A New Look At An Old Problem
Opioid misuse is deeply pervasive, even in an all-American place like Marshalltown, Iowa. It’s estimated 1 in 6 children live in a home with active addiction. “As a family doctor in the community for 20 years, I’m burying someone every week,” says Dr. Tim Swinton. “I’m seeing people struggle throughout their lives and then have kids who also struggle. And they use drugs to deal with the stress of it all.”
Dr. Nicole Gastala arrived in Marshalltown fresh out of medical school and a member of the National Health Service Corps (which brings health care professionals to underserved communities). She quickly noticed a lot of patients with chronic pain and chronic opioid use.
“Primary Health Care started a pain management program back in 2014,” recalls program manager, Andrea Storjohann, RN. “We realized patients were in pain and many were misusing prescriptions. They were calling and yelling at me a lot. So, we decided to start a program where medication would be more closely managed.” They also began screening patients for substance use disorders. “Once you start screening for addiction, you start finding it,” explains Dr. Gastala.
A conversation with the head of the Substance Abuse Treatment Unit of Iowa revealed no one in the area was using medication assisted treatment (MAT) to address opioid use disorder. The nearest methadone clinic was an hour away, too far for patients in a community where transportation was already a serious problem.
Dr. Gastala talked with her bosses at Primary Health Care, underwent training, and received a waiver to prescribe buprenorphine. Dr. Swinton received the waiver as well. Primary Health Care also received a MAT expansion grant, allowing them to treat 30 patients in the first year.
The benefit quickly became apparent. “Counseling only has a 6-10 percent efficacy rate,” Dr. Gastala explains. “With MAT, there’s 60-80 percent success rate for treatment retention. That decreases the risk of overdose. We want to normalize the use of MAT. It is a treatment, just like other diseases have treatments. When you work in public health, you have to focus on what the patients need and adapt your practice.”
The Marshalltown program currently treats between 50 to 75 patients. Andrea Storjohann has witnessed the difference it’s making. “We work closely with the Substance Abuse Treatment Unit of Iowa to provide the counseling and behavioral health component that goes with MAT.
We also work with the jail, providing MAT and giving presentations throughout the community.”
The Marshalltown MAT program is so successful, PHC now offers the program at other sites, including the Des Moines facility which has over 100 patients.
Dr. Gastala now provides similar services to a clinic in Chicago and is pleased to see the service she set in motion expanded. “Once you treat a couple of patients and see the impact and their life improving, it’s such a rewarding experience. It’s a privilege to be a part of their lives and see them benefit from care.”
Primary Health Care MAT Program was a featured award winner in the 2019 Innovation Now project of the Addiction Policy Forum.