People with opiate addiction, who can spend months, or even years, waiting to get into treatment, are at greater risk of contracting HIV or other infectious diseases, overdoses and death, Sigmon said Tuesday. When those people land in hospital emergency departments or the corrections system it drives up government spending.
“We know that (medication-assisted) maintenance treatment is so effective in saving lives and reducing infectious disease, but in Vermont and around the country a significant problem is that treatment capacity isn’t meeting the demand,” she said.
The waitlist for services at the Chittenden Clinic, which serves also serves Franklin and Addison counties, has hundreds of people who are left to treat their addiction on the street or spiral further into life-threatening drug use, officials say.
The program she came up with has three components. The first in a handheld plastic device that looks like the game Catch Phrase, a 1990s-era CD player or a smoke alarm (depending on who you ask, a reporter or research assistants).
It’s called the Med-o-Wheel and it is designed to improve adherence to medication regimens. Sigmon is using a locked version to securely dispense buprenorphine, an opiate agonist that keeps people from getting dope-sick but, if taken as directed by a doctor, doesn’t produce a high.
The other components are daily phone calls from an interactive voice recording that tracks whether a person is experiencing withdrawals or cravings, and random call-backs for urinalysis to track compliance with the program.
People on a waiting list for medication-assisted treatment are screened and then offered a spot in the clinical trial as either part of the test group using the Med-o-Wheel or in the control group.
During three-month trials, between 79 percent and 88 percent of people receiving the interim technology-assisted buprenorphine treatment stayed clean of illicit opiates — heroin or pills they are not prescribed. Nobody in the control group stayed clean while waiting to get into treatment, according preliminary results recorded by Sigmon.
The results also show people testing the new technology-assisted treatment program were less likely to inject heroin or other opiates, which decreases the risk for overdose and infection.
“They’re treating themselves, but instead of taking an FDA-approved medication orally or under the tongue they’re injecting a drug, either pills or heroin and putting themselves at risk,” Sigmon said of those wait-listed patients in the control group.
Sigmon took additional steps, beyond the random urine tests, to ensure the Med-o-Wheel trial group didn’t divert or abuse their buprenorphine, which can sell for $50 a pill on the street and is sometimes injected by addicts to get high.
While the devices lock, they’re certainly not impenetrable and a determined person could break one open. Sigmon says that hasn’t been a problem.
“People are so desperate for opiate treatment that we’ve had remarkable adherence,” Sigmon said, acknowledging that was unexpected, because of the instability addiction creates in people’s lives.
After the three months though, patients receiving treatment in the test group are often “going back out onto the street,” because they’re still wait-listed at methadone clinics that don’t have the capacity, despite an infusion of state and federal money, to keep up with demand.
The same is true for people who spend three months in the control group, but in those cases Sigmon offers people a chance to enter the test group and receive treatment. That serves two purposes, she said. There is the humanitarian component of helping those people, but it also has interesting research outcomes.
Control group patients that get an opportunity to use the Med-o-Wheel are able to make the same strides as people who started out in the test group, which is encouraging, she said.
The major driver of wait lists for opiate treatment at the Chittenden Clinic and elsewhere is a lack of prescribing doctors, and treatment programs that require daily trips to a doctor’s office or clinic sometimes fail because patients are traveling hours each way — especially if they’re coming from rural areas.
Sigmon wants to see if doctors at clinics, hospitals and in private practice will adopt all or part of her program to increase the number of patients receiving help. The Chittenden Clinic is beginning to use the devices, which cost between $450 and $500, for its patients.
Next spring, Sigmon hopes to host an educational event for health care providers to get familiar with the Med-o-Wheel and the treatment program she’s built around it.
She’s also looking at what her next grant sponsored trial might look into, though she’s several months away from officially completing this one. Sigmon said she would like to extend the trial period to see if the encouraging results she’s seen can be sustained over a six months or longer period.
For many people addicted to opiates, that’s closer to the reality of life on a wait list.
