Trendy Bars, Breathtaking Beaches, and a Rising Body Count: How Westerly is Failing its Opioid-Addicted Residents

A police car rolls past the cemetery, its tires cutting through newly fallen snow. Powder collects on headstones indiscriminately; the burial plots for those who’ve succumbed to the worst drug epidemic in US history, drawing none of the disgrace that plagued the sufferers in life. As the officer parks his cruiser in a lot not half a mile from the riverfront cemetery, settling in to observe what appears to be the only business unaffected by the storm, patrons bustle from their cars to the entrance in a continuous parade of brightly colored ski jackets and winter hats, heads bowed against the driving wind and deluge of snow.

Most of the patrons emerge from the building mere minutes later; some return to their vehicles just after the fifty minute mark. They are young and old, dressed in business attire or sweats, and come in pairs or groups, idling in the parking lot to share a cigarette or conversation. One woman parks in the spot closest to the entrance and makes a beeline for the door, her dark eyes darting toward the police cruiser from beneath her hat with undisguised wariness, her ungloved hands balled into fists by her sides.

A white sign with royal purple lettering adorns the front lawn of the non-descript building, a stick figure logo jumping for joy next to the words: The Journey to Hope, Health, & Healing. The ‘O’ in ‘Journey,’ is shaped like a compass, as if within the building one will find detailed directions, the path to a new life.

The sign is sandwiched between one for ‘Optometry’ and another for a financial solutions office. The Journey to Hope, Health, & Healing doesn’t look like a medical or professional building, much less an outpatient substance abuse treatment center for opioid dependence that sees upwards of three-hundred patients each day. And this—this image of deception, of a methadone clinic hiding in plain sight—is how the town of Westerly likes it.

Methadone is a synthetic analgesic used as a substitute in the treatment of opiate addiction. A parallel treatment, Suboxone, is a combination of buprenorphine and naloxone that blocks the “high” experienced from opioid medications. The third medication-assisted treatment (MAT) option for opioid addiction is Vivitrol, an extended-release injectable dose of Naltrexone, allowing the patient a thirty day safety net during which they can put effort into other areas of their recovery via counseling.

“I really don’t think they see it as a big enough issue in the community,” says Dr. Lisa Noyes-Duguay, of the doctors and nurses at the Westerly Hospital, a hospital recently acquired by Lawrence + Memorial Healthcare in 2013 and now part of Yale New Haven Health system. “They think patients should just buck up and detox on their own. They don’t realize that it’s a disease.”

Dr. Noyes-Duguay is a Westerly doctor utilizing Vivitrol in her practice, and due to institutional barriers that prevent access to Vivitrol, she is treating just two patients with the medication at present. The Journey is required to have a state license to administer methadone, and per that license, can serve only a certain number of patients. The average number of patients Westerly’s handful of suboxone providers can treat is 100. Vivitrol can be prescribed by any individual licensed to prescribe medications.

In 2016, opioid drug overdoses killed 42,200 Americans, up from 33,000 in 2015, which had previously been the worst year for opioid drug overdoses in American history. This is more than the yearly toll of lives lost to breast cancer; this is more than lives lost to either gun violence or automobile accidents during each of those industries’ peak years for American deaths; this is more than the deadliest year of the HIV/AIDS epidemic, and more than the body count for the entire Vietnam War.

In October of 2017, President Trump declared the opioid epidemic a public health emergency, yet tax cuts to federal funds for addiction services continue, and medical professionals, those seeking treatment and their loved ones, and even average citizens worried by reports of opiate addiction and its effect on society lament that the US government isn’t doing enough to thwart the rise of drug deaths. Petitions for increased medication-assisted treatment programs abound, and their efficacy has been demonstrated by the World Health Organization, Centers for Disease Control and Prevention, and National Institute on Drug Abuse. Yet the demand for increased access to Vivitrol never comes, or is so weak, it goes unheard.

The average American, even the average American with a history of opiate abuse, has never heard of Vivitrol, despite its tremendous potential as a catalyst to recovery. Many of the articles in newspapers and online dealing with the scope of the opioid crisis and the potential of medication-assisted treatment don’t even mention Vivitrol as an option.

Both methadone and suboxone allow patients to achieve sobriety, however, when an individual, in conjunction with his or her provider, feels ready to come off Vivitrol, usually after an average of fifteen months, there is no taper process or withdrawal needed. The medication is an opioid receptor antagonist, which means that the drug effectively ‘blocks’ the opioid receptors with little to no side effects. Vivitrol and Naltrexone—the daily, oral, pill form of the drug—are not habit forming, have zero abuse potential, and no toxicity.

