Separate unit for opioid disorder treatment builds fellowship

Caron Treatment Centers has introduced a stand-alone treatment unit exclusively for patients with opioid use disorders, based largely on some opioid-dependent patients' impression of feeling like outsiders in the program's traditional age- and gender-specific units.

In an interview with Addiction Professional, Caron medical director Joseph Garbely, FASAM, explained that having all opioid use disorder patients on the same residential unit on its eastern Pennsylvania campus has allowed Caron to mobilize medical and nursing resources for these high-need patients more effectively. Establishment of a defined program also brings into focus Caron's wider use in recent years of buprenorphine maintenance treatment and injectable naltrexone as part of a comprehensive opioid treatment and recovery strategy.

“The patients feel now that there are people they can talk to who understand them,” says Garbely. “They can compare notes on some of the scary experiences they've had. Before this, they felt there was stuff they had to hold inside. They didn't feel safe.”

Garbely says that while staff members had gone out of their way to help opioid-dependent patients feel they were part of the larger group, some of these patients sensed that other patients looked down on them because of their heroin use. Now, patients with opioid use disorders at Caron are establishing a true fellowship.

Program composition

Around a dozen patients at any one time are participating in the program, which was launched in March. Garbely says that nearly all patients are accepting one of the two forms of medication-assisted treatment (MAT) being employed in the unit. But he adds that services are comprehensive and should not be seen as “medication as treatment.”

The decision over which of the two medications is used hinges largely on individual patient history and patient preference. Somewhat surprisingly, Garbely says, most of the patients are opting for injectable naltrexone (Vivitrol), even with the added challenge of having to be opioid-free before initiation of the drug.

Caron is establishing outpatient networks to ensure that patients remain on MAT after discharge from residential care (Garbely says Caron aims for around a six-week stay on average in the opioid program).

Caron also has faced an insurance reimbursement barrier to Vivitrol treatment while patients are in residental care, but Garbely says it has worked with drug manufacturer Alkermes to overcome this challenge.

Garbely says it has been gratifying to see Caron's organization-wide buy-in to MAT in the 18 months or so since it began offering buprenorphine maintenance. “Everyone who works in this unit asked to work in this unit,” he says.

The organization now demands this kind of support from its outside partners in this effort as well. Operators of recovery residences in the community, for example, are informed that if they want to continue to receive referrals of opioid use disorder patients from Caron, they must accept and allow these patients' use of anti-craving medication post-discharge.

Use of technology

Garbely says Caron's individualized approach to treating patients with opioid use disorder relies heavily on technological tools for treatment. Like the rest of Caron's patient population, its patients with opioid use disorderrs receive a tablet computer during their stay. Patients on the unit use the computer to access educational material and to take periodic screenings that measure cravings, depression, anxiety and other quality-of-life factors.

12-Step principles remain a critical component of this program as well. But Garbely explains that because many Narcotics Anonymous (NA) groups generally don't allow members receiving MAT to engage as fully sharing participants, Caron has brought in another organization to coordinate recovery support meetings.