Rx Appalachia by Buer Lesly-Marie;

Author:Buer, Lesly-Marie;
Language: eng
Format: epub
Publisher: Haymarket Books
Published: 2020-03-15T16:00:00+00:00

She was told to take bupe daily, but she prefers to take it on an as-needed basis to help control anxiety and stress, which is exactly what she does. This gives her some control over her life, she feels; she stores some of the bupe so that she will have a supply in the event that she is unable to get it regularly. Perhaps those who favor highly controlled bupe consumption would say Star’s method reduces her chances of successfully ceasing illicit drug use. Star has been removed from chaotic and harmful drug use for years at this point, so maybe not. What it does show is that people do not trust that they will have continued adequate access to MAT?

Programs

At the time of my fieldwork, it was nearly impossible to pinpoint a bupe program’s structure because of constant shifts. Some programs opened and closed repeatedly without warning. Requirements at other settings changed sporadically. This chaos was caused by consistently changing reimbursement rates and government buprenorphine regulations and should be unsurprising considering bupe’s relative novelty and quick uptake across the country.

Prescribers must undergo SAMHSA training and be specially licensed with a DEA number to provide buprenorphine. Providers may only have up to thirty patients at one time in their first year of prescribing. In the second and subsequent years, providers may apply to SAMHSA to qualify to have 275 patients. The DEA can audit providers at any time to ensure that they are serving only their limit and are prescribing legitimate doses. All Kentucky clinics have drug testing and a behavioral modification component as mandated by the Kentucky board of licensure. This mandate reflects federal clinical guidelines. Some clinics hold twelve-step groups to meet the behavioral modification requirement. Others provide individual therapy sessions, billing either individuals or insurance companies for these sessions.

Both of the clinics I visited required clients to attend individual counseling sessions and provided case management services, such as assistance in finding housing. Case management is limited due to fickle policies and lack of insurance reimbursement. One buprenorphine counselor spent about thirty minutes with each client from once a week to once a month, depending on how long and how successful a client has been in the program. She mainly provides cognitive behavioral therapy.

Cognitive behavioral therapy asserts that such mental health concerns as anxiety and depression result from particular negative thought and behavior patterns within the individual. These negative mental paths are disordered in that they are not changed, even when presented with contradictory information. Thus, cognitive behavioral therapy is focused on making implicit ways of thinking explicit, analyzing thought and behavioral patterns, and altering mental models to result in more positive thoughts and behaviors.15 This type of therapy can be practiced in many types of ways; one counselor I spoke with said she focused on relaxation techniques to prevent anxiety and negative thoughts. While alterations in thinking and coping may be useful, relying on individual therapy as the only ancillary service to bupe continues the focus on the individual without altering the environment that produces individual experience.

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