If a person struggling with opioid addiction tries to use opioids on Vivitrol, the euphoric effects of the heroin or pain pill are completely blocked. This holds another advantage over methadone and suboxone; a methadone patient can potentially use on methadone by staying on a slightly lower dose and using ‘on top’ of the prescribed drug. For a suboxone patient, the drawback is that it must be taken daily, not at a clinic in front of a nurse like methadone, and a patient whose cravings become overwhelming can obtain opioid intoxication simply by skipping a dose or two before resuming opioid use. The downsides to methadone and suboxone are nominal for many patients, especially when viewed along the continuum of a harm reduction spectrum, but worth examining in conjunction with the underprescribing of Vivitrol.

In March 2015, there were three options for opiate-specific addiction treatment in Westerly: Westerly Behavioral Health, where Dr. Robin and Dr. Walter Curtice provided Suboxone treatment, Dr. Noyes-Duguay, another Suboxone provider, and The Journey to Hope, Health, & Healing, the town’s methadone-maintenance treatment facility. Three years later, Dr. Robin has passed away, resulting in the subsequent closing of his practice. Dr. Noyes-Duguay has increased her license to allow for 275 suboxone patients as opposed to the 100 slots her previous license allowed for, and expanded her practice to include Vivitrol treatment. Dr. Curtice now practices at Quality Medicine LLC on Granite Street.

On the official Vivitrol website, visitors seeking help with their opiate dependence can plug in their zip code and find a Vivitrol provider within fifty miles of their location. Dr. Noyes-Duguay, Quality Medicine LLC, and Westerly Primary Care, of the Northeast Medical Group, are the only Vivitrol treatment providers listed in Westerly, RI. The Journey to Hope, Health, & Healing can also provide Vivitrol treatment, and are in the process of being added to the official Vivitrol website. Within fifty miles of Westerly, there are twelve additional Rhode Island Vivitrol providers; within fifty miles of North Palm Beach, Florida, where almost two dozen substance abuse facilities are listed as being located, there are thirty-eight Vivitrol treatment providers listed within a fifty mile radius.

Though South Florida is known as the recovery capital of the world, it seems that, at least at first, individuals traveled to Florida for treatment for the same reason that anyone travels to Florida: warm weather and palm-tree lined beaches. As the number of people seeking treatment in Florida increased, more treatment centers opened to meet the demand, triggering a continuous cycle of the opening of additional treatment centers to keep up with the influx of patients. In Westerly, treatment centers are not being opened to meet the need of the town’s residents, because the needs of the town’s residents are not being discussed, or are being discussed at forums where the attendees are already aware of the town’s treatment option shortcomings.

“The community has their head in the sand,” said Dr. Noyes-Duguay. “I was at a forum where this speaker, some doctor from Middlesex, said, ‘Unfortunately there’s nobody in the community that can help [addicts] because nobody is prescribing Vivitrol or Suboxone.’ And I almost fell out of my chair. I’m in the audience going, ‘What do you mean? There are plenty of us out there; no one’s referring the patients to us.’ ”

At the same time methadone clinic patients are braving the snow to flock to 86 Beach Street in Westerly, a young man in Orlando, Florida wakes up to very different weather, and a very different morning. Andrew Tidd isn’t in a rush to get to a clinic; his body has already delivered his daily dose of medication-assisted treatment via the injection that will dispense fifteen milligrams of Vivitrol into his body each day over the course of a month. In light of this, Andrew is getting ready for his job at a packaging warehouse, after which he will spend time with family, or engage in many of the other activities his newfound lifestyle of recovery allows for.

“When I finally went to detox and sobered up, I realized this is what I have to do,” Andrew said in regards to Vivitrol treatment. “I would do the Suboxone and it would work, you know, for a couple months, but I’d always go back to the same thing, it was never anything like, consistent.”

Florida has a grant for Vivitrol, provided by the state’s Alcohol and Drug Abuse Association (FADAA), and Andrew was able to get on the grant through the detox he completed. He has to attend counseling once a month, and perform additional maintenance tasks per the terms of the grant that help him stay clean. Andrew has been on Vivitrol for ten months, and has not relapsed once during that time.

