New clinic has been many months in the planning.
Timothy Johnson

Community Services Opens Clinic to Help Treat Drug Addiction

<p>Martha&rsquo;s Vineyard Community Services will open a new clinic on May 22 to dispense a drug that has helped many people escape the grip of addiction to heroin and other opioids.</p>

Martha’s Vineyard Community Services will open a new clinic on May 22 to dispense a drug that has helped many people escape the grip of addiction to heroin and other opioids.

The new clinic, located in a refurbished building on the Community Services campus in Oak Bluffs, will dispense the drug sold under the brand name Suboxone.

Suboxone is a combination of the generic drug nalaxone (the same drug in Narcan, used to revive overdose victims) and the synthetic opioid buprenorphine. While Suboxone is controversial in some quarters because it can be subject to abuse, people who use the drug in combination with psychotherapy are able to function well and lead normal lives.

“It’s a combination of a blocker and a narcotic,” said nurse practitioner Janet Constantino, who is licensed to prescribe the drug as part of the Community Services intervention center. “It blocks the receptors but it also prevents people from going into withdrawal. Not everyone, but some people get on this medication to give them some time to get their life together. Some people stay on it for a few months, some people stay on it for a few years,” she said.

Suboxone has been available on Martha’s Vineyard for several years, but doctors who prescribed it did not accept insurance reimbursement.

The clinic at Martha’s Vineyard Community Services will accept insurance, making the drug more widely available on the Island.

“We feel it’s really important that we offer Suboxone out of our clinic because right now, while it’s available on the Island, people can’t use their insurance cards for it,” said Julie Fay, executive director of Community Services, in an interview this week. “This enables people who are insured, through MassHealth or through whatever to receive Suboxone, covered by insurance. We feel very much that because it is part of the road to recovery, we need to be making it available.”

Ms. Constantino said most people who go on Suboxone have to go to a private doctor and pay out of pocket for it. “We really felt that if this was a medication that was going to help people with addiction it should be available to everyone, not just someone who is able to pay out of pocket for it.”

Ms. Fay said the regulatory hurdles involved in establishing the clinic were formidable, requiring licenses from both the Massachusetts Department of Mental Health and the Department of Public Health.

“As with anything that’s third party reimbursable, the regulatory hoops you have to go through are tremendous,” she said. “Putting it together here [on the Island] is always more difficult, because of the scale issues.”

Since the drug has the potential for abuse, the clinic will follow protocols that heavily monitor its use.

“The street value of Suboxone is pretty high,” Ms. Fay said. “We have to make sure we are setting up a program where we are not risking the prescriptions that are being let out there, hit the streets. We do that through different security mechanisms.”

Ms. Constantino said protocols will include random drug testing, prescriptions for limited amounts of the drug, and close medical monitoring of the doses taken.

The protocols surrounding dispensing the drug recognize that addiction is complicated and often has more than one component. Medical studies show it is most effective when coupled with counseling.

“Everyone that comes into our program also has to get individual or group therapy,” Ms. Constantino said. “You should learn skills to deal with your addiction, and coping skills. It shouldn’t just be a medication, it should be getting to the root of the problem. If they have an anxiety disorder, or depression, maybe that’s the reason they’re using in the first place, to self medicate. There always should be a therapy component to the medication.”

According to statistics compiled by the Massachusetts Department of Public Health, Dukes County ranked among the highest counties in the state for the rate of fatal opioid overdoses for its population from 2016 to 2018. DPH recorded a total of 15 opioid overdose deaths during that three-year period.

According to Community Services, from November 2016 to December 2017, 16 Vineyard residents were transported off-Island for emergency detoxification related to opioid use.

A working coalition of medical professionals, law enforcement officials, and members of the recovery community, facilitated by Community Services, meets regularly as part of an Islandwide effort to combat the opioid epidemic. Ms. Fay credited the coalition with providing a sense of urgency to establish a Suboxone clinic.

“The urgency was certainly spurred on by the coalition, but it’s something that Janet has wanted to do, and that the community here has wanted to do for awhile,” Ms. Fay said. “We just didn’t have the bandwidth to get it up and running. We’re ready to move now that we have this separate space to house it in.”

She also conceded that the coalition was not unanimous in its views about the use of Suboxone as a medically assisted treatment. Twelve-step programs and other therapies advocate total abstinence from narcotics.

“I wouldn’t call it resistance,” Ms. Fay said. “I would say people voiced their view. People in the recovery community have very different views on it. We have to respect all those views, and we do.”

Comments

Submitted by Anonymous (not verified) on Thu, 04/26/2018 - 20:40

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Person MV

I don't doubt the dedication to community of this organization, nor do I doubt the sincere efforts to combat this very serious problem. I do question the location (steps from the high school, Y, and hockey rink). And I can't understand how a regional high school with excess land gets the authority to lease its land to this organization and all the others. Oak Bluffs once again gets to shoulder the cost of this with zero tax income to offset it. Tone deaf and almost certainly illegal. I hope it helps somebody. Truly. Because it for sure hurts a lot of others. Congrats Chimark and Edgartown. You win again.

deshandra brown Edg

Another 'broken record' playing the same song from Oak Bluffs.(all while OB gets HUGE financial benefits from the hospital ambulance transfers and 'port town' fees from the ferry) In Edgartown we absorb a lot more than you do and get NOTHING back financially. State Beach, south beach, airport business park plus large acreage in airport, regional transfer station, Courthouse, and lets not forget the jail. We had to retire one officer on disability, had another one out for a year with injuries, and have to eat massive overtime bills to cover their shifts since the Jail is understaffed and cannot perform their duties with the number of officers assigned. Our sewer plant accepts septic waste from other towns as well. Trying getting your facts straight for a change.

