To Treat Addiction In Rural America, Start With Hiring Specialists : Shots - Health News While opioids get all the attention, rural communities struggle with substances like meth and alcohol too. One clinic is building up capacity to treat all of them, using both medicine and counseling.

For One Rural Community, Fighting Addiction Started With Recruiting The Right Doctor

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Opioid addiction has gotten a lot of attention in recent years. And that's led to more resources to combat it. But in many rural communities, it hasn't been enough. Reporter Bram Sable-Smith traveled to northern Wisconsin, where one clinic is using resources earmarked for opioids to tackle all kinds of substance abuse.

BRAM SABLE-SMITH, BYLINE: Lindsay Bunker lives with her 6-month-old daughter on the Lac Courte Oreilles Indian Reservation in northern Wisconsin. She's 32, struggled with addiction for over 10 years - mostly to heroin. Then this summer, she dreamed a nightmare - two men were attacking her baby while she thought only of drugs.

LINDSAY BUNKER: And in my mind I was thinking, if I can just get one hit, if I can get one line, I can save her. And, like, I woke up. And I was just, like, panicking, like, how can a mother think like that?

SABLE-SMITH: That dream was a wake-up call.

BUNKER: I knew right then and there, like, that drug is so evil.

SABLE-SMITH: In a lot of rural America, though, that's where the story could have ended. She might never have gotten into treatment. Bunker got into recovery with the help of Suboxone, a medication that's been shown to be very effective in treating opioid addiction. But Suboxone treatment can be hard to get in rural areas because only providers who receive special trainings are able to prescribe it. One study found that more than 80 percent of rural counties in the U.S. do not have a single physician who can. And that's why, three years ago, the NorthLakes Community Clinic up here in Ashland, Wis., recruited Dr. Mark Lim.

MARK LIM: They told me, oh, they need an opiate waiver who could prescribe Suboxone.

SABLE-SMITH: Even Dr. Lim himself is surprised he's here in this rural town of 8,000. He's dreamed of living in a big city since he came to the U.S. from the Philippines. But he was intrigued by the idea of starting a program to address the opioid abuse problems that have plagued much of rural America.

LIM: My wife actually told me that this is the opportunity because I want to create something.

SABLE-SMITH: And this region of Wisconsin was a place where the program he created could have a big impact. It is nearly twice the state's average of drug and alcohol deaths. So he took the job - with one stipulation.

LIM: I'm not an opiate doctor. I am an addiction doctor. What I mean by that is I treat the illness. I don't treat the substance. So if I'm just going to be the Suboxone doctor, then I'm not doing a full practice of addiction.

SABLE-SMITH: Lim says yes, Suboxone can be effective for treating opioid abuse. But addiction is not just about opioids. Meth use in Wisconsin has grown by 250 percent in recent years.

LIM: You have to work with alcohol, too. You have to work with marijuana, too. You have to work with methamphetamine, cocaine. We have a lot of methamphetamine here.

SABLE-SMITH: So while it's rare to have a doctor who can prescribe Suboxone in a rural area like this one, Lim says it's just a start. Only about 40 of his more than 200 patients are on it. Instead, patients like Lindsay Bunker spend most of their time working with substance abuse counselors and in group sessions that treat addiction as part of their overall mental and physical health.

THOMAS CROTEAU: All right. So today, we're talking about opiates.

SABLE-SMITH: Substance abuse counselor Thomas Croteau leads a group of Dr. Lim's patients in a session on reasons to stop using opioids. Lindsay Bunker shares with the group.

BUNKER: While I was using, I felt, like, really bad that I was hurting my family. So that's why I would use more.

CROTEAU: Yeah. So it's actually - it continues the addiction.

BUNKER: Yeah. Yeah.

CROTEAU: It just makes it spiral out of control even more and more...

SABLE-SMITH: This kind of recovery program that combines clinical and counseling services is exactly what rural communities need, says John Gale, who researches rural health at the University of Southern Maine.

JOHN GALE: Because most people with a substance use disorder have co-occurring mental health and substance use problems.

SABLE-SMITH: And while most of the attention and dollars are focused on opioid abuse right now, Gale says rural communities struggling to address addiction can use those resources to build a larger treatment capacity.

GALE: And then you begin to create a community where you can treat all sorts of substance use disorders.

SABLE-SMITH: And that's exactly what Dr. Mark Lim created at his clinic in northern Wisconsin. For NPR News, I'm Bram Sable-Smith in Ashland, Wis.

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