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ND's first opioid clinic in Minot busier than expected; Fargo next

Mark Schaefer, Community Medical Services regional manager in Minot, stands at the pharmacy counter where clients at the opioid treatment center receive their daily dosages Minot Daily News photo.

MINOT, N.D.—Less than six months after opening its doors, Minot's opioid treatment clinic is busier than its corporate owners expected it might be at this point.

Community Medical Services has seen its client base grow to about 53 people since starting up in August.

"That's pretty rapid," Mark Schaefer, CMS regional manager in Minot, said of the growth. "It's definitely faster than what they expected."

The Minot facility is North Dakota's first opioid treatment clinic using drug therapy with methadone to assist in client recovery.

CMS operates four methadone clinics in Arizona, four in Montana and one in Alaska. It is setting up a clinic in Fargo that is scheduled to open in late spring or early summer. Heartview in Bismarck also is preparing to open a clinic.

Most clients at Minot's CMS clinic are from the Minot area but some also come from places such Bismarck, Jamestown, Williston and Grand Forks because closer treatment options don't exist at this time, Schaefer said. About 95 percent are self-referred and come with a strong motivation to complete the program.

"The phrase I hear most often is, 'I just can't do this anymore,'" Schaefer said. "They are ready to change. They just need the tools and the assistance to get going."

Some clients have been through the courts or other addiction programs and see a need for methadone treatment, he said. CMS works with other treatment programs and a client's other medical providers in coordinating care.

Client demographics show an age range from 19 to 62. Some trace their addiction to prescription painkillers and others to street drugs. Some have struggled with addiction only a couple of years while others may have conquered an addiction years ago only to find themselves relapsing after taking a prescription painkiller.

The first step for a potential client is an initial screening. The clinic only works with opioid addictions of more than a year, Schaefer said. Clients are initially assessed by the clinic physician and a counselor. They continue to receive counseling, and they visit the clinic daily to receive their methadone. Over time, they are able to reduce visits and take a limited amount of the treatment drug home with them.

Methadone is controlled by the federal Drug Enforcement Agency. Although methadone does not create a drug-induced high, it is addictive, Schaefer. Methadone helps stabilize clients, who in most cases can be weaned off the drug.

The experience in CMS's Arizona clinics shows about an 80 percent success rate in eliminating opioid abuse, he said. Clients typically continue with a clinic and methadone use for two years.

"It's definitely long-term treatment," Schaefer said. However, he added, "Within three days we see a different person, and the most common phrase they use is, 'I just feel normal.'"

Once addicted to an opioid, a person might no longer get the "high" but needs the drug to avoid feeling ill, he said. During that withdrawal, methadone serves to reduce drug craving. Overdoses can occur with relapses so methadone plays an important role in both preventing the relapse and reducing the reaction should an opioid be re-introduced into the body.

CMS also is piloting the use of Suboxone in Arizona to possibly add it to its treatment pharmacy. Schaefer said Suboxone can be a preferred alternative for some clients, especially after reaching the stage where they are able to reduce clinic visits and add self-dosing at home.

Clinic services are self pay, but CMS is working with the state on Medicaid and with private insurers to eventually provide coverage. A voucher program does exist that can provide subsidies to low-income individuals. About a dozen clients are taking advantage of that program in Minot, Schaefer said.

The out-of-pocket cost of $85 a week for treatment often is less than people had to come up with, sometimes illegally, to obtain illicit drugs, Schaefer said. About half of clients are employed when they seek help, and they are able to become better employees as a result of addressing their addictions, he said. The other half often are able to join the workforce.

"We have had many, many clients getting jobs. They are working toward reunification with their family," Schaefer said. Parenting improves and so does family economics. One client was excited to say she was able to get her hair done — something she never had money to do while addicted.

"That daily routine is a new routine for them," Schaefer said. "It becomes a new routine that doesn't involve those negative things."

In pioneering a new service in North Dakota, CMS worked with the Department of Human Services to establish the necessary state rules and clinic policies. CMS still works closely with the North Central Human Services Center in Minot. Schaefer said it also was necessary to meet federal licensing rules and to work with local entities, including residential treatment programs to develop policies so residents can participate in the opioid treatment.

Schaefer said it is too early to say what CMS's caseload in Minot will look like into the future, but the clinic is staffed to accommodate up to 70 clients. The clinic employs three nurses who work separate shifts to fulfill the facility's nursing needs. It has two counselors, one of whom sees clients via telemedicine from Montana. An internal medicine doctor, board-certified in addiction treatment, sees patients via telemedicine and also in person during visits four times a year. Schaefer said CMS is seeking a local provider for those medical services.

Client appointment hours are between 6 a.m. and 11 a.m. weekday mornings and for a couple of hours Saturday mornings.

Schaefer is a Minot native who worked with various local service agencies before joining CMS. In his new role, he has sought to get the word out about the clinic's services through meetings with community groups and leaders. He said CMS's goal is to educate people not only about its services but also about other addiction services that exist in Minot.

CMS also strives to be a good neighbor in north Minot in keeping an unobtrusive presence.

"We are very grateful about how it's been received," he said. The opening of a clinic had been delayed while the city investigated to make sure a methodone facility would be an asset and not a liability.

Schaefer said the clinic is addressing a problem that impacts local residents and their families.

"The people struggling with it are already here," he said of opioid addiction. The clinic doesn't add to the problem but it can be a solution, he added.

"When they are coming here, they are not getting into trouble," he said. "They are getting connected with family and they are doing better."

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