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In many states, there aren't enough resources to treat everyone addicted to opioids. Things are especially bad in rural areas where the nearest methadone clinic or addiction doctor may be hours away. But in a small Maine town, some primary care doctors are stepping in. As Susan Sharon of Maine Public Radio reports, they've worked intensive outpatient drug treatment into their regular practice.
SUSAN SHARON, BYLINE: Bridgton, Maine, is the kind of place people like to go to get away. For a small town, it has a lot to offer - lakeside cabins, a ski resort and plenty of hiking trails. But about 10 years ago, Bridgton began showing signs of something else - a serious drug problem.
CATHERINE BELL: I had a lot of young people calling the agency to come into treatment.
SHARON: Catherine Bell is a drug and alcohol counselor and the CEO of Crooked River Counseling.
BELL: They were using needles. They were shooting heroin. And it was just, like, really bombarded.
SHARON: Bell says she knew that if treatment was going to be successful, patients would need methadone or Suboxone, in addition to counseling. Both medications reduce withdrawal symptoms and cravings for opioids. But in this small town of 5,000 residents, there were no addiction doctors, and the nearest methadone clinic was about an hour away. For a while, it seemed hopeless, and then Bell met Dr. Craig Smith. Smith is a family doctor at North Bridgton Family Practice. Over lunch one day, Bell blurted out an idea.
BELL: I said, I'll tell you what. You prescribe. I'll do the counseling for you.
SHARON: Doctors can be trained and certified to prescribe Suboxone for up to a hundred patients each, but many are reluctant to take on the treatment because of how they think it will affect their regular practice. Dr. Smith told Catherine Bell he'd have to think about it.
CRAIG SMITH: In the month of August that year, I had four or five patients that had overdosed and died. One was a 34-year-old mom - two kids. I had no idea. I'd seen her, like, twice for a physical. I still feel guilty about that.
SHARON: Smith didn't want to turn his back on his patients, so in 2009, with the support of his hospital and Bell's assistance, he started prescribing Suboxone. At the time, few doctors were doing it.
JENNIFER SMITH: My initial feeling when I was thinking about getting training for this sort of program was, you know, I don't want those people in my office. I run a family practice. I see a lot of kids. You know, I don't want them here.
SHARON: Dr. Jennifer Smith works in the same family practice with her husband, Craig, and Catherine Bell. She says it took them two years to convince her that she should prescribe Suboxone. She finally realized it wasn't new patients who needed help. It was patients she was already treating, including pregnant women. She just didn't know they were using drugs. So now the practice combines medication with intensive outpatient counseling and group therapy.
(SOUNDBITE OF BABY BABBLING)
SHARON: At this women's support group, mothers are allowed to bring their babies.
UNIDENTIFIED WOMAN #1: I just had a surgery. I did good, though. I had a prescription for pain meds and didn't get them Filled.
UNIDENTIFIED WOMAN #2: Good for you.
UNIDENTIFIED WOMAN #3: Good.
UNIDENTIFIED WOMAN #2: Good. Yeah.
SHARON: The group meets at the clinic twice a month. The women say they like the convenience of having all of their medical care and counseling under one roof. It's easier to schedule appointments. There's better coordination of their treatment, and patients know they can be upfront about their addiction. Smith says that's made her a better doctor, and she can see that what she's doing is making a difference.
J. SMITH: I mean, you see people going back to school, going back to work, staying out of jail, taking care of their kids, getting DHS out of their life.
SHARON: Not everyone who enters treatment is successful. Counseling is mandatory. So is drug screening. And those patients who can't or won't comply are forced to drop out. There are now four doctors in the Bridgeton area who prescribe Suboxone, but demand for treatment isn't letting up. The federal government is considering a proposal to lift the 100-patient cap, and if that happens, they say they are prepared to take on more. For NPR News, I'm Susan Sharon.
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