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St. Vincent Charity Medical Center hosted a virtual dementia tour on Thursday, May 3, 2018 for caregivers who wanted to experience how a patient with dementia sees, hears and feels in their world.

Ran by Crossroads Hospice, the tour is described as an active empathy exercise where participants learn what it’s like to have dementia as they try to perform everyday tasks. Each participant wears sensory-numbing apparatus, such as two layers of gloves, headphones that create sounds and background noises, darkened glasses that create the feeling of macular degeneration and spike shoe inserts to create sensitivity issues for the feet. They are then asked to read charts that list several tasks to perform within eight minutes.

“I was surprised at how physically uncomfortable it was to complete the tasks. I had to put my body in awkward, uncomfortable positions to get things done. If I had the body of an elderly person I wouldn’t have been able to do it,” said Megan Lincoln, clinical pastoral care resident, St. Vincent Charity Medical Center. “It makes me wonder if it’s frustrating for them when I talk to them in a clinical setting because they may not fully understand what I am saying or be able to fully see me.”

That why it’s important to use the element of touch to let people suffering from dementia know you are present and speaking to them, advises Wendy Zurca, provider relations, Crossroads Hospice. She suggests avoiding trying to engage them from the side or at an angle, but to speak with them head-on and to try to engage in eye contact.

After the tour, participants received a checklist of the observations made by a facilitator of how they acted while attempting to complete the tasks then explaining why a dementia patient might act in that manner. 

They also received a list of suggestions for caring for dementia patients including to give ample time for tasks; cut down on noise and distraction; allow them to do the same thing over and over, because it makes them feel safe; stay positive about all the good things they can do and all the good times you will have through this journey together; and take care of yourself. 

“It’s like living your life like a puzzle but without all the pieces,” said Marie Talley, clinical pastoral care resident, St. Vincent Charity Medical Center. “It took me forever just to read the instructions for the exercise and I feel agitated now just from the 10 minute experience. I can’t imagine living like this every day.”

More than 150 St. Vincent Charity caregivers from security, nursing, social work, pastoral care, medial residents, physicians, quality management and more took part in the experience. Providing a hands-on experience helps caregivers better identify the day-to-day struggles of dementia sufferers, improving their ability to provide compassionate care.    

“I feel very humbled by the experience,” said Anna Luzar, nursing director, St. Vincent Charity Medical Center. “My father had dementia. He’s been gone 18 years but I wish I could just give him a hug and say I’m sorry you had to live like that.”

WVIZ-TV recently profiled a program at St. Vincent Charity Medical Center that offers free transportation program to Rosary Hall patients completing intensive outpatient program (IOP) for addiction. 

The program provides patients in Rosary Hall’s IOP with no-cost, individualized transportation through Uber or Lyft for all assessments and treatment sessions.

The program is a partnership with Circulation, a Boston-based startup which was the first to launch a digital transportation platform that integrates health systems with Uber or Lyft's driver network for non-emergency transportation. St. Vincent Charity was the first hospital in the nation to utilize the technology for addiction treatment.

"There's a fair amount of research that shows that completing an intensive outpatient program is one of the strongest predictors of sobriety," said Dr. Ted Parran, co-director of Rosary Hall. 

In 2018, attendance rates for IOP sessions for clients utilizing the transportation program is nearly 90 percent. This compares to a 76 percent attendance in the 30 days prior to launching the transportation program.

In 2018, the program has provided:

• 2,074 rides
• 116 clients served
• 17,471 total miles traveled

Since the launch of the program in August of 2017, the program has provided:

• 3,452 rides
• 179 clients served
• 26,763 total miles traveled

The WVIZ-TV segment follows patients Mike and Alice who have been battling addiction and view this transportation program as a critical lifeline that so many patients desperately need. 

"Actually getting from the sober home to the bus stop can be a challenge," said Orlando Howard Rosary Hall’s manager of outpatient treatment services. "By the time people make it to Rosary Hall they are often financially devastated and have destroyed their personal relationships and support network." 

