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Medication and More

April 1, 2008
by Gary A. Enos, Editor
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An innovative private practice finds an effective balance of Suboxone and support for opiate addicts

The circumstances that bring Vermonters with opiate addiction to the doors of Synergy Counseling Group's clinics in Montpelier and South Burlington all differ to some degree. Some are longtime heroin users who have attended a more conventional treatment program in the past, while others have developed a pain medication dependency and never have pursued treatment in the past.

But nearly all of the agency's patients can relate a similar pattern in their thinking about the Vermont program. First, word on the street about a medication called Suboxone initially attracted them. Then, once they arrived, they found that the rest of what the program offers proves to be as important as the medication.

James hamel, ladc, cadc
James Hamel, LADC, CADC James Hamel, LADC, CADC, and his innovative multidisciplinary practice offer a striking contradiction to the notion that addiction treatment agencies cannot effectively integrate biomedical and psychosocial approaches to healing. And in fact, Synergy doesn't stop at that. Plans are in the works to incorporate acupuncture, movement therapy, and yoga into program offerings that already include a variety of holistic approaches, with the overall goal of placing as many recovery-affirming services as possible under one roof.

Hamel says the private-practice structure of the Synergy operation, which was launched in early 2007, is critical to its success because it attracts professionals who value the flexibility of designing services without concern about dictates from a board of directors.

“I wanted to look for a way in which to develop a program that would alleviate the anxiety of providers about working with opiate addicts,” says Hamel.

Program's origins

Opiate addiction treatment issues weren't even on Hamel's radar until 2000, when the addiction counselor relocated from Texas to Vermont. Suddenly, at least 90% of the clients he was seeing were dealing with a primary opiate addiction—with these individuals relatively evenly split between those using heroin and those using prescription opiates.

As Hamel began to learn about the potential of the medication buprenorphine to help opiate addicts in recovery maintain sobriety, he also began to see some of the concerns physicians had about becoming regular prescribers of the medication. Some didn't appear to want opiate treatment patients sitting in the same waiting room with the families in their practices. Even many of those who enrolled in the process to be certified as prescribers turned out largely to be “certified non-prescribers” because they weren't working with many or any new patients, Hamel says.

His goal was to establish a new setting in which medical professionals could spend part-time hours meeting with patients while still maintaining their off-site practices. The idea was for clients in the program to receive a comprehensive assessment followed by medication, scheduled group counseling, and whatever other support they might need. “We would also introduce other applications of the recovery process, such as exercise and wellness,” Hamel says.

Synergy now has a staff of 18 medical, addiction, and mental health professionals. The medical staff generally works part-time, while the program employs a full-time alcohol and drug counselor. It is exhilarating for Hamel to see these professionals from different disciplines working together in the same building, accustomed as he was to attending seminars in Texas where physicians in suits would occupy one side of the room and counselors in sandals the other, feeling worlds apart.

The two Vermont clinic sites can serve up to 150 patients at a time, although only a maximum of 90 can be on Suboxone at one time because that is the patient limit for the program's medical director, Tim Wargo, MD. For Wargo, the Synergy effort represents an ideal fit, as he always has looked to venture beyond conventional practice in his career.

“The conventional stuff doesn't go far enough,” Wargo says. “It doesn't answer all the questions people have. What we stress to patients is that they have to do something else in addition to the medication.”

Medication procedures

What the program finds is that the Suboxone gives addicts in recovery the stability to make them amenable to the counseling and the other support services, according to Hamel and Wargo. From their first encounter with the program, clients learn that the medication isn't a cure-all. “Wayne,” a 21-year-old client who entered the program for treatment of an addiction to OxyContin, explains that he visited the clinic four times for comprehensive assessment interviews before he finally received a Suboxone prescription.

The assessment process generally involves a full physical exam, a mental health evaluation, and a substance use evaluation. The medical doctor talks to the client about diet, exercise, and other lifestyle issues in addition to the medication. “People will say they have never had a doctor talk to them about these things before,” Hamel says. “It's their first ‘a-ha!’ experience.”

Synergy's entry sign for clients

Synergy's entry sign for clients