Like much of the US, the Northwest has experienced a scourge of fatal overdoses from heroin and other opiates over the last decade. Many of Washington’s addiction hotspots are in small towns where options for rehab are scarce.
For Jordan Mohammed, the last 8 years have been a blur of addiction and recovery.
“I got bit by a dog when I was younger,” he says, “and my doctor got me started on pain medication, and then just cut me off.”
Pills eventually gave way to heroin. At 25, Mohammed says he’s known 19 people who have died of overdoses. His hometown, Longview, is a hotspot in the national scourge of opiate addiction, where jobs in sawmills near the Columbia River make chronic pain a common ailment. Both parents and his sister are all now recovering from opiate problems that started with prescriptions for chronic pain.
To get clean, Jordan’s tried both 12-step groups and methadone. But a growing body of research suggests a drug called Suboxone offers the family’s best hope of stable recovery. Here’s the catch: “You have to have good insurance, somebody helping you, or some miracle in your life to find a doctor that can get you on Suboxone,” Mohammed says.
Suboxone is hard to abuse, and unlike methadone, which is administered at special clinics, it can be prescribed by ordinary family doctors. But just a tiny fraction choose to do so: in parts of the Northwest, there’s just one prescriber serving several counties.
Mohammed’s father Jan says his own doctor prescribed more and more opiate painkillers over nearly 20 years, until he was taking nine pills a day. When he asked about Suboxone, Jan says, “The Doctor says ’well, you’re gonna have to find that by yourself.’ And he wasn’t rude about it, mean about it, but he knows there’s nobody there.”
That’s how the Mohammeds ended up getting their prescriptions 75 miles from home, from Lucinda Grande, a family practice doctor outside Olympia. Patients come from up to two hours away to see her, largely, she says, because many of her peers are reluctant to take on recovering addicts as patients.
“There’s a common perception that people who have addiction problems are needy and they’re demanding, and it kind of burns you out to always be trying to help them,” Grande says.
According to Liza Hutchinson, a researcher at the University of Washington who’s studied the reasons many doctors choose not to prescribe Suboxone, one key issue is training. “Most primary care physicians, especially a generation ago, were receiving probably almost no training in addiction,” she says.
Even when doctors see the need and want to prescribe, “They struggled to convince either their clinic administration, or the surrounding supporting staff within their clinic, that it was a good idea.” Hutchinson says there’s still a lot of fear a nd misunderstanding around addiction, and prescribing Suboxone does involve a few practical hurdles as well: it requires special permission from the DEA, and there’s also urine testing and scheduling time for counseling.
At Dr. Grande’s office, it’s clear the two months since Jordan Mohammed’s last visit have been a marathon. He got in a fight and spent two weeks in jail, which nearly cost him his construction job. Then, he missed an appointment because he couldn’t get a ride here.
In the mean time He’s been buying Suboxone pills off the street for $20 each to avoid the vomiting and aches that come with heroin withdrawal. “I’ll buy one or two, and I have to stretch that one or two as long as possible, just to take the edge off the way I feel,” he says.
Just days before his appointment, Mohammed couldn’t find any Suboxone at all, and he ended up buying heroin instead. Still, Dr. Grande says even a relapse shows the need for treatment other than abstinence. “A lot of people feel like they should have the will power, that they should just be able to do it, and power through it, and that’s just impossibly hard for most people.”
Addiction can change the wiring in your brain; most Suboxone patients will need to take a small dose for years on end--in some cases, forever. But after years in thrall to opiates, the Mohammed family says Suboxone has made them feel normal again.
Copyright 2015 Northwest Public Radio