This, combined with the challenges of public transportation, including costing patients up to $25 per week in bus fare, requiring countless hours in transport time, and exposing patients to multiple relapse triggers along the way, present the single largest barrier for patients in addiction treatment.

Watch the full segment on St. Vincent Charity's IOP transportation program below.

In celebration of the national observance of Doctors’ Day, two St. Vincent Charity medical residents visited the Bingham Early Learning Center. Dr. Randol Kennedy and Dr. Emre Bucak did show-and-tell and dress-up with the preschool children. They also spoke to the kids about what how doctors help keep people healthy and why going to the doctor shouldn’t be scary – even if shots are involved. 

“I hope we inspired some future physicians today. Or at least made their next trip to the doctor a little less scary,” said Dr. Kennedy of the experience.

Led by St. Vincent Charity’s community outreach department, the Doctors’ Day activity is one of many activities St. Vincent Charity does in the Central neighborhood of Cleveland. St. Vincent is active in the Central community, doing health screenings at many housing facilities in the neighborhood, providing diabetes education and serving as an active partner with elementary schools in the neighborhood.

“The kids were so excited to have visitors and meet the doctors,” said Anita Sabolik, director of Bingham Early Learning Center. “We try to expand their horizons and of hands-on learning and interaction with the doctors was a wonderful experience for them.” 

St. Vincent Charity Medical Center also honors Doctors' Day with an internal celebration thanking all of it's physicians and naming the annual Physician of the Year. 

"We are blessed with outstanding physicians and its an honor to work beside them and to thank them every year on Doctors' Day," said Dr. David Perse, president and CEO, St. Vincent Charity Medical Center. "What makes St. Vincent Charity a special place is that we extend our celebration of physicians by serving the surrounding community and we live our mission outside the walls of the medical center."  

Doctors’ Day is observed annually on March 30.

Weight loss surgery is life changing. It can dramatically change a person’s weight and overall health. However, the complete lifestyle overhaul that accompanies bariatric surgery can come with some unexpected transformations. Research shows weight loss surgery can also lead to dramatic changes in one’s personal relationships as well.

A study recently published in JAMA Surgery, looked at the effects bariatric surgery has on people’s personal lives and how it might change relationships.

The research showed that for those who were single, having bariatric surgery was associated with an increased rate of marriage and new relationships. But for those who were already in a relationship, bariatric surgery was associated with an increased rate of divorce and separation.

Those who lost the most weight were most likely to have a change in their love lives, according to the study. The study highlights the fact that changes in weight can affect more than just physical size. As a person's self-confidence and other lifestyle behaviors change with pronounced weight loss and improved health, other aspects of their personal lives can change, as well.

“People’s relationships change after weight loss surgery because the person has fundamentally changed,” said Dr. Anita Maximin, clinical psychologist in the center for bariatric surgery at St. Vincent Charity Medical Center. “The transformation doesn’t stop once the excess weight is gone. After they have gotten their health under control, they begin to look at other areas of their life where they can make improvements. That can cause upheaval in personal relationships if a partner, family member or friend is not onboard with their new life.”

No one wants to hear that improving their health and well-being could lead to the end of a relationship, but weight loss isn’t usually the root cause of a separation.

“For the majority of people, it doesn’t have anything to do with ‘I don’t love you anymore’,” Dr. Maximin said. “The dysfunction in the relationship was already there. Many of my patients were stuck in unhealthy relationships because they would rather be in the relationship than be alone.”

Once someone begins feeling better physically, and they start to see positive improvements in other areas of their life, it gives them confidence to address any unhappiness that has existed in their relationship or end it completely, says Dr. Maximin.

