Bullhook health center fights opioid addiction

Bullhook Community Health Center in Havre is making strong efforts to combat opioid drug addiction in the community, offering many different treatments and resources to help people live clean productive lives, Psychiatric Nurse Practitioner Suzanne Lockwood said.

Havre is not facing anything that isn’t being faced across the country, Lockwood said, with Havre, compared to the national figures, having a lower rate of drug-related deaths.

She added Bullhook offers counseling, medically assisted treatment and a variety of other tools that are used to help patients better their lives.

Lockwood said she has been a psychiatric provider for the area for more than 25 years and has more than 600 active patients. She added those 600 patients have severely debilitating mental illnesses and more than 60 percent of those patients struggle with a chemical dependency as well.

Treatment options

Patient care varies on the needs of each individual, Lockwood said, “if it’s helpful to them to be abstinent (from drugs and alcohol), I present that to them.”

She added patients sometimes just need counseling, sometimes they need medically assisted treatment and sometimes they need all the above; but the care they receive is not different in that it is to help them get better.

Patients’ care depends on what patients require, she said. The protocol for the medically assisted treatment, Lockwood said, is patients need to fit specific requirements such as having lab work done to determine if the patients’ livers and kidneys are strong enough to receive that specific treatment method.

Some of the patients don’t fit that criteria, she said, so that method of treatment is not appropriate for them. Providers then start looking at other ways to approach the patients needs, Lockwood added, usually with a large range of services available.

Lockwood said medically assisted treatment providers can use different medications to address different levels and kinds of addiction.

Bullhook Health Center CEO Brian Hadlock said those medications are not a substitute drug, but a drug that curbs the craving and allows some normal functionality so people can work and go about their lives and not suffer the effects of opioids.

“That is why they are some of the most-effective drugs that have come out so far,” he said, adding Bullhook Health Center has seen great success with patients who are receiving this form of care.

The medications are approved by the Food and Drug Administration, Lockwood said, and are used to decrease patients urges to use opioids and alcohol. The medication that providers use at Bullhook are primarily suboxone and naltrexone/Vivitrol.

Suboxone is a partial opioid antagonist, that is specifically for opioid addiction, which covers the opioid receptor sites so people dont feel the need to use, Lockwood said. Naltrexone/Vivitrol is a stronger opioid antagonist, that is used through injections, which latches on the receptor sites for the same purpose.

She added there has been recent research coming from the Netherlands and Denmark which shows naltrexone/Vivitrol is effective for methamphetamine addiction, and she has seen similar success in treating that.

Hadlock said most private insurance covers this treatment, although Medicaid’s coverage depends on a great many variables. Adult Medicaid coverage has seen large cuts last year, he said, and some of the programs Bullhook is seeing success with now are becoming a challenge to be paid for. But with the success in these programs, Hadlock said, hopefully there will be coverage from Medicaid in the future.

“‘Cause this is a population, quite honestly, more often than not, don’t have a lot of private insurance associated with them,” Hadlock said.

The nice thing, though, he added, is Bullhook has a sliding fee scale and anybody who comes for behavioral health visits can pay on the sliding scale.

Lockwood said Bullhook’s programs are strictly outpatient care, but case managers can work with patients to get inpatient care.

Hadlock said there are inpatient programs in Great Falls, Butte and Billings with which Bullhook already has relationships. The number one concern, he said, is to find what program would be the best fit for patients.

He added that there are a lot of resources for people to pay for the treatments although a problem they often run into when looking for inpatient treatment is availability.

The problem of not having enough treatment centers to provide for the needs of the patients poses a risk to the patients, Hadlock said. He added some people, because of not being able to receive immediate care, will go out and use, never returning, or they might get depressed about their usage because now they feel they have no other options and don’t know if they can wait for treatment.

“This is all a reality for these folks,” Hadlock said, “and we do the best we can to get them in as quick as we can, so having a relationship with these different facilities definitely helped.”

