Amherst doctor among first to use drug implants to stem opioid craving

Jamey Summers of Northampton is in a good mood for someone about to have surgery. He is sitting in an exam chair in Dr. Kate Atkinson’s office in Amherst while the doctor and her staff go over the procedure. They will insert four small rods containing drugs to curb opioid dependence into the crook of his left arm. Atkinson has never done it before.

“Ouch!” Summers, 41, exclaims as the doctor uses a black marker on his skin to show where the rods will go, but his grimace quickly turns to a smile. “I’m kidding.”

Atkinson is in a playful mood, too. “Do not drop these on the floor,” she says, ribbing her two clinical assistants as they pass her the implants. “They cost about $1,000 each.”

Summers, a building contractor, is happy because his days of having to go to a pharmacy to get his medication are over. That process, he says, has been hard, with him coming away feeling frustrated and stigmatized.

“I’m a stable patient that has a great background and I go into the pharmacy and it’s always a problem getting this (prescription) filled,” Summers said in an interview before arriving at Atkinson’s office. “They make up rules and they tell you some made- up rules. You go up and research on the laws and they aren’t really the rules.”

The implants, called Probuphine, were approved by the FDA in 2016. They contain the opioid dependence treatment drug buprenorphine and release it in a slow, steady dose over the course of six months. The rods are then replaced as doctor and patient deem necessary.

The rods are designed to be used in patients who are already stable with low-to-moderate doses of buprenorphine, which is found in oral addiction treatment medications like Suboxone.

Opioid-related deaths have risen sharply in Massachusetts, with an estimated total of more than 2,100 in 2016. That’s more than triple the approximately 650 deaths in 2011 and an increase over the previous year, when about 1,800 people died, according to state data.

Buprenorphine is seen as a lifesaver. But with the state exerting stricter controls over opioid prescriptions, people like Summers have found trips to the pharmacy difficult.

One of the tools Massachusetts has been using to stem abuse of prescribed opioids is a prescription drug monitoring program — a computer database of all prescriptions, who is prescribing them, filling them and taking them. With the opioid crisis worsening in recent years, control over the process and how doctors are prescribing the drugs has tightened.

As of last month, there were more than 290,000 people receiving Schedule II opioid prescriptions, the strongest legal kind. That’s about 4.3 percent of the state’s population, and a sharp decline from 2014, when 10.9 percent of the state’s population was being prescribed such medication.

The success of the monitoring program can be seen in the number of patients who were marked as being individuals with activity of concern, which includes getting multiple prescriptions from different pharmacies in a short period of time. There were 250 of these from April through June of 2017, a small fraction of the nearly 10,000 people with concerning activity during the full year of 2014, according to the data.

But for people like Summers, who depends on medication to curb an opioid addiction, this aggressive monitoring program has put him on the defensive. He knows first-hand that opioids are dangerous, but wishes drugs like buprenorphine would be seen as the life-savers they are. “It shouldn’t be grouped in with those medications, and we suffer because of that,” he said.

Pharmacist Paul Serio at Serio’s Pharmacy in Northampton — who is not Summers’ pharmacist — notes that with the stricter guidelines opioid prescriptions do take longer to fill. There is a careful balance to strike when dealing with addictive medication, he says.

“Guidelines are in there for the safety of the consumer, but a patient shouldn’t feel that they are being blocked,” he said.

With the state’s tightened drug monitoring program, pharmacists now have to log prescription data into the system within 24 hours of filling one. Doctors also are restricted in the amount of medication they can prescribe.

“If you go to a dentist, if you’re 18 or younger, you can’t get more than a three-day supply (of pain pills),” Serio said. “If you’re more than 18, no more than a seven-day supply.”

Back in Atkinson’s office, Summers is waiting for the anesthetic to kick in.

“They choose the most sensitive part of your body to put them in, but it’s OK,” he says, adding that the results will be worth the discomfort.