“Unfortunately, I see a lot of situations where the partner wants the surgical candidate to remain overweight and to subsequently depend on them. When the idea of weight loss surgery is brought up in a relationship like that, there can be a lot subtle sabotage and resistance from the partner,” she says. “The candidate then needs to think about if they want to be in a relationship with a person who doesn’t want them to be healthy.”  

Many people-of-size are in relationships where there is a lot of dependency on their partner for routine daily things. A spouse, or partner, may be helping with everything from bathing, cooking, taking care of the home and finances, to even the most intimate of things such as using the toilet. This creates a dynamic where the partner is used to feeling needed and if the situation changes to one where they don’t feel needed anymore it can cause resentment and a fear of being left.

Not all partners or family members have bad intent when expressing hesitation or fear over a loved one undergoing bariatric surgery.

“Many spouses I speak with in my practice are just afraid of surgical complications and anesthesia. They are scared of their loved one not waking up,” says Dr. Maximin.

Her advice is to have conversations with your partner about what they are really afraid of and then to address these fears together with the surgeon or medical team. 

“When reluctant spouses come to an appointment they usually change their minds and their fears are calmed once they meet the team,” she said. “Do your research, focus on the physical benefits of surgery and start these conversations early. In a healthy relationship your partner is going to want you to be as healthy as possible.” 

Dr. Maximin offers this advice – don’t let a fear of change hold you back. Issues in a relationship can be tackled one step at a time, but its best to try not to tackle relationship problems while preparing for surgery. Bariatric surgery preparation is grueling. It’s physically and mentally exhausting and it’s not the time to trying addressing deep-seeded relationship issues.

“Patients often put a lot of pressure on themselves that all of their issues will be fixed by surgery. Yes, you will feel better, but fixing a bad job situation or home stress isn’t a guarantee,” says Dr. Maximin. “That’s why it’s so important to talk to someone and get counseling.”

World famous chef Julia Child once said, “this is my advice to people: learn how to cook, try new recipes, learn from your mistakes, be fearless, and above all have fun.”

Undergoing the type of lifestyle change that accompanies bariatric surgery is extremely challenging. If you don’t have a lot of experience cooking or preparing meals at home, finding healthy meal recipes can feel like another hurdle to overcome – don’t let that derail you on your journey. Building up a diverse selection of new, healthy recipes may seem time consuming or overwhelming, but try thinking about it as another lifelong skill you are working to master.

“It’s easy to tell someone to eat healthy, but many people don’t know how or they have just run out of healthy ideas that sound appealing,” said Sam Chin, registered dietician, St. Vincent Charity Center for Bariatric Surgery. “Something I stress with my patients is that cooking is just like any other learned skill, it takes practice. Sometimes it can take between three and four tries to get a recipe down. If you fail the first time, just keep trying.”

During the March Center for Bariatric Surgery support group meeting, Chin led a cooking demonstration of a recipe for chicken caprese.

Support group participants also talked about the benefits of making meals and eating at home, such as: saving money, bonding with family and having greater control over the nutritional content of the meal.

Also, cooking often creates a sense of accomplishment, says Chin.

For those in the regular food phase of bariatric surgery diet, one serving of the chicken caprese recipe below is the full protein portion for one meal (25g). Add a side such a non-starchy vegetable like green beans, asparagus or brussel sprouts and a healthy carbohydrate like brown rice to complete the meal.

“Balsamic vinegar is great for adding flavor to vegetables without adding a ton of sodium,” Chin said. “Buy the reduced version of balsamic vinegar because its thicker and has a stronger taste, or just heat-up regular balsamic vinegar at home to make it thicker and increase the flavor.”

