SANTA CRUZ COUNTY — Money from grants obtained by local drug treatment center Janus has started to flow to medical providers throughout Santa Cruz County as the effort to treat opioid addiction expands. As the funding impacts, there will be more treatment available as well as treatment that is more effective.
More than a year ago, a group of four staff members at Janus of Santa Cruz started work on a complex grant application that required about 1,000 hours of grant-writing time and was submitted through the California Department of Health Care Services to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The application was successful.
Two grants, one for $2.2 million for the southern part of Santa Cruz County, plus parts of Monterey and San Benito counties, and another grant for $2.4 for northern Santa Cruz County, have started to be distributed through Janus to other agencies. Officials hope to double the number of patients served in the next two years and to improve treatment approaches.
Santa Cruz County has its share of people who are dependent on opioid medications such as hydrocodone, with brand names such as Norco and Vicodin, and oxycodone, marketed as OxyContin and Percocet. Morphine, codeine and fentanyl are also opioids.
Janus of Santa Cruz is the hub
The expanded effort to treat opioid dependency is referred to as the Hub and Spoke program, with Janus of Santa Cruz as the “hub” of the project. There are partnering agencies throughout the county that operate as the “spokes.” Janus functions to bring not just money to its partners but also makes medical staff available and facilitates staff training.
Robin Oakey, a therapist at Janus, who has extensive experience working with opioid dependent people, said that the goal of the Hub and Spoke program is to double the number of people served in the two years of the grant.
“There are about 11,000 people in Santa Cruz County who have opioid use disorder,” she said. “We want to increase the number of people served from about 1000 per year to 2000 per year.”
Oakey pointed out that with 11,000 opioid dependent people and only 1,000 being served, there are a large number who are not seeking treatment.
The key part of Hub and Spoke is what is called “medication assisted treatment,” or MAT. Medication assisted treatment is nothing new, but the availability of the medication at the heart of the program, buprenorphine, usually prescribed as Suboxone, is being made available through prescriptions on a scale never seen before.
For more than 50 years, medication assisted treatment depended upon methadone. Both methadone and Suboxone have similar medication effects. The Suboxone protocol is different in that it does not require nearly daily visits to a methadone clinic during the first few months of treatment.
A Suboxone patient generally goes to their doctor once a month, gets their prescription, goes to the drug store, and can then participate in what can be a very long treatment process that can stretch out over years. Over time, patients frequently reduce the amount of medication they use. New federal guidelines for opioid treatment, released with much publicity by Secretary of Health and Human Services Alex Azar in February, show far more support for medication assisted treatment than previous federal policy.
Participating Hub and Spoke partners include Clinica Del Valle, Dignity Health (Dominican), Palo Alto Medical Foundation, Plazita Medical Group, SC County Health Services Agency and Salud Para La Gente all of which are already providing increased services or plan to soon. Members of Central California Alliance for Health will also have access to services as will Janus patients. People with no insurance will be eligible for services through part of the grant.
Many people with opioid use disorder use larger amounts of medication than originally intended or use medication for a longer time. Another indication of opioid use disorder is repeated or unsuccessful efforts to cut down or control opioid use.
The goal of treating 2,000 patients a year does not represent the upper limit of treatment capacity, Oakey pointed out.
“No one will be turned away who asks for treatment,” she said.
PAMF is a partner
Palo Alto Medical Foundation (PAMF) is one of the “spokes.” William Morris, MD, who specializes in pain reduction, is the PAMF director of opioid assessment services and is also the director of medication assisted treatment at Janus.
Morris said the grant money is allowing more people to be treated at PAMF, partly because more staff training can now be funded. A special federally-issued license is needed by a provider in order to prescribe Suboxone. In spite of progress, there are still months-long waiting times for people to get into treatment once they walk through the door at PAMF, a problem Morris believes will be helped with this new effort.
“We need to come to understand that becoming dependent upon opioids is not a moral failing and that now we can treat this problem much more effectively with medicine,” he said. “Clearly opioid use disorder is a chronic relapsing disease, but it is treatable.”
Before Hub and Spoke, PAMF clinics had served about 200 patients in the last four years and in the next two years, using PAMF resources and Hub and Spoke resources, PAMF hopes to be able to treat 1,000 patients with opioid use disorder, Morris said.
According to Morris, results with Suboxone are mixed, but it is helping many people.
“One aspect of treatment with Suboxone is that just as some people require insulin for life, some patients will require Suboxone for many years and tapering off Suboxone can take a year or more,” he said.
PAMF has medical offices in Watsonville and Santa Cruz.
Salud Para La Gente
Salud Para La Gente is also a Janus partner in Hub and Spoke. Dr. Amy McEntee, DO, chief medical officer of Salud Para La Gente, said the grant had permitted a large increase in the services they are able to offer. When a patient has an opioid dependency issue, either on prescription medications or on heroin, Salud Para La Gente can now provide treatment right away, McEntee said.
“When we identify someone with a problem, we can get them into programs,” she said.
Before the Janus Hub and Spoke support, their services were far more limited, she said.
One of the main missions of Salud Para La Gente is to educate their patients.
“Since patients have learned about Suboxone we have had an increased interest in treatment. There is not the stigma that was attached to methadone,” McEntee said.