Medication-assisted treatment program fights opioid epidemic

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In his early 30s, Daniel Herrera weighed 420 pounds and started using cocaine in a desperate effort to lose weight. He turned to a doctor in Taos, who prescribed him oxycodone to numb the chronic pain he had carried in his back and shoulders his entire life. But even 110 pounds lighter and with his pain dulled, he soon found himself held down by another weight – an addiction for which there seemed to be no remedy.

Herrera spent the next several years in and out of correctional facilities, where he first discovered heroin in a prison cell in Los Lunas. When he got out, he only sunk deeper into addiction. Each time he was released, it was with the assurance that he could get clean, but he was unaware of any resources in Taos County that could help him do so. Then he discovered a program in Questa that was said to take an innovative, nonpunitive approach to treatment.

He met Dr. Gina Perez-Baron at Questa Health Center in 2015. If he joined the program, she said, he would be prescribed Suboxone, a medication that would alleviate drug cravings and withdrawal symptoms. Combining that medication with focused monitoring, honesty and group therapy, he would have a real shot at getting clean. Herrera was skeptical that she could deliver.

“We butted heads right at the beginning,” he said. “That was my first time having to ask for help from anybody, and I didn’t know how to handle it. You have to have a lot of trust and raw honesty, which is hard for a lot of Chicano men to admit to other Chicano men, ‘I’m suffering and I’m drowning and I need help.’”

Despite his caution, Herrera started working with Perez-Baron, meeting every week in Questa for confirmatory drug testing and group sessions led by therapists and physicians. He started to see progress as he hacked away at a shared problem with other recovering addicts in a context free from the stigma he encountered nearly everywhere else he went.

When Perez-Baron went to Abiquiú to replicate the same model at Las Clinicas del Norte, Herrera followed, and again, when she came to Taos earlier this year to set up a program in partnership with Tri-County Community Services.

The ‘alchemy model’

Perez-Baron graduated from Stanford University School of Medicine in 2006 with the intention to treat addiction. After working for some time in the private sector, where she treated “doctors, lawyers and CEOs” for addictions similar to those she treats today, she departed to provide medical services to areas with little access to medical care. She headed to Northern New Mexico, where she has practiced since 2013.

“All addiction, whether it’s to opiates or to alcohol or to shopping or to gambling or working or to your cellphone, they’re all addictions to painkillers,” she said. “They all function the same way in our brain – trying to avoid pain and escape to pleasure.”

That concept is a major tenet of her approach to addiction treatment. She bases her programs on what she calls the “alchemy model,” which combines medications, usually Suboxone, with behavioral health therapy. The latter, she said, is the most crucial piece in addressing an addiction, which according to the Centers for Disease Control and Prevention, is a disease. “Heroin and opiates change our physiology,” she said, “and if you want people to get treatment, we have to be able to make them sit in their seat, able to sit in their skin, to receive that care. You’re not going to get that with just talking.”

The U.S. Food and Drug Administration approved Suboxone, the commercial brand name of the combined chemicals buprenorphine and naloxone, in 2002. The drug effectively tricks an addict’s brain into thinking it has “its drug of choice on board,” Perez-Baron said. This, she added, is how a therapist is able to start working with an addict to identify the underlying causes of addiction.

Research has shown that a large number of heroin and other opioid addicts have experienced some form of a trauma in their lives, which is one of five components – or “comorbidities” – that Perez-Baron seeks to address in her treatment program. “We address affect disorders,” she said, “anxiety and depression, insomnia, chronic pain, ADHD – and the big, big, big one that we always miss and that always comes and bites us – is trauma.”

Once an addict’s underlying struggles are identified, Perez-Baron works to help an addict find healthy ways to keep addiction triggers at bay. “With trauma and with addiction, we kind of hijack our lower trauma brain, our lower animal brain, and those impulses, it’s automatic,” she said. “People already have the needle in their arm before they even realize what they’re doing.”

The end goal is to also have an exit strategy in place for Suboxone, which many recovering heroin addicts stay on for years, even after showing marked improvements.

Herrera, now 44, has been clean for 36 months, but is staying on Suboxone for the time being. “It helps with the cravings for sure,” he said. “It helps with the chronic pain, my back, my joints, the shoulders and neck.”

That medication, along with the therapy he has been receiving through Perez-Baron’s program, has also helped him return to his wife and family and get back to work doing what he loves – fixing old cars at a small auto-body shop he and his dad operate in Arroyo Hondo.

“I like to work on ‘64 Impalas and ‘69 Camaros,” he said, “anything pre-’60s. It’s not all computerized, it takes spark, gas, fire and a little bit of oxygen, and as long as you take care of ‘em, they run. They kind of talk to you after a while.”

He also has started working for an organization called Ryno here in Taos, which offers recovering addicts the opportunity to tell others their stories and provide advice on how to get clean.

But Herrera also knows the realities of the disease he wrestles with, that managing it requires a constant awareness of what matters most to him in life. “It’s routine – week to week, day to day, minute to minute – you just fall into a pattern after a while,” he said.

opioid epidemic

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