VALLEY — The opioid epidemic is widespread throughout the country, and rural Colorado is no different. That’s why Dr. Jack Westfall recently began conducting a study to lower opioid overdose in the San Luis Valley and the Eastern Plains.
After visiting practices around the state, he and his team at University of Colorado Denver’s High Plains Research Network knew they needed to work on researching the opioid issue. According to 2014 data from the Centers for Disease Control, 20 or more people per 100,000 people overdose in the Valley, primarily from opioids.
They applied for funding and received one of three $3 million grants from The Agency for Healthcare Research on Quality last July.
The first part of the research involves a baseline study to understand the public’s perception of opioid use disorder (OUD) and medication assisted treatment (MAT). Circulation of the 25-question survey began earlier this month in 24 counties, and Westfall hopes for a 50 percent response rate out of 1,500 questionnaires.
The surveys are color coordinated so that the researchers know if the results came from a community leader such as a city councilor or if they are from the general population.
“We’re specifically surveying people in community that have either an opportunity to observe people with OUD and refer them to care,” Westfall said, “but also people in the community who have an opportunity to impact policy.”
The results will then be used to craft a three-phase community intervention program. First, Westfall wishes to increase the number of physicians who can prescribe buprenorphine, also known as Suboxone, with a waiver training course. The drug is used as therapy for people who are addicted to heroin, fentanyl, oxycodone and other opioids.
“They don’t get high on it but it keeps them from going through withdrawal,” said Westfall.
Right now the only physician who can prescribe buprenorphine in the Valley is Dr. Barbara Troy, a family practice physician and obstetrician at Valley-Wide Health Systems. Before coming to the Valley in 2014 Troy lived and worked in Espanola, New Mexico. When she witnessed a large number of people using heroin she decided to become a licensed prescriber.
"I went out to one of the frontier towns and saw it was very important and very necessary in order to take care of the patients,” said Troy.
However, prescribing buprenorphine is only a small part of her workload. Because of a cap set by Valley-Wide, Troy can only have a total of 30 OUD-related patients at any given time.
“It’s actually kind of a small percentage,” Troy said. “I have more OB patients.”
As an obstetrician she cares for many addicted mothers. According to Troy the majority of her patients don’t relapse, especially if they participate in the other treatment components such as counseling.
“They’re functional. They can take care of their families, have a job, make a living and pay taxes. That’s the goal.”
Troy wishes for other licensed providers in the Valley since she can only help so many.
“Everyone in the Valley deserves to get some treatment,” said Troy. “If more of us do it then we all just need to take care of a few patients and we’ll have a great healthy Valley.”
San Luis Valley Health would like to participate in MAT but it currently doesn’t have the resources.
“It’s not as simple as just writing a prescription,” SLV Health Chief Medical Officer Dr. Greg McAuliffe said. “It’s not just as simple as training the physician. There’s lots of other pieces that have to be in place to make that program work.”
McAuliffe compares it to running a methadone clinic inside of a hospital that requires its own behavioral health specialists and care coordinators along with other support staff and services. The hospital does offer the necessary training to physicians who are interested. However, they haven’t found anyone willing to increase their patient load.
“That isn’t to say that we won’t have providers who are interested in doing it. But right now it’s got to be something you have a passion for doing.”
According the McAuliffe the Valley isn’t alone when it comes to insufficiently treating OUD. He says that what holds most communities back from having more licensed providers is figuring out how to make treatment affordable.
“We would love to be able to provide [MAT] for these patients,” said McAuliffe. “We really would like to be able to do that. We’ve got to figure out how to put the infrastructure in place and make it sustainable.”
Westfall realizes that being certified isn’t enough, so the second phase is educating a doctor’s entire practice. The program will provide practices with access to OpiSafe, a MAT registry and tracking system, so that they’ll have the tools they need to prescribe safely. He hopes this’ll lead to nurses and other staff members becoming better equipped to identify and manage people with OUD.
Finally Westfall wants to raise community awareness about OUD. “People don’t know they can get help and don’t know that their cousin can get help.”
Using a method called Boot Camp Translation, the research network will develop locally tailored messages that make the medical jargon easier to understand. “The national ‘one-size-fits-all’ guidelines rarely work in rural Colorado,” said Westfall,” so we try to make it local.”
As more people become aware of the issue, Westfall believes the stigma will decrease. He says that there are new studies that call OUD a chronic disease that could affect anybody. Troy also believes it be a chronic disease.
“We have 45-year-old farmers who go in and get knee surgery and their surgeon gives them a bottle Percocet,” said Westfall. “Twenty-five days in they’re addicted to it. Then they start asking their friends for Percocet and then they start buying them off the street. If they can’t get a prescription they may find heroin.
“It’s not the same as it was 25 or 40 years ago when it was homeless people in downtown Denver. Now it’s our neighbors and our neighbors’ kids getting addicted.”
Westfall hopes for the community intervention phase to begin later this year. The follow-up surveys will be sent out around next spring.