Federal Program Gives Oklahoma Family Physicians More Tools To Fight Opioid Abuse
Justin Zagaruyka’s problems with substance abuse began early. He started smoking marijuana when he was 11 or 12. Within a couple years, he was using methamphetamine. He kicked meth four years later, but then he started drinking heavily. Soon, he was taking opiates.
“I’d go use the opiates because it would sober me up a little bit, you know, when I’d get too drunk. So I would go snort a lortab or a roxy and then I would be back up and ready to go and I could drink more,” Zagaruyka said.
Zagaruyka sits at the black kitchen table of his Oklahoma City apartment. His five-year-old son plays video games nearby. An older son naps in his bedroom. Zagaruyka says his kids used to be scared of him, and he accidently hurt the older child more than once.
“I dropped him on his head once when we were playing. He had to have staples in the back of his head, you know. That wouldn’t have happened if I was sober,” Zagaruyka said.
About 15 months ago, Zagaruyka realized he was killing himself. He went to a detox program.
“I started out on librium for alcohol withdrawal and suboxone for the opiate withdrawal,” Zagaruyka said.
Suboxone is the brand name for buprenorphine and naloxone. It’s an opiate itself, and it tricks the body into thinking it has taken a drug like oxycodone or heroin. It reduces cravings and withdrawal effects, and cancels out a potential high if the patient takes another opioid.
Addiction to opioid pain medication and heroin continues to plague Oklahoma. Public health officials are urging physicians to use medication-assisted treatment like suboxone to help people deal with substance abuse. The U.S. Department of Health and Human Services is now trying to get more physicians -including general practitioners - to prescribe suboxone. A waiver program has been in place for years that allows doctors to initially treat 30 patients at time. After one year, they can increase to 100. That upper limit was increased to 275 this summer.
Dr. Layne Subara, an osteopathic family physician, prescribes suboxone to patients at his office in Skiatook. He says it is the state’s most cost effective method to address the addiction problem.
“The state doesn’t have the funding, it’s just not there, to put treatment centers in every county,” Dr. Subara said. “But fortunately we have primary care physicians in every county who could potentially take the training and expand access to care for this problem.”
When a family physician treats addiction, Dr. Subara says it’s just like any other chronic disease, such as diabetes or hypertension. But medication-assisted treatment works best when combined with therapy. Access to counseling is a challenge for many of Dr. Subara’s patients.
“Oftentimes that’s not covered by insurance, and frankly, a lot of these patients, especially when they start out, are not in very sound financial condition if you can understand that. And it’s really difficult for them to afford the cost associated with counseling,” Dr. Subara said.
At the very least, Dr. Subara often recommends patients attend Narcotics Anonymous.
Amy Selsor, a Registered Nurse at Catalyst Behavior Services in Oklahoma City, thinks family practitioners shouldn’t prescribe suboxone.
“I personally think they need to be addiction specialists,” Selsor said.
Addiction specialists have smaller caseloads, and she says general practice physicians don’t have a specialized understanding of addiction.
“You need to have the therapy with it in conjunction with it to do it correctly. And I don’t think there’s the capability in the far reaching rural communities of Oklahoma for that,” Selsor said.
So far, few physicians are prescribing suboxone in Oklahoma. The U.S. Substance Abuse and Mental Health Services Administration lists 28 doctors in the state who hold the waiver, but physicians who completed a recent training seminar in Oklahoma City could help push that number upwards.
Meanwhile, Justin Zagaruyka has turned his life around. He’s stayed away from alcohol and opiates for over a year, and he started eating healthier. He works full time, and he’s taking classes to become a video game designer. And his relationship with his sons has changed.
“We have fun together. They’re not, you know, scared to be around me,” Zagaruyka said. “They’re not walking on eggshells so that they’re not making me mad or whatever. Because it takes a lot to get me mad now.”
And, he says, he tapered himself off of suboxone, too.
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