Opioid treatment

Charles Fawcett, Region Ten’s Louisa office director, outside the office on Ashley Street in the town of Louisa. The agency plans to begin offering suboxone treatment with counseling in August to people in recovery from opioid addiction.

The agency responsible for substance abuse and mental health services in Louisa County will begin offering medicated-assisted treatment this month to patients who struggle with opioid drug addiction.

People will be able to come to Region Ten’s office in the town of Louisa to receive suboxone, a drug that curbs their desire to use heroin and other opioids with fewer side effects than other medications.

Until now, Louisa residents seeking this treatment had to go to Region Ten’s Charlottesville branch, a difficult task for people without a car.

“I’m so excited this will be available closer to home,” Lisa Rengers, who heads the Louisa Reentry Council, which helps people recently released from jail to transition back into the community, said. “People are trying to stay clean and sober, and transportation is definitely an issue.”

Many Region Ten clients lost their driver’s licenses when they were convicted for drug-related offenses. Others simply don’t have the money to maintain or put gas in a vehicle. JAUNT provides a bus service to Charlottesville, but it operates just three days each week on a limited schedule.

“If you’re working, how are you going to get time off to get counseling and care?” Rengers said.

Region Ten began the suboxone service in Charlottesville two years ago as part of a statewide initiative to focus more resources on opioid treatment, according to Rebecca Kendall, the agency’s community mental health and wellness coalition director.

“Louisa is one of the hotspots in the region for overdoses, along with Greene County and Charlottesville,” she said. 

Recent data compiled by the Virginia Department of Health shows that Louisa County’s rate of emergency room visits for overdoses exceeds that of other localities in the area. 

In 2017, the rate of visits by Louisa residents was 182 per 100,000 people for opioid overdoses, which typically includes prescriptions. The rate of visits for heroin overdoses was 51 per 100,000. The actual number of visits by Louisa residents was 64 for prescription overdoses and 18 involving heroin.

The state has ramped up efforts to treat recovering addicts with suboxone as an alternative to methadone, which is only available at privately-run clinics that specialize in drug treatment. The Medicaid expansion in 2018 also made more Virginians eligible for treatment by extending coverage to people at higher income levels.

Besides Region Ten, some private doctor’s offices are licensed to administer suboxone. Kendall said she would like to find primary care doctors willing to accept patients once they have begun suboxone use. The time needed to transition a patient to regular use of suboxone is about three months.

“It’s more effective than methadone and there’s less opportunity for diversion,” Kendall said. “The research indicates it’s the best chance for opioid recovery.”

Some people in Louisa County have been charged in court with abusing methadone or trying to sell it to third parties.

Suboxone is not without its critics, who say it can be abused too. During the recent trial of Kelly Clark, a town of Louisa man who was convicted of trying to kill a police officer, Louisa County Commonwealth’s Attorney Rusty McGuire suggested Clark had mishandled his suboxone prescription. However, McGuire did not present drug test results to show how the drug might have affected Clark’s behavior.

Patients are most likely to overdose on suboxone if they mix it with sedatives such as benzodiazepines, medications that can slow breathing, according to Peter Grinspoon, a Harvard Medical School professor.

Patients in Louisa will be required to undergo counseling along with suboxone treatment, Kendall said. Research shows that providing the medication and counseling together is critical for success.

As part of the treatment service, Region Ten will offer to show patients’ families and friends how to use Narcan to prevent an overdose. The medication evades an overdose by blunting a drug user’s high. Emergency medical service workers in Louisa County have been using Narcan for several years when they respond to overdose calls.