QUINCY, Ill. — When Dr. Michael Connolly moved from Wisconsin to Quincy in January 2017 to teach at Southern Illinois University's Center for Family Medicine, he was shocked at the number of opioid prescriptions and substance use disorders.
"It was mind-boggling to me," Connolly said.
SIU recently had received a federal grant to certify physicians like Connolly in administering Suboxone, a brand name partial narcotic to treat opioid dependence, and Connolly sought certification in administering it. He applied to do so and completed the certification in April 2017. He began seeing patients the next month.
At the time, Connolly was the only doctor in the Quincy area to treat opioid substance abuse disorders with medications. As part of the certification, he could only see 30 patients his first year, a requirement to prevent "pill mills" and ensure that doctors make patients use the medication to stay in recovery. Within six months, Connolly quickly neared that number. Now, he can treat up to 100 patients.
"There's a lack of doctors in the area who will prescribe medically assisted treatment with medications like Suboxone, so that's why I went ahead and did the certification," Connolly said.
Commonly cited reasons nationwide for a lack of doctors becoming certified are the federal prescribing restrictions, cumbersome requirements for certification, and a concern over abuse of the medication.
Data from the American Journal of Public Health in 2016 say that although there are more than 900,000 U.S. physicians, only about 50,000 doctors are certified to administer Suboxone. The journal also showed that in Illinois, only about 40 percent of people with an opioid dependency can receive medically assisted treatment because so few doctors can prescribe the medicine. In Missouri, that percentage is about 35.
To receive medically assisted treatment, Connolly does an initial interview with the patient, and has them go through lab work and a urine test. When that is all completed, patients return for induction.
"The person abstains from any opiates for 12 to 14 hours before seeing me," Connolly said. "They come in withdrawal, and we administer the medicine on an hourly basis until they're no longer in withdrawal. You see people looking really bad, and by the time they leave, they're just fine — not high or in withdrawal."
The Suboxone, given in the form of a pill or dissolving strip, works by moving into receptors in the brain as the opioids leave the receptors while the person is in withdrawal. The Suboxone holds withdrawal symptoms in check when it does this. Because Suboxone also satisfies a person's need for opioids, it suppresses cravings, as well.
Suboxone treatment can continue at home, with follow-up visits to a health care provider. Patients who no longer experience withdrawal symptoms and do not have uncontrollable cravings enter a maintenance phase. In the maintenance phase, the patient takes medication as prescribed, stays free from illicit drug use, and seeks counseling support.
The decision to discontinue Suboxone is made after consulting a doctor.
"It's another tool in our box," Connolly said. "We still recommend counseling, formal treatment centers and Narcotics Anonymous."
Patients come to Connolly through a variety of avenues.
Some recently have moved to the area and see Connolly to continue receiving the medically assisted treatment they started in the last community. Other times patients are recommended by Preferred Family Healthcare in Quincy or the legal system, or they come on their own because they are sober but are still suffering from cravings or suffering from withdrawal.
Active users are "challenging, but it's gratifying work," Connolly said.
Most of his patients are from Quincy, a couple are from Missouri, and one comes from another Adams County community, he said. He stressed that patients aren't your stereotypical "junkies."
"You wouldn't be able to pick my patients out on the street as people who are using," Connolly said. "Yesterday I did an induction on a 59-year-old who has been abusing prescription medication and has even tried heroin and crystal meth. I have a couple of professionals in town. It's everyone in your society. Look to your left, look to your right, and you'll find someone who's addicted."
Each person he sees is memorable to him.
"There are success stories," Connolly said. "Some, even with medically assisted treatment, still struggle. Some are still resistant to parts of the treatment."
Fortunately, Connolly said there is another physician at SIU who is undergoing certification to treat patients with Suboxone.
"The intent is to certify everyone," he said.
This is an AP-Illinois Exchange story offered by The Quincy Herald-Whig.