He was born in Orlando, but grew up not far from Westerly. Andrew’s adoptive mother is a police officer in Connecticut, and Andrew has returned to his place of birth in order to avoid the triggers of early recovery. If there were grants for Vivitrol in Rhode Island or Connecticut, Andrew says that his mother was unable to locate any.

Andrew is an example of a person in recovery unable to be readily located in Westerly at this time: someone who has achieved abstinence from opiates through the use of Vivitrol. Studies have confirmed Vivitrol’s efficacy in reducing frequency and severity of relapse for opioids, alcohol, and for those dually diagnosed with a substance abuse and other mental health disorders. As opposed to methadone and all forms of buprenorphine—Suboxone, Subutex, Zubsolv, and Bunavail—Vivitrol and naltrexone can be prescribed by any individual who is licensed to prescribe medicine, yet many doctors and pharmacists are unaware of this fact.

“You absolutely need a special license in order to prescribe Vivitrol,” a pharmacist employed by Lawrence & Memorial Hospital declared at a Westerly community event during which a local grassroots group, entitled Shine a Light on Heroin, presented on the benefits of Vivitrol. Later, when one of the members of the group sent the pharmacist an email with screenshots from the Substance Abuse and Mental Health Services Administration and Alkermes websites, detailing the ability of MDs to prescribe Vivitrol, the L&M pharmacist admitted he had been wrong.

A google search of Westerly primary care doctors turn up twenty results, many of which are primary care groups that incorporate more than one doctor. Twenty plus doctors with the ability to broach the subject of opiate addiction. Twenty plus doctors able to offer a possible solution. Twenty plus doctors with the ability to prescribe Vivitrol, and only two taking advantage of this opportunity.

David Chipperfield is another southern Rhode Island / southeastern Connecticut resident who traveled south to Florida to make the recovery capital work for him. David grew up in Westerly, and was described as a free spirit by those who knew him. David liked to surf, and had a young daughter named Eden Rose. David was twenty-six years old when he died of a drug overdose. “No matter how hard I tried or how much I loved him nothing could be done to change this outcome,” David’s father, Spike Chipperfield, wrote on Facebook of his devastating loss.

This is a common sentiment expressed by the parents who’ve lost loved ones, and it is likely that, at the time of crisis, it feels like nothing else could be done. But consider the patient brought to the ER after a heroin overdose. Per the Vivitrol website, “if your healthcare provider decides that you don’t need to complete detox first, he or she may give you Vivitrol in a medical facility that can treat sudden opioid withdrawal.” In a perfect world, in a hospital setting, with willing, knowledgeable doctors, patients could be started on Vivitrol immediately following an overdose. In a scenario a bit closer to our current reality, after Narcan has displaced the opiate receptors in the brain and the risk of further respiratory depression has been eliminated, the emergency room nurse would call a member of the patient’s family or a friend willing to aid the patient with the impending process. A certified peer recovery specialist or recovery coach would be provided, and different treatment options explored. From the hospital, patients without private health insurance could be aided in their state-funded health-care application, transported to a rehabilitation facility, and urged to stay for a minimum of 90 days, during which time they begin Vivitrol treatment in conjunction with counseling, and any and all supplementary interventions the facility provides.

When the ninety day inpatient treatment has been completed, the patient would return home if a supportive sober environment can be provided; otherwise they would move into a state-regulated sober living house, and begin intensive outpatient (IOP) treatment; options exist for daytime or evening IOP. They can attend 12-step meetings if this is a helpful part of the recovery plan. Every thirty days (or sooner if need be, as the Vivitrol injection can be administered earlier than the thirty days), until the patient has healed enough to have the skills and strength to attend appointments on their own, the appointed support personnel accompanies the individual to their Vivitrol provider to continue medication-assisted treatment.

One member of the community knows just how critical getting into a supportive sober living environment is. On Friday, February 23, 2018, Lisa Cote Johns, of the Community Speaks Out organization, walked out onto the auditorium stage of Grasso Tech High School for a forum on the dangers of opiate abuse. “I’d like you to meet my son,” she begins, a woman whose diminutive size belies the strength in her voice. “And today is actually his birthday. However I won’t be able to introduce him to you today, because my son is dead. He overdosed in a sober house in New London, Connecticut after relapsing on heroin after getting out of jail.” Christopher Johns tried seemingly every type of substance abuse treatment during his fourteen-year battle with opiate addiction, including a seven months’-long stay at the Narcanon scientology center disguised as a rehab. Did he ever have the chance to try Vivitrol on his journey? “He never had the option,” Lisa says with palpable sadness.

