By Tara Bannow

The Bulletin

Mosaic Medical is venturing into a specialty that’s new for the community health center: helping patients overcome their addictions to opioids.

Until now, Mosaic, which operates 12 sites across Central Oregon, including clinics in Bend, Redmond, Madras and Prineville, has mostly referred patients with substance abuse disorders to other providers. But a two-year $812,500 grant from the Health Resources and Services Administration will allow Mosaic to hire new providers who specialize in substance abuse.

“This is totally new,” said Dr. Christine Pierson, Mosaic’s chief medical officer.

Mosaic plans to hire two master’s-level therapists with substance abuse training and two substance abuse nurse case managers. The clinics already have behavioral health consultants who work alongside primary care providers, but the new providers will have specific training in substance abuse treatment, said Elaine Knobbs, Mosaic’s director of programs and development.

One of the hallmarks of opioid addiction treatment is medication-assisted treatment, which can be done using a couple of different drugs. Methadone, which has been around the longest, is a synthetic opioid that’s dispensed, usually daily, from federally designated facilities. It’s meant to relieve withdrawal symptoms by mimicking some of the effects of drugs like heroin or prescription pain medications. Buprenorphine, commonly prescribed in a mixture known as Suboxone, is an opioid that’s weaker than methadone and whose effects level off after a certain dose, reducing the risk of overdose.

Unlike methadone, buprenorphine can be prescribed by doctors and does not need to be taken within a specific facility. A major barrier to opioid abuse treatment has been the shortage of providers, both locally and nationally, willing to obtain the certification necessary to prescribe the drug. Central Oregon has a handful of providers with the certification, and the state will not release their names.

“Here’s why: As soon as their name goes out there, a bunch of people start knocking on their door,” Pierson said.

Mosaic has one physician certified to prescribe buprenorphine, but the doctor asked that her name not be used because she is only prescribing the drug for her current primary care patients.

The new grant will allow Mosaic to get at least one — but probably more — of its providers certified to prescribe buprenorphine, Pierson said. It can be difficult to convince doctors to get into that specialty, as the patients can be complex and challenging, she said.

“It takes the right person to be able to do this effectively,” Pierson said. “I think we have a lot of those people. Whether they really want to do that as opposed to maybe they have passion around diabetes and all these other things, I don’t know. So we have varied interest.”

Mosaic’s providers will still refer some patients to other substance abuse providers in the community — especially at the beginning, when treatment is more intense — but others may stay with Mosaic throughout their treatment, Pierson said.

Medications are one tool in the toolbox, however, Pierson said. Counseling that addresses the psychological side of addiction is probably even more important.

The irony is that so much of today’s opioid addictions start because of pills doctors prescribed to control chronic pain, Pierson said.

“And a pill is not the answer,” she said, “and so now we can use another pill, plus, to help get them get off this other pill. It’s a horrible conundrum.”

Over time, the pendulum has swung from doctors prescribing too many opioids to prescribing too few and denying them to appropriate candidates, Pierson said. In 10 years, she said she hopes society will have landed somewhere in the middle.

A 2016 to 2020 regional health improvement plan for Central Oregon compiled by dozens of stakeholders, including health care providers and local government officials, highlights substance abuse and chronic pain as one of the top issues facing the region. Oregon’s death rate from prescription opioid overdoses has tripled since 2000, according to the Centers for Disease Control and Prevention.

Some of the plan’s goals include creating better links between primary care and substance abuse specialists, creating better outreach systems, educating doctors on pain management practices and expanding needle exchange programs.

It’s not just Oregon or Central Oregon; the federal government is seeing the same problem across the country, Knobbs said. The $2.6 million in HRSA substance abuse grant funding that went to eight community health centers in Oregon is a small portion of the $94 million distributed nationwide.

Knobbs added, “What HRSA is saying they’re seeing across the nation is definitely a reality in Central Oregon.”

— Reporter: 541-383-0304,