Chicken Caprese Recipe

Servings: 4

Prep time: 20 minutes

Ingredients:

• 1 pound boneless, skinless chicken breasts
• 1 tablespoon olive oil
• 1 teaspoon dry Italian seasoning (or equal parts of garlic powder, dried oregano and dried basil)
• 4 thick (1/2 inch) slices ripe tomato
• 4 1-ounce slices fresh mozzarella cheese
• 3 tablespoons balsamic vinegar
• 2 tablespoons thinly sliced basil
• Pepper to taste

Directions:

1. Heat a grill or grill pan over medium high heat.
2. Drizzle 1 tablespoon of olive oil over chicken breasts and season to taste with pepper.
3. Sprinkle Italian seasoning over the chicken.
4. Place the chicken on the grill and cook for 3 to 5 minutes per side, or until done. Cook time will vary depending on the thickness of your chicken breasts.
5. When chicken is done, top with a slice of mozzarella cheese and cook for 1 more minute.
6. Remove from heat and place chicken breasts on a plate.
7. Top each breast with one slice of tomato, thinly sliced basil and pepper to taste. 
8. Drizzle with balsamic vinegar or balsamic glaze and serve.

Nutritional values:

Serving size: 6 ounces (4 ounces chicken with 1 ounce tomato and 1 ounce cheese)

Calories: 230

Fat 9 gram

Cholesterol: 80 milligrams

Sodium: 105 milligrams

Carbohydrates: 4 grams

Dietary fiber: 0 grams

Sugar: 2.5 grams

Protein: 33 grams

Doctor. Mentor. Public servant. Friend.

Since 1979, Dr. Joseph Sopko, chief medical officer at St. Vincent Charity Medical Center, has played all these roles and more. He has become part of the fabric of what makes St. Vincent Charity the unique and compassionate organization that is today. Dr. Sopko was recently recognized for his invaluable contributions during the annual doctors’ day celebration where he was presented with the physician of the year award.

“We often recognize physicians for their exceptional achievements, but we can easily overlook the people who have become almost institutional. It’s easy to look past someone when they have become a fixture,” said Dr. David Perse, president and CEO, St. Vincent Charity Medical Center. “Joe is the most deserving person for this award. He should really be named physician of the generation. He is a mentor, colleague and friend and an avid advocate of our physicians.”

In December 2017, Dr. Sopko took on the role of chief medical officer and acts a key advisor to Dr. Perse. He provides invaluable oversight and consultation to hospital leadership for strategic planning, quality, operational improvement and other hospital initiatives.

An accomplished pulmonologist, during his tenure at St. Vincent Charity Dr. Sopko has held a number of leadership roles within the organization as well as in the medical community. His expertise and leadership has been the backbone of pulmonary services and the critical care unit at St. Vincent Charity for over almost four decades.

“Healthcare organizations have become bigger and mass produced and this is a shining beacon of a place that is different,” Dr. Sopko said when receiving his award. “What I have always loved about St. Vincent is that the organization encourages physicians’ independence and doesn’t put physicians in a box.” 

Often referred to as “Uncle Joe” by his fellow caregivers, Dr. Sopko has been known to go out of his way to do nice gestures for staff. Whether it be something as simple as replacing and assembling a coffee maker for a break room or bringing in a radio and playing classical music to help a colleague relieve stress, he shows genuine kindness and likes to see everyone at St. Vincent Charity thrive.  

“He is a bit of an unsung hero. He does so much everyday behind the scenes that people may not even realize what a dedicated physician and leader he is to St. Vincent and to the community,” reads his nomination for physician of the year.

Seeming to have boundless energy, since 2003 Dr. Sopko has served as a district captain in the U.S. Coast Guard Auxiliary. He also performs duties as a volunteer physician for the U.S. Coast Guard, performing exams for U.S. Coast Guard members, teaching safety courses and he is often on-duty at big local events ensuring water safety for boaters.

His exhaustive array of volunteer efforts doesn’t stop there. Dr. Sopko is also an active member of the Advisory Board of the Greater Cleveland RTA, an advocate for Edwin’s Leadership and Restaurant Institute and a board member of Les Delices, a nationally recognized group of musicians who perform French Baroque music.