Person MV

The airport businesses are taxed. You can go to the assessor's page and download the handy spreadsheet with all the town properties and valuations. You'll find a classification code for each taxpayer, and you don't have to scroll far to see Airport Road businesses. Looks to me like those businesses are paying property tax, as they should, and the town is not getting "NOTHING" as you insist above. We've all got beaches...comes with being an island. The transfer station gets paid for the waste it accepts (though not enough with the broken meters, but that's another article, and one the Gazette should consider...septic pumping fraud on this island). The courthouse and jail are small fish. Are you saying the Edgartown taxpayers are covering the overtime for county/state staff? Even if true, a drop in the bucket. Oak Bluffs, which does not have the benefit of a ton of eight figure homes, has the high school, mvcs, much of island elderly housing, the ymca, the hockey arena, and the hospital. Unlike the business park, they don't pay a penny in taxes. They also require a ton of town resources. OB taxpayers subsidizing the mostly much richer island. You are correct in pointing out the ambulance transfers, and ambulance fees in general. A modest but not insignificant offset to an otherwise outrageously unfair balance between the towns. I think my facts were and are straight, but you do speak with great authority and I'm always ready to listen and change my mind if I'm wrong.

deshandra brown Edg

@person, thanks for pointing out the business park revenues. I'll concede that point. When the jail has 'problems', they call Edgartown PD for back up,As I stated, Edgartown officers routinely get injured bailing out the understaffed jail when there is an altercation there or another town arrives with a 'problem arrestee' .. When Edgartown officers are 'out sick' recovering from injuries, we get stuck with the tab for overtime for other officers to fill their shifts. It happens often, and we had one officer go out on disability retirement from injuries suffered bailing out the jail. It cost us overtime shifts for a year while we then had to PAY for a new officer to attend an academy to replace him. To your point 'we all have beaches'. Correct. However no town is as generous to the general public as Edgartown. It requires life guards at south beach, patrols at south beach,life guards at bend-in-the road and constant ambulances to the beach all summer (when not busy at the beach the ambulances are picking up the injured from the rental mopeds *what town allows the rentals??* that descend on the town roads). Ask stingy up island towns about beach access. How many lifeguards are at the inkwell? Every time the land bank (another freebie in Edg) purchases a property for ALL to enjoy, it comes off the tax rolls. The transfer station doesn't pay taxes either. Just because a well managed town has '8 figure homes' its not our responsibility to subsidize those who do not. When it comes to regionalization of any services, you won't get a lot of interest here because of that sort of view that Edgartown 'should pay more because they can'. So the jail, courthouse, south beach etc etc do require a 'ton of town services' which we do subsidize.

Submitted by Anonymous (not verified) on Fri, 04/27/2018 - 04:19

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Victor C Tisbury

Congratulations to MVCS leadership and staff... and the Island Wide Substance Use Disorder Coalition! Using well researched and approved medications to deal with addiction is as important as using well researched and approved medications to deal with any other complex, chronic health condition!

gina Menemsha/nyc

In a perfect world, your assumption would prove true.. While it's a noble approach the MVCS is taking, not sure it will have a substantial impact.. I suspect that making the serious & expensive drug Suboxone more easily available via Insurance coverage, it's only a substitute, not a cure for deadly street heroin abuse.. The Medical Community said that about Methadone too.. ..

Submitted by Anonymous (not verified) on Fri, 04/27/2018 - 10:40

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Faith Ann Lubitz Northampton MA

Many many people are using cannabis products to get off of opioids. Totally safe and effective, unlike suboxone. I hope to see this approach made accessible ASAP.

Submitted by Anonymous (not verified) on Sat, 04/28/2018 - 00:02

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MWG Edgartown

This is great, the island is a great place, and seeing us do right by the community for this massive systemic problem is testament to that. Town partisanship needs to take a backseat to the health of the populace of the whole island, there is pride in contributing to this.

Submitted by Anonymous (not verified) on Tue, 05/01/2018 - 05:43

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Person Boston

While I applaud the attempt to help those with opioid addictions which God knows the island and country need, I hope that people both patients and practitioners are well aware of the horrors most experience trying to get off Suboxone. It can be worse then any other drug to quit by a terrifying degree. It’s effects can last years. It is a very, very tricky and dangerous substitute from what I have seen in the recovery business. The upside is that It stops opioid withdrawal symptoms but is an awful trade. To go off it is a whole other nightmare that from what I have seen makes it absolutely insane to start taking in the first place. It is SO much worse to quit for the majority then any opioid could ever be. People just think the opioid withdrawals are the worst cause they haven’t withdrawn from this drug. The tapers I have seen work, so that patients don’t lose their minds completely are years long. Everyone is different but this stuff is scary, scary, scary. The pharma company or companies have even designed and implemented subcutaneous pumps for people and they are being installed in those of a stunning young age. Let’s face it it’s big business, huge money on one level. I just hope there is as much concern as hope with this stuff. From what I have seen as I said in the recovery business, God help anyone trying to get off Suboxone. Maybe the canabis products in prior post bear looking into. I know nothing about it but bet my life it’s better then Suboxone. Thanks and good luck. I hope you have some very experienced folks handling dosage and tapers. I know your hearts are in the right place. I wish you all the best. But this stuff is an absolute horror to get off of without a doubt. The problem is people either don’t know what it’s like or if they do they don’t want to discuss it they just want to prescribe it.

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