May 11, 2017

An SVSU-led community health clinic offers hope for opioid addicts

By Justin Engel

Theo Hoxie was 15 the first time he stole morphine from his cancer-stricken mother’s medicine cabinet. Using a syringe lifted from a friend’s father, he injected the drug into a vein and felt the weight of the world lift from his shoulders.

It was an act of desperation from a young man chasing a high he first experienced months earlier when he popped a Vicodin out of curiosity. The morphine and the Vicodin — both belonging to a category of drugs known as opioids — offered reprieve from a home he considered torn. Neither pharmaceutical sealed the breach, but each provided a temporary escape from the despair of it all.

“It was like my soul had been awakened,” Hoxie said, nearly two decades later, of those initial euphoric experiences. 

“I thought to myself, ‘This is the feeling I have been missing my whole life.’”

And, for much of the rest of his life, Hoxie chased that feeling. The pursuit led him down a deadly road. He dropped out of high school and instead graduated to more potent opioids. Oxycontin. Methadone. Heroin. More heroin. 

He spent much of the next decade-and-a-half living in vehicles and alleyways, serving jail time for possessing drug paraphernalia, befriending and falling in love with other opioid addicts, then watching many of them die. Hoxie, for a long time, accepted he would die from the affliction, too. 

He isn’t waiting to die anymore.

His fortunes seemed to change the day he walked into The University Clinic, a Bay City-based primary care facility forged from a partnership between SVSU and the Bay County Health Department. Over the years, he sought sobriety at 16 different residential treatment centers and five community health clinics, but at those places, Hoxie always fell off the wagon within weeks. Sometimes, days.

The Jackson native will turn 33 on July 6. When that day arrives, he will mark nearly two years of independence from opioids, by far his longest stretch since swallowing that first Vicodin at age 15. While associates credit Hoxie’s determination for the accomplishment, he is quick to share the triumph with others. 

“I’m alive today because of The University Clinic,” said Hoxie, now employed and living with his girlfriend in Tawas.

“I truly believe that clinic saved my life.”

While the specter of relapse always looms over individuals with drug histories, Hoxie said the clinic’s interdisciplinary approach and dedicated staff — including SVSU faculty members with clinical experience and student interns training alongside them — provided his best chance ever at a healthy and happy existence. The office’s medical staff supervised his detox from opioids, its occupational therapists helped relieve the pains of his drug-abused body, and its social workers set him up for a sustainable lifestyle, free of drugs. 

His ongoing recovery is a success story for The University Clinic, but it’s a rare bright spot in an otherwise dark narrative underway in the United States. 

Opioid addiction has surged nationally in recent years, prompting medical professionals and lawmakers alike to label the problem an “epidemic” — the same status applied to history’s deadliest outbreaks of smallpox, polio, typhus and the bubonic plague. 

In a 2016 report, the U.S. Centers for Disease Control (CDC) announced the rate of deaths related to opioids increased 200 percent between the years 2000 and 2014. In 2015, more than 33,000 people died from the epidemic.

No neighborhood is safe from the problem. Its reach stretches from the streets of crime-infested communities, where Oxy is traded for unseemly acts … to doctor’s offices, where painkiller prescriptions sometimes are offered like candy. Its victims range from homeless people opting for heroin over food … to parents passed out from overdosing in idle-running vehicles, their infant children still strapped to safety seats in the back.

Bay City and its surroundings certainly aren’t safe from the opioid problem, as The University Clinic’s staff and associates discovered. And Hoxie is far from the first opioid addict — and likely far from the last — to seek help there. 

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“I never thought I’d see the day when more people were dying from overdoses than automobile accidents,” said Joel Strasz, who began his health care career in Bay County in the late 1990s. 

“That’s what’s happened, though. It’s happening here.”

Four years ago, Strasz was promoted to health officer — the top post — at the Bay County Health Department, where The University Clinic now is housed in downtown Bay City. During his time there, he watched the opioid crisis develop both afar and near.