In Westerly, and the greater Rhode Island and southeastern Connecticut area, those seeking inpatient rehabilitation struggle to obtain referrals, transportation, or insurance coverage prior to the intervention. Aftercare following an overdose is often a piece of paper and a promise to be present at an intake appointment. Patients are pressured toward methadone or suboxone because they’re the ‘easier’ options. Rather than changing the system to meet the needs of people struggling with—and dying from—opioid addiction, the barriers to Vivitrol treatment remain in place, and it seems that no one has gotten mad, desperate, or lucky enough to knock them down.

“Suboxone sucks.” This, from Justin Carta, a former real estate agent who’s been clean from opiates for four months. “I know it works for some people, and I know I shouldn’t say that, but I mean, I went to detox specifically for suboxone, and I became a slave to that. Being at Stonington [Institute] and seeing how they were pushing it...a lot of my friends did the Vivitrol shot, and there was no adverse reactions, no side effects. It worked out for them. You go see a doctor once a month, and you’re all set. The suboxone thing just doesn’t make sense to me.”

A patient must be seven to ten days opiate-free before receiving an initial injection of Vivitrol, and the potential for a relapse between doses is elevated during the first few months. By aiding a patient in gaining admittance to an inpatient rehab directly from the emergency room, where they could begin Vivitrol—or administering Vivitrol in the emergency room—the first barrier to treatment is eliminated. Employing mental health professionals and recovery coaches trained and dedicated to help Vivitrol patients in early recovery greatly reduces the second barrier. However, some medical professionals don’t see it this way.

“Vivitrol, like methadone and suboxone, is a crutch,” says a psychiatric nurse at Lawrence & Memorial Hospital with a knowledge and history of treating substance abuse patients. He made no comment on the fact that doctors in the very hospital in which he was employed would likely not expect a patient with a broken ankle to walk, unaided, out of the hospital without a crutch. “AA has worked for almost a hundred years for a reason,” he replied “They’re not going to hit rock bottom if they’re on a bunch of medications.”

Unfortunately for David Chipperfield and Christopher Johns, hitting rock bottom meant hitting the bottom of a recently dug grave. For the worst three years of the opioid epidemic in terms of death toll, Westerly has had a mere trio of Vivitrol providers. Dr. Noyes-Duguay, Dr. Curtice, and the Journey to Hope, Health, & Healing are doing the difficult work of offering Vivitrol in a town where the health system is set up to make the gateway into that specific treatment as difficult as possible.

“That’s why I chose the [sober] house that I chose,” Justin Carta says, “because they don’t allow methadone or suboxone in the house. They allow Vivitrol, obviously. But I just didn’t want to be around people not using methadone or suboxone the right way. It’s not the common sense solution.”

Justin tried to determine how many friends he knew of that had overdosed, never having gotten the opportunity to try Vivitrol. “I would probably say fifteen, give or take. Being totally real, not trying to dress it up or dress it down, I would say fifteen. For the people that have gotten to use it, it’s honestly been a blessing for them. I see it, I hear about it.”

Neither Westerly’s medical community nor the community as a whole view addiction the same as cancer or other diseases, where the assumption is that patients will be supported throughout the progression of their illness. Thus far, residents of the beachfront community have been unwilling to stand against the big businesses represented by insurance companies, accepting the falsehood that their mental health and substance abuse services are comprehensive.

Evidence to the contrary exists all around them, in the number of methadone patients that gather at the clinic each morning, and the number of tombstones erected in Riverbend Cemetery over the past three years. In the need for fathers like Spike Chipperfield and mothers like Lisa Cote Johns to write obituaries like David Chipperfield’s and Christopher Johns’. And in the need for the memories of those fifteen unnamed souls, who fought their addictions with only a fraction of the remedies that could have been at their disposal, to be kept in the minds of the ones, like Justin, who made it, though the odds are not, and never have been, in their favor.

Sources:
--Dr. Lisa Noyes-Duguay, MD, Suboxone and Vivitrol provider
--Andrew Tidd, person in recovery
--Justin Carta, person in recovery
--Lisa Cote Johns, co-founder, Community Speaks Out, mother of Christopher Johns
-- Jill Chipperfield, sister of David Chipperfield
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Published on May 29, 2018 04:10
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