He said Bullhook is outpatient because the program can work with a larger body of patients. Inpatient treatment is challenging for most people, he added. The lack of incare facilities and the individual’s financial ability can make inpatient programs an impossibility. With outpatient care, patients can come in, based on their providers recommendation, and receive the care they need, making steps toward recovery.

He added Bullhook also has group counseling that is facilitated by a medical professional. These group-counseling sessions are more about clinical aspects and offers peer support, Hadlock said. These meetings are not structured like an Alcoholic Anonymous meeting, he said, although Narcotics Anonymous and Alcoholics Anonymous are good programs and Bullhook does not discourage patients from attending those meetings.

“The idea is to work yourself out of business,” Hadlock said, “it’s to make sure you never have to see that person again.”

Hadlock added that patients who leave the program clean and healthy still need to maintain self-care. In cases when former patients don’t, more often than not, they relapse and return to treatment.

To avoid that, he said, Bullhook does everything that it can do to identify organizations within the community that can be referred to patients for personal self care after and during treatment.

“I think the number one thing to remember is people who are struggling with addiction, whether it be opiates or meth or any other kind of stimulant or prescription medication, is that it is a struggle, it is real to them,” Hadlock said. “This is their reality and they go through these cycles of depression, guilt, anxiety and find that their addition relieves all of those. It is a cycle, it could be a daily cycle as much as it is a weekly cycle, and we have to have compassion and understanding to be able to help them.”

Impacting the community

Since Bullhook was established there has been a noticeable impact on the community with general health getting better, Lockwood said.

Hadlock said he thinks community health care centers are positioned very well with the amount of knowledge and support that they receive from local, state and federal entities that help train staff and providers.

He added there are case managers who work directly with patients after and before visits so patients receive constant contact to keep them motivated.

“I think those are some of the major reasons why community health centers have so much success with the outcomes,” Hadlock said.

Whether patients come in for behavioral health, addiction, dental or medical the rate of success is much higher in community health center environments, he said, and costs about 24 percent less than other options.

Lockwood said people come in through a variety of ways. She said she has worked with some patients in the community for more than 20 years but while some people she sees repeatedly, some she never sees again.

She said 90 percent of the people in the Hill County Drug Court for the past five years have an underline major mental illness in addition to an drug dependency.

Drug courts have been around for the past 10 to 12 years, Lockwood said, and in some areas the courts are just figuring out how to work well; but what is being seen is a large amount of success related to the courts compared to alternative private treatment.

She added the statistics show the rise in opioid use is related to a large availability of the drugs, through prescription medications or other means.

All a person needs to do to receive help is to come in and ask, Lockwood said.

Hadlock said Bullhook has some phenomenally trained staff with incredible experience.

Working alongside Lockwood, he said, are two nurse practitioners, one licensed addiction counselor, two cognitive behavioral therapists, two behavioral health specialists, a couple of nurses and case managers, and a peer support person.

Lockwood said the two behavioral health specialists are school-based. One is working in Havre Middle School and the other is in Havre High School. They are specifically there for additional prevention and mental health, she said, adding that the program is relatively new, in its second year, but it has already begun to show signs of success. The success is the specialists ability to connect with the students and work with them toward living a healthy lifestyle, she added.

Lockwood said Bullhook now has a peer support person, the first year for the position. The person is someone who has a chemical dependency or struggles with serious mental illness but has been in recovery for a long period of time, she added. As a peer they can assist with people who are also working toward recovery, she said.

Hadlock said the peer support person is someone who has first-hand experience with the problems facing the patients, the process it takes to overcome addiction and the struggles with mental health.

“It’s just somebody who understands the process,” Hadlock said, “that understands, develops trust with the patients because they can’t say, ‘you don’t know what im talking about, you don’t know what I’m going through.’ Actually ‘yay’ they do, they know exactly. I think it develops that level of trust that can’t be developed anywhere else.”