The CDC in March 2016 issued recommendations to the nation’s doctors, urging caution when prescribing highly-addictive painkillers. Since 1999, the amount of prescription opioids sold in the U.S. quadrupled. Medical professionals had lowered the threshold for deciding when patients needed painkillers and how long they needed the medicine, experts argued, and those increasingly lax standards resulted in more Americans growing dependent on — and eventually abusing — the pharmaceuticals. In many cases, those pills served as gateway drugs to cheaper alternatives with more potency and deadly potential such as heroin.

Those national trends took an alarmingly local turn in recent years, Strasz observed.

Michigan Department of Health and Human Services figures showed medical professionals in Bay County wrote more opioid prescriptions-per-person (1.9) than in any of the 82 other counties in the state in 2015. That figure represented a sizable spike from Bay County’s 1.2 opioids prescribed-per-person just six years earlier.

The statistical surge seemed to coincide with other trends. 

Overdose deaths in Bay County jumped from five people in 2005 to 25 people in 2016. Of those 25, 23 died from opioids.

Riverhaven Substance Abuse Services, a recently-defunct office within Bay-Arenac Behavioral Health, reported 15 percent of clients receiving treatment for substance abuse at the facility were seeking help for opioid abuse in 2005. That figure soared to 48 percent in 2014.

“The numbers didn’t look good,” Strasz said. “We needed to do something.”

In May 2015, he issued a public health advisory for Bay County regarding the opioid epidemic. The advisory remains in effect today.

“I’m waiting for the problem to lessen significantly before ending the advisory,” Strasz said. “It doesn’t look like it’s going to do that anytime soon.”

Raising public awareness is one approach taken by The Bay County HOPE (Heroin Opioid Prevention and Elimination) Project, an organization Strasz assembled as part of the public health advisory. 

Its members discuss the problem at community forums as well as middle and high schools where opioid abuse also is on the rise in Bay County.

HOPE members apply other strategies to curbing the epidemic, including referring addicts to treatment centers. 

“That’s where The University Clinic has become so important,” Strasz said. 

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The clinic began as an experiment. No other county-run health department in the state housed primary care staff, which offer the sort of services patients often seek when visiting family doctors and physicians. 

Funded by a $1.5 million U.S. Health and Human Services grant, SVSU and Bay County Health Department officials opened the clinic’s doors in January 2015, providing a variety of health care resources to clients who were less likely to seek primary care at traditional facilities.

“People suffering from chronic health conditions like hypertension and diabetes are who we targeted first,” said Kathleen Schachman, SVSU’s Randall Wickes Endowed Chair in Nursing and one of the clinic’s coordinators. 

Clients trickled in at a slow pace for months. Early efforts at promoting public awareness for the facility attracted relatively few people, Schachman said. 

Then the clinic redirected its outreach and began seeing results within its first year.

“Things really started to pick up when our social workers and student interns reached out to homeless shelters in the area,” she said. “This just happened to be a population that had nowhere else to go.”

Soon, positive word-of-mouth from clients attracted others. The office’s proximity to a bus station, the county jail and courthouse, and a park known as one where people abused drugs led growing numbers of individuals with limited resources to the clinic’s front door.

“In some cases, these are people who don’t usually get the care they need until they are in a crisis, and don’t always show up for their appointments,” Schachman said. “A lot of places don’t want these people as patients, but we are willing to take them on, and to treat them with respect.”

Serving the homeless, in particular, made Schachman acutely aware more resources were necessary. 

To meet those needs, Schachman applied for — and received — a trio of grants in 2016 worth a total of $2.9 million from the U.S. Department of Health and Human Services as well as the Michigan Health Endowment Fund. 

The funds beefed up the clinic’s mental health resources, established a partnership with Wayne State University, secured an alliance with Bay-Arenac Behavioral Health, and expanded a three-days-a-week office schedule to five. 

As the clinic evolved during its second year of existence, the increased traffic revealed a growing community problem. Clients arrived with a variety of needs outside of mental health-related issues such as high blood pressure, lung disease, and diabetes, among others. Many of these problems, though, often were accompanied by another: opioid abuse. 

* 

Dorothy Lee, an SVSU associate professor of nursing and a nurse practitioner at the clinic, estimates two-thirds of her clients suffer from opioid dependency. 

