he said.

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