“When people think of the gems of Cleveland, they often think of the obvious, such as the Cleveland Orchestra, the Cleveland Museum of Artor the Cleveland Cavaliers. However, it’s important to recognize the other, brighter gems of our community, such as St. Vincent Charity and our very own Dr. Joseph Sopko,” reads his nomination.

“St. Vincent Charity’s mission of caring for the whole person, physically, emotionally and spiritually is reflected in everything Dr. Sopko does. He embodies ‘In Omnibus Caritas’ or ‘charity in all things’, the motto of the Sisters of Charity of St. Augustine.”

St. Vincent Charity Medical Center recently announced that Dr. Dale Levy has joined the organization as cardiothoracic surgeon, expanding the St. Vincent Medical Group to include an open heart and thoracic surgery program.

“St. Vincent Charity has a rich history of cardiac care dating back to 1950 and we remain dedicated to providing high quality cardiovascular care today,” said Dr. David Perse, president and CEO. “I’m extremely pleased to welcome someone of Dr. Levy’s caliber to our organization and I’m confident his expertise in minimally invasive heart surgery and pulmonary screening will complement our highly skilled cardiovascular team.”

In 1950, Dr. Henry Zimmerman launched the cardiology division at St. Vincent Charity Medical Center. Under Dr. Zimmerman, St. Vincent Charity was at the forefront of innovations in cardiac care. In 1956, Dr. Earl Kaye performed the first open-heart surgery in the Midwest, only the third in the country, at St. Vincent Charity. Shortly after, the hospital opened one of the first diagnostic and evaluation laboratories in the Midwest.

Dr. Levy specializes in open heart surgery with a special interest in bypass and valve surgery, as well as minimally invasive surgical procedures. He also has extensive experience in management of pulmonary nodules and lung cancer screening.

“Throughout the majority of my career I have had the privilege of working at faith-based healthcare organizations and I’m looking forward to continuing on this path at St. Vincent Charity,” Levy said. “I’m especially excited about the opportunity to bring a new specialized service to St. Vincent Charity with the pulmonary nodule clinic and lung cancer screening.”

A lung nodule is a spot on the lung that is seen on an X-ray or computed tomography (CT) scan. According to WebMD.com, a lung nodule shows up on about one in every 500 chest X-rays. The discovery of a nodule on the lung doesn’t necessarily mean cancer and often lung nodules are benign. When a spot on the lung is identified, patients are typically monitored with follow-up surveillance CT scans over the course of two years.

“The availability of pulmonary nodule clinic at St. Vincent Charity Medical Center gives family medicine physicians, primary care physicians and patients another high-quality lung cancer screening option in the Cleveland-area,” Levy said.

Dr. Levy joins St. Vincent Charity Medical Center from OhioHealth Doctor’s Hospital in Columbus, Ohio where he served as chief of the division of cardiovascular and thoracic surgery since 2006. In addition to this role, Dr. Levy also held positions at Blanchard Valley Hospital and Mt. Carmel Hospital. Prior to his time in Columbus, Dr. Levy spent three years as chief of cardiac surgery at St. John Medical Center. 

Dr. Levy completed residencies in both general surgery and cardiothoracic surgery at Mt. Sinai Medical Center in New York, New York.

In a recent profile by Cleveland Jewish News, Dr. Levy discussed his return to Cleveland and the unexpected path that led him to a career cardiothoracic surgery: 

When Dale Levy was growing up in Pepper Pike, he always thought he would become an obstetrician like his father. But while attending Orange High School in Pepper Pike, he volunteered at Hillcrest Hospital in Mayfield Heights and saw there was a whole world of surgery beyond being an OB-GYN.

After going to school at Case Western Reserve University's medical school and accepting a position as a research assistant for an artificial organs' department and seeing his first operation there, he knew it was something he had to do.

"Cleveland is a great place to live and be," he said. "I hope to expand the open-heart surgery services here and to develop a very strong general thoracic surgery as well. There are several exciting areas of thoracic surgery as well that can be developed fully, and this is a great area to do that."