“Some come in — their heart on their sleeve — and ask for help with it,” said Lee, who has 25 years of experience as a nurse in facilities across the state. “With others, they’re much more guarded, and say they’re here for something else.”

“Something else” often involves a desire for the staff to write a prescription for opioid-based painkillers. While Lee and others at the clinic are authorized to order such medicine, education and experience help them distinguish individuals in need of pain relief from those seeking a high. 

The staff does not write prescriptions for those in search of the latter. Instead, the clinic offers them help in achieving sobriety. Sometimes the patient welcomes the extended hand. Sometimes not.

“There is the attitude of, ‘It’s OK, because at least you came to us for help, and we want to help,’” Lee said. “They might leave frustrated when they don’t get what they want, but sometimes those same people will come back later when they realize we can help them and that we aren’t going to judge them.” 

Lee said The University Clinic staff recognize people addicted to opioids are suffering from a disease, not a weakness, as some in the public — and in medical care circles — perceive the problem.

“No one becomes an addict by going into a situation saying, ‘I’m going to make a bad decision today,’” Lee said. “They start off thinking they can control themselves, but that’s not the case. There’s so much that gets broken and hurt when you become addicted to a drug.”

The staff’s empathetic approach was what distinguished The University Clinic from all the other facilities Theo Hoxie visited while trying to kick his opioid habit. 

“I thought it might be one of those community clinics you had to call for an appointment at 8 in the morning and wait in line,” he said. “That was not the case. They took me in with hugs and smiles. They listened to my story. I’ve never had that before.”

Hoxie initially was evaluated by Lee. 

“I told her I was an addict, but she didn’t treat me like I was an addict,” Hoxie said. “Most doctors treat addicts like crap. The University Clinic staff wanted to understand me, and then they wanted to help me.” Lee connected Hoxie with the clinic’s social work supervisor, Sherry LaMere, an SVSU social work adjunct instructor with 34 years of clinical experience. LaMere and her master’s degree-level social work interns assisted Hoxie in securing his first phone. He was provided with ongoing therapy as well as help in crafting a résumé that landed him a job as a therapist technologist working with autistic children.

Hoxie continues to visit the clinic, nearly two years after staff there helped him get clean. Lee continues to treat him for the Hepatitis C he developed from injecting himself with an infected needle. Social work staff check in to ensure he remains connected with support systems in the community. He also visits the clinic to receive a healthy dose of something else:

“Love,” he said. “That place has shown me so much love.”

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Hoxie so far has proven to be a success story for the clinic. Other examples show why there is a need for the clinic. 

“It’s heartbreaking, some of the stories you hear,” Lee said. “I asked this girl who came here once — she was 20 and had been on heroin since 11 or 12 — ‘How do you define health for you?’ She said, ‘Health, to me, is not trying to kill myself every time I try to get off this stuff.’”

Lee hasn’t heard from that particular patient in months, and fears the worst.

The best chance many addicts may have for recovery lay in the clinic’s interdisciplinary approach, staff say. 

“The more we look at our patients’ lives in a comprehensive way, the more we can help them,” LaMere said. “The less often you have to refer a patient to an outside service, the more likely it is we can keep them engaged, helping them immediately and over a sustained period of time. Otherwise, people can get lost in the transition of care.”

Offering a “one-stop shop” for health care needs help staff build a rapport with patients. With rapport comes trust.

“It’s all about trust,” LaMere said. “Frequently, that means interdisciplinary staff connect with patients at the emotional, physical and mental level.” Sometimes that effort involves literally meeting them where they are. LaMere has traveled throughout the city to locate University Clinic patients who missed appointments for a variety of reasons. 

Officials hope the clinic’s reach will expand soon. Schachman plans to apply for grants aimed at establishing satellite clinics north of Bay City.

In the meantime, the downtown clinic will serve as a center for healing in a community struggling against an epidemic.  

“These are people who have been exposed to war,” Lee said of Hoxie and other opioid addicts. “It’s a different kind of war, but that’s what it is. That’s what we’re faced with here.”