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Fentanyl has changed the landscape of addiction treatment in Wichita, increasing demand for services and creating weekslong wait periods that sometimes prove fatal.
Addiction specialists in Wichita say this is because fentanyl, a highly potent and addictive opioid, has pushed addiction treatment centers to their limits. Demand can result in weekslong gaps between when a person first seeks treatment and when they’re able to receive it. During these gaps, the risk of overdose is high, experts say.
Keith Dockter works quickly to connect people to services through his work as an outreach specialist at the residential addiction treatment center Holland Pathways. For those struggling with substance addiction, the most challenging day is often the day they ask for help, Dockter said.
“I know it’s important to capture that moment of bravery for people,” he added.
Dockter remembers when he first began his addiction recovery journey off of meth and heroin in 2015. He initially felt defeated, but after his second attempt at treatment, he joined a community that ultimately helped him start a new life.
Fentanyl has recently found its way into a large proportion of Wichita’s street drug supply, which complicates the recovery process. Over the past four years, the number of people who died from an overdose in Sedgwick County doubled; fentanyl was identified in more than half of all overdose deaths last year. In many cases, people unknowingly ingest fentanyl because it’s been laced into other drugs, which can lead to accidental overdoses.
Treatment centers see dramatic rise in demand
Substance abuse and mental health problems go hand in hand, said Rena Cole, a clinical psychologist at Sedgwick County’s community mental health center, Comcare. Most Comcare patients with a substance abuse disorder are also assessed for a mental health disorder, she said. Opioids such as fentanyl can trigger or worsen symptoms of depression or anxiety and may drive a person to use a substance more often.
Three years ago, Comcare saw almost no fentanyl cases. In the year following the start of the pandemic, the mental health center saw a 25% increase in requests for its Substance Use Disorder program, Cole said.
Additionally, the number of people who met the criteria for an opioid use disorder in Comcare’s District Drug Court Program — a therapy-based rehabilitation program for drug offenders — increased by nearly 50% from 2020 to the start of 2022, Cole said.
“I think we definitely could use more availability in (addiction recovery) programs,” said Heather Roe, an addiction physician at Harmony Medical Clinic in Wichita.
Because Harmony Medical Clinic is privately owned, most of Roe’s patients are insured, and she tries to make herself available to new patients within a week. The avenues for treatment are more limited for those without insurance, she said. Wait times for programs like Comcare can be as long as six weeks.
Medication-assisted treatment ‘the gold standard’ for opioid addiction
Harmony Medical Clinic utilizes medication assisted treatment to treat opioid addiction. Severe withdrawal symptoms can often cause opioid users to relapse when they try to quit. Medications such as methadone and buprenorphine lessen these symptoms by binding to the brain’s opioid receptors and releasing endorphins in place of the illicit drugs.
“But it is so long acting that they’re not getting a spike — they’re not getting high,” Roe added. “They go to work, they take care of their children, they go to school … whatever other goals they have in their lives.”
Methadone treatments, which have been around for decades, can effectively decrease mortality rates. Using medication assisted treatment in combination with cognitive behavioral therapy is considered the “gold standard” for treating opioid use disorder, Cole said.
In many cases, addiction can be linked back to trauma, Dockter said. Holland Pathways takes a holistic approach, combining medicated detox with therapy sessions to find the root cause of an individual’s addiction.
“The brain is really powerful, and you can rewire the brain,” he added. “I think when you … show (the patient) that there isn’t something morally wrong with them, it helps them understand the way they have been.”
Holland Pathways’ facility, located in west Wichita, is made up of five brown-roofed houses with patio chairs and well-trimmed grass that wouldn’t look out of place in any neighborhood in the city. The facility contains 64 beds, and patients typically stay for 30 days as they complete a 12-step program tailored to suit their individual needs. Some activities include yoga sessions, exercise groups and time spent with a therapy dog.
Collectively, the staff at Holland Pathways have over 150 years of personal recovery experience, Dockter said. This helps staff meet their patients where they’re at — a skill Dockter said makes Holland Pathways unique.
“No matter what comes through this door that someone is going through, somebody here has possibly been through it or knows somebody who went through it,” he said.
How fentanyl complicates addiction treatment
Thirty days in a residential program barely scratches the surface of a patient’s recovery, Dockter said. The most difficult part begins after discharge, when the risk of relapse increases. Holland Pathways incorporates relapse prevention into its treatment, and it also encourages patients to join sober living communities.
“If we take you out of the bar scene or the community of people that you’re using drugs with, and we don’t give you a different community to be replaced in, most likely you’re going to go back to that old life,” Dockter said.
Relapse prevention has become more critical due to fentanyl’s high potency. Following treatment, an opioid user’s tolerance level will have substantially dropped, and the withdrawal caused by fentanyl appears more intense than that caused by heroin, Dockter said.
Even if a patient receives medicated treatment, fentanyl makes stabilization difficult, Roe said. Fentanyl leaves the body at an inconsistent rate, and the drug’s high level of potency makes it difficult for a patient to step down to even a heroin level of potency.
Fentanyl has also made Roe’s job harder because there’s “much more death now than there was,” she said. “A lot more people — when they come in to start care with me and I ask why they’re coming into treatment now — almost all of them come in with a story like, ‘My friend just died of an overdose.’”
Harm reduction keeps people alive until they receive treatment
Long wait times for treatment, combined with fentanyl’s potency, lead to the increased risk of deadly overdose.
“If you’re waiting even two weeks before treatment, what’s going to happen?” Roe said. “Because I can tell you, they’re not going to be doing nothing for two weeks. Their neurochemistry will not allow them to be doing nothing for two weeks.”
The lack of a safe drug supply in Wichita increases the risk of overdose, Roe said. Almost every patient Roe meets is on fentanyl — but not by intention. Even if someone’s preferred drug is heroin, they run the risk of purchasing something laced with fentanyl, Roe explained.
Harm reduction efforts could prevent overdose deaths, she said. Roe serves as a health care representative for Safe Streets in Wichita, a nonprofit coalition that advocates for policies that keep people with substance addictions who are not actively seeking treatment safe.
Harm reduction efforts are limited by Kansas laws, Roe added. Fentanyl test strips allow users to check whether a drug contains fentanyl, but these strips are currently considered illegal drug paraphernalia in Kansas and in about half of all U.S. states.
The Kansas Senate blocked a bill aimed at decriminalizing fentanyl test strips in May. Some lawmakers who opposed the bill said test strips might enable drug users and that anyone who wants to avoid an overdose should do so by avoiding drugs entirely.
Dockter called that absurd.
“If a diabetic was eating too much chocolate and they went into diabetic shock, they’re not going to necessarily shame that person,” he said. “With addiction though, people are just like, ‘Why don’t you just stop?’
“People are going to use,” Dockter added. “If we help them in the interim stay safe and not overdose and die, and then in six months, they can turn their life around.”
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