Earlier this week, St. Vincent Charity Medical Center was honored to host the Most Reverend Bishop Nelson Perez of the Catholic Diocese of Cleveland. While visiting the hospital, Bishop Perez met with Sister Judith Ann Karam CSA, congregational leader of the Sisters of Charity of St. Augustine, as well as St. Vincent Charity’s David Perse M.D., president & CEO; Sister Miriam Erb CSA, vice president of mission and ministry; Joseph Sopko M.D., chief medical officer; Audley Mackel M.D., medical staff president; and Beverly Lozar, senior vice president.

Together, the leadership team introduced St. Vincent Charity’s distinguished doctors and caregivers, and shared stories of our devotion to treating every patient with clinical excellence and compassionate care. Bishop Perez learned about key services, including the renowned Spine and Orthopedic Institute, the Center for Bariatric Surgery and Rosary Hall. And, on a tour of the main campus, Bishop Nelson saw first-hand the emergency department, psychiatric emergency department and more.

Bishop Nelson took in much of the history of St. Vincent Charity Medical Center, which has served as Cleveland’s downtown hospital since it was established in 1865. Pieces discussed from the hospital’s timeline included:

• 1873 – St. Vincent Charity opened its first operating room and Cleveland’s first amphitheater for demonstration of surgical and clinical procedures to medical students.
• 1950 – Specialized work in heart disease began with the opening of the Cardiovascular Laboratory, one of the first diagnostic and evaluation labs in the Midwest.
• 1952 – Rosary Hall was founded by Sister Mary Ignatia Gavin CSA after she had been transferred from St. Thomas Hospital in Akron, the birthplace for Alcoholics Anonymous.
• 1956 – The first open-heart surgery in the Midwest was performed on a 6-year-old girl by Dr. Earle B. Kay. The surgery used the Cleveland-developed heart lung machine known as the Kay-Cross Heart Lung Machine. The Cardiac Recovery Unit opened in October and was designed as one of the first in its kind in the country to provide more safety for the cardiac surgery patient.
• 1985 – Arthur Steffee, M.D., chief of orthopedics at St. Vincent Charity, performed the first vertebral implant in the country. He used a metal and plastic replacement he designed himself. Dr. Steffee went on to form Acromed, which he later sold to DePuy in 1998 for $325 million.
• 1988 – St. Vincent Charity opened the psychiatric emergency room, one of only two in the state of Ohio.
• 1997 – St. Vincent Charity was the first hospital in the region to begin offering bariatric surgery.
• 2007 – Dr. Louis Keppler, co-medical director of the Spine and Orthopedic Surgery, performed the first short-stem hip replacement surgery in the U.S. Those procedures now account for nearly 30% of all hip replacements performed in the U.S.

Northeast Ohio Catholic magazine of the Catholic Diocese of Cleveland also published coverage about Bishop Perez and his visit to St. Vincent Charity Medical Center.

Dr. Ted Parran, associate medical director of Rosary Hall at St. Vincent Charity Medical Center, recently spoke with the Springfield News-Sunabout the growing number of cash-only opioid treatment centers. A nationally renowned expert in addiction medicine, Dr. Parran discussed the need for more research on opioid treatment centers and the responsibility of providers in prescribing these medications.  

Dr. Ted Parran, associate medical director. Rosary Hall, St. Vincent Charity Medical Center. 

Experts: Cash clinics divert treatment drugs to Springfield streets

SPRINGFIELD — Office-based opioid treatment centers that accept only cash to prescribe recovery medications such as Suboxone are hindering treatment and diverting dangerous medications to the street in Clark County and across Ohio, experts said. 

But the clinics provide a necessary service for some patients who don’t have time for more extensive counseling, proponents said.

Suboxone is used to help people stop using heroin or other illicit drugs such as fentanyl without going through withdrawal.