It’s taking longer than expected, so Atkinson asks physician assistant Charles Milch to give Summers a second shot.

“I wanted to learn how to do this so I went to Atlanta and learned all about it,” she explains as the wait continues. “We just didn’t have anybody it seemed appropriate for at the time. All of a sudden, Jamey decided he really wanted it.”

Summers says he became dependent on opioids in 2012 after first being prescribed Percocet for kidney stone pain and then, a short time later, for a back injury.

“What happens is you find out once you stop, you still need them, man,” he said. “You get sick, and you get low, and you get desperate.”

Summers says he never tried heroin, a drug many who get addicted to opioid pills turn to, but his dependency on the pills scared him. His cravings were like intense pangs of hunger.

“I was embarrassed to go and get seen,” he said. “I’m middle class and made good money and I hadn’t spent a day in a crack house or a slum, and here I am asking about this stuff.”

Summers was living in Pittsburgh at the time, working as a real estate agent. He says his trip to a shady clinic there to get a prescription was his wake up call. He paid the receptionist $100 cash, had what he was told was an MRI and left with a prescription. The doctor who ran the clinic was subsequently arrested, and it was then that Summers decided he had to kick his habit.

“I can’t afford a criminal record,” he said. “I don’t have one and I don’t want one and that’s that.”

Summers, who is married with a young daughter, called his mother, who took him for his first addiction treatment appointment.

Since then he has tried many maintenance medications, with Suboxone being the best for him.

It “saved my life,” he said.

Summers’ arm is finally numb and Atkinson begins. She slides a shoelace-shaped applicator under his skin and says she’s pleasantly surprised how smoothly the rod goes in.

One by one, she places the four white rods, about an inch-and-a-half in length, into place through a small hole in the crook of Summers’ elbow. She says with a smile that she can feel the rods drop out of the applicator as they are put into place.

“We practiced on sides of pork, and you’re much better behaved,” she says to Summers.

She bandages him up — no stitches — and tells him to keep the bandage in place. Will it be sore? Summers asks.

“It could be sore,” Atkinson answers. “Just take some morphine — kidding!”

Atkinson, who believes she is one of the only local doctors certified to perform the Probuphine implant, says it is good to have primary care doctors perform the implant surgery, because they know their patients’ full stories and can be good judges of how well they will do.

It’s been the same for prescribing oral opioid treatment medication.

“I’ve been watching Suboxone save lives literally,” Atkinson said. “A young woman whose life was a total disaster — she was shooting heroin, and had been in jail, and thrown out of her house — I worked with her using buprenorphine. Over years going to (Alcoholics Anonymous) and getting help, she got off of everything.” Eventually the woman got herself a high-paid job.

“I tend to be cutting edge; I like trying new things,” Atkinson said of her decision to learn the Probuphine implant procedure. “This felt like it would fit in as a good tool.”

Atkinson says she hears other patients, like Summers, say that having to go to pharmacies to get the medication to control their drug dependency is humiliating.

“Jamey wants people to know that there are normal people who have these issues,” she said.

State Rep. Peter Kocot, (D-Northampton), is the House Chairman of the Joint Committee on Health Care Financing. He believes Probuphine implants are an exciting direction for opioid treatment.

“You don’t have to take a daily pill and it can’t be diverted easily,” he said. “That is the problem with Suboxone. Folks have been known to sell the pills.”

One thing Kocot says he has learned through his work on the issue is that opioid treatment is unlikely to be successful when the focus is on abstinence and 12-step programs. Research is showing that a good percentage of the addicted population needs opioid treatment medication to stay off the harder opioids. That’s another reason to be excited by implant treatment, he says.

Summers himself calls the medicated implants “the holy grail.”

“It’s hands off, you’re getting your dose every day, you never forget to take it,” he said. “Kids can’t get into it; people can’t steal it; you can’t lose it. I think it’s the future of pain and addiction.”

Dave Eisenstadter can be reached at deisen@valleyadvocate.com.