A recent study of opioid treatment providers in Ohio by Dr. Ted Parran of St. Vincent Charity Medical Center in Cleveland showed about 48 percent of the clinics accepting new patients took only cash for services instead of insurance.

Some cash clinics charge about $500 for an initial office visit and $200 to $300 a week for follow-ups, Parran’s study found. Those appointments would typically be reimbursed $20 by Medicaid and $50 to $60 by Medicare, he said.

“If you saw a patient every week and asked for $200 for the month, that would be more in line with the typical $50 per outpatient visit that would be reimbursed by insurance,” Parran said.

Some doctor’s offices or clinics typically charge cash for recovery services, including providing prescriptions that can be filled at a pharmacy using Medicaid or Medicare, said Wendy Doolittle, CEO of the Springfield-based nonprofit drug treatment center McKinley Hall.

Those clinics typically won’t provide counseling treatment more than once a month, she said. Some clients have told Doolittle a portion of the prescription can be sold on the streets.

However, one local treatment center told the Springfield News-Sun that recovery medications can be used for people who work full-time jobs and cannot attend treatment three to five days per week.

Brenda Griffith is the director of the nonprofit Reasonable Choices Inc., a certified alcohol and drug treatment provider on Urbana Road in Moorefield Twp. The organization charges $150 per month for cash clients but also accepts Medicaid and private insurance.

“Our niche is a working class clientele,” Griffith said. “You can’t have one size fits all.”

Some people with good insurance will choose to pay cash for Suboxone or similar medications because of the stigma that comes with it, said Jeanette Limoli, a recovering addict and director of Choices Inc., a new outpatient treatment facility that opened in December on South Burnett Road. The facility accepts only Medicaid and private insurance payments, she said.

 “Cash clinics sometimes give people a chance to go on with their busy lives but also get some help,” Limoli said. “Sometimes it can also be a place that breeds addiction because there’s not a lot of accountability. It all depends on what the clients going for … There’s got to be more than one way to get clean.”

More providers are needed in the community, especially those looking to collaborate with certified treatment centers on a full slate of services, not just prescribing medications, Doolittle said. The local substance abuse coalition hopes to educate doctors about prescribing recovery drugs in hopes of collaborating in the future.

“That medication is just that — it’s medication-assisted treatment,” Doolittle said. “Treatment is important. We need them to get on board with us and to work together with certified treatment centers so that people can get better … We need to make sure we’re not adding to the problem but correcting it.”

On the streets

Parran also is studying whether cash clinics prescribe more Suboxone to patients than needed.

“Law enforcement has that impression and the state pharmacy board has that impression but nobody really has the data to prove the point,” he said.

Initial data indicates clinics that accept insurance prescribe 16 mg per day of buprenorphine, a recovery medication, while those that require cash are more likely to prescribe 16 or more mg per day, Parran said.

“That then really becomes a moral and ethical issue for prescribers if requiring large amounts of cash for visits is associated with prescribing higher doses of an opiate that has a street value and can be diverted in order to generate money perhaps for office visits,” he said.

Most of the recovery medications sold on the streets is used by people as their own sort of outpatient detox, Parran said.

An 8 mg strip of Suboxone sells for about $20 on the street, according to the Ohio Substance Abuse Monitoring Network. If a patient needs 12 mg per day but receives 24 mg as part of a prescription, Parran said they can take what they need and sell the rest.

It also puts some addicts back in an environment with people who might be selling or abusing drugs, he said.

“It’s a very safe medicine from an overdose standpoint but it’s still a medicine of use and abuse and a medicine of addiction if used in the wrong way,” Parran said.

A drug raid at a Springfield home earlier this month netted 20 grams of drugs, as well as a pill bottle containing buprenorphine, according to court records.

Suboxone is moderately available in the Dayton region but is highly available in Columbus, which saw an increase in illegal use of Suboxone on the streets the first six months of 2017, according to the substance monitoring network.

Springfield and Clark County haven’t seen a lot of illegal Suboxone recently like in other areas, Springfield Police Division Opioid Diversion Officer Meredith Freeman said. The city has had an influx of methamphetamine and cocaine, she said.

“I’m not hearing (about Suboxone) like I used to,” she said. “I don’t know if that follows the trend that they’re going to different things now or different drugs.”

Making it harder

Reasonable Choices Inc. began as a free store and food pantry 13 years ago, said Griffith, a recovering alcoholic.

It later morphed into a counseling center and decided to offer treatment services to residents who were driving to Columbus for office-based treatment, she said.

In July of 2016, the Ohio Attorney General’s Office and the Drug Enforcement Agency raided the treatment facility’s office on North Limestone Street near Madison Avenue.

The search ultimately led to one of its doctors voluntarily retiring his license in lieu of further investigation in April 2017, according to the State Medical Board of Ohio.

Reasonable Choices hasn’t been charged criminally as of Feb. 21 but the investigation remains open and ongoing, Attorney General’s Office spokeswoman Jill Del Greco said.

Griffith told the News-Sun she hasn’t spoken with AG’s office since the raid.

Since that time, the nonprofit received accreditation from the federal Commission on Accreditation for Rehabilitation Facilities in December, Griffith said. It’s also in the process of opening both a peer support building at its old facility on North Limestone Street.

The organization accepts private insurance, Medicaid and cash payments, Griffith said. It typically charges about $150 per month, or $37.50 per week for its cash protocol, Griffith said. The majority of the people who pay cash continue to work professional jobs in multiple fields, including manufacturing, while using recovery medications, she said.

Some people can’t work full-time jobs and go to a clinic five days per week, Griffith said.

“You can’t have a cookie cutter, one-size-fits-all approach,” she said.

Griffith has never raised rates, she said, but other cash centers are charging hundreds of dollars per visit.

The center also cannot prescribe more than 16 mg of Suboxone per day because it doesn’t have an addictionologist on staff, she said.

The organization also offers Vivitrol — an injectable drug that blocks opioids from interacting with the receptors in the brain and eliminates the experience of feeling high. However, it requires clients to stay clean for 10 days before they take the injection, which has been difficult for some patients, Griffith said.

Next month Reasonable Choices will begin offering injectable Suboxone that will keep addicts from selling leftover strips, she said.

“These things are being addressed,” Griffith said. “It’s going to make it a lot harder.”

Full slate

Later this year, the Substance Abuse Prevention and Treatment Coalition will sponsor a medical providers training about addiction, said Greta Mayer, CEO of the Mental Health and Recovery Board of Clark, Greene and Madison Counties.

They hope to host a dinner for physician, physicians’ assistants and nurses, Mayer said, that will include a discussion with an addiction specialist. The dinner will likely also include a panel discussion with local experts.

 “They’ll understand the disease of addiction and they’ll understand the full continuum of treatment and recovery supports that are needed long-term so the medication is just one piece and how they can be a part of that one piece,” Mayer said.

After the training, the board will then host a training to help doctors get a waiver to prescribe buprenorphine, Mayer said. The Drug Enforcement Agency can then assign the physician a special identification number, which is required to be included on all buprenorphine prescriptions to allow for better record keeping.

“We’re hoping that general training will feed some interested folks to learn about how to do this type of treatment so we have more responsible, ethical, quality providers in the community,” Mayer said.

Some doctors may look at Suboxone as harm reduction because it’s not heroin or fentanyl, Doolittle said.

At McKinley Hall, treatment includes nine hours per week of counseling, including educating patients about addiction and triggers, as well as group therapy, Doolittle said.

“If more doctors can see just how effective this is, it may change their minds,” she said.

Most people use services for about a year, including recovery housing, transportation, peer support specialists and case management, she said.

“All of these things are required for people to get well,” Doolittle said. “You can’t just do a 15-minute session and give someone 24 mg of Suboxone per day and think they’re going to get well.”