For 16 years, prescription opioids ruled Jo Pagel’s life. From 2001 to 2017, she battled cancerous tumors in her breasts, lymph nodes and uterus while fighting an addiction to OxyContin.
“I didn’t know a thing about it,” Pagel, 63, said of the drug, which was prescribed to her in 2001 to quell pain from her cancer treatments, surgeries and neuropathy in her hands and feet. “I just knew I wanted to beat my cancer. Whatever my doctors told me I needed to do to beat my cancer, that’s what I was going to do.”
Pagel has since beat cancer three times and retired from a 35-year career teaching physical education for the Rapid City School District. But her struggles with OxyContin continued until another drug, now being offered in Rapid City, helped her kick her addiction.
In late September, the Addiction Recovery Centers of the Black Hills held Rapid City’s first complete medication-assisted treatment (MAT) clinic.
Alongside traditional addiction treatment like counseling, doctors in the clinic with a special certification also have the option to prescribe patients Suboxone, a drug crafted to lessen the effects of opioid withdrawal, give users a very slight high meant to kill cravings, and block certain brain receptors, preventing patients from getting a real high should they relapse. It’s the first center in Rapid City to offer the full range of MAT, with counseling and the administering of Suboxone under one roof.
Doug Austin, CEO of the Addiction Recovery Centers at 1520 Haines Ave., said MAT is for people who have "tried pretty much everything" to beat addiction and still come up short. Austin understands the difficulty, too. A Vietnam War veteran, Austin struggled with alcoholism for decades and even relapsed after a nine-year stint of sobriety before finally putting down the bottle for good.
In-patient rehab and counseling helped Austin get to where he is today. Medication-assisted treatment and counseling — the recovery center offers Cognitive Behavioral Interventions for Substance Abuse and Moral Recognition Therapy, two different behavioral treatments for addicts — Austin believes, are even more effective.
“It’s our job to change the way they think," he said. "You change your thoughts, you change your world. I’m a firm believer in that.”
He's also a firm believer in the man running the center's MAT program, Dr. Stephen Tamang.
“He really has a real drive for helping people with opioid and heroin addictions," he said of Tamang. "I lucked out when I got him.”
Tamang is a family physician for Regional Health and one of just two doctors in Rapid City who can prescribe Suboxone and currently use it in a MAT program. The other, Troy Thompson, is a physician’s assistant who works alongside Tamang at the center.
“It’s a real elegant drug,” said Tamang of Suboxone, explaining that it attaches to the same brain receptors stimulated by opioids, killing cravings. "When you give people a tool where they don’t have cravings anymore, it’s like not being hungry anymore. You’re probably not going to binge eat if you’re not hungry.”
Pagel’s take on Suboxone is a bit simpler.
“It was a gift,” she said.
Pagel began using Suboxone in mid-2017 when Tamang was just beginning MAT in a Regional Health program that didn’t offer counseling and other behavioral health treatment now being offered at the recovery center. Tamang characterized Pagel as a perfect patient and one of Rapid City’s first and best success stories for MAT and Suboxone. There’s the potential for thousands of similar success stories in Rapid City, Tamang said.
“There are so many people that are addicted to prescription narcotics, it’s ridiculous,” he said. “Highly functioning people. Those are the people that I feel like we could get to and help. They don’t have the stigma of being a drug addict, but they know they have a problem and this would be a wonderful tool for them. I think you could hit thousands of people in Rapid City and it would help immensely.”
That’s not to say Suboxone and Naltrexone — used to treat alcoholism in the recovery center’s MAT program — make overcoming addiction easy.
“I had withdrawals. I had the whole shebang,” Pagel said. “It plays tricks with your mind. I was really depressed. I didn’t understand why.”
Pagel had moments of paranoia where she thought everyone was talking about her, or that people didn’t like her. She had trouble concentrating, felt nervous, shaky and had trouble dealing with things logically and rationally. Those issues, she said, still crop up “once in a while.”
But Pagel stayed the course with an eye to the future.
“I just knew I wanted to be around to see my grandchildren grow up so I needed to get off of it,” she said. “I was afraid what it was going to do with my brain.”
Pagel stopped using her prescribed OxyContin pills on June 29, 2017, and began taking Suboxone twice daily. Slowly, she was weaned off Suboxone until Sept. 25, 2017, when she took her last dose.
“I never abused it, but I knew when I had to take it,” she said. “If I didn’t, I was trouble. This is a recovery. It’s a long process. I’m still dealing with it. I’m finding things out about my body that I didn’t have for 16 years.”
But not everyone is sold on Suboxone, which is actually two drugs: Buprenorphine and Naloxone. Buprenorphine is a powerful opiate that, in its small dosage in Suboxone, produces a mild high meant to kill cravings. Naloxone blocks the brain receptors triggered by opioids, effectively preventing a person from getting a real high should they relapse or a stronger high should they abuse Suboxone. Naloxone also induces symptoms of withdrawal when Suboxone is abused and its opioid-blocking effect means it’s also used to resuscitate people from opiate overdoses.
Critics characterize the administering of Suboxone as effectively giving addicts opioids to fight an addiction to opioids. The abuse of Suboxone, often intravenously, and illicit sale can also be a problem for some, as can the detox from Suboxone, which can last months compared to the weeks it takes to detoxify from OxyContin or methadone.
Further, Buprenorphine is known to cause withdrawal symptoms similar to opioid withdrawal when users are taken off the drug. The paranoia, confusion, anxiety and mood swings Pagel described are some of the most common withdrawal symptoms from Buprenorphine.
“Depression really set in,” Pagel said. “Depression was probably the biggest side effect.”
But it’s tough to argue with some of the numbers. In one study — the first randomized large-scale clinical trial testing the effectiveness of Suboxone — approximately 49 percent of participants reduced their abuse of prescription opioids when using it for at least 12 weeks. When people ceased using Suboxone, that rate dropped to 8.6 percent. Tamang said he has read other studies where the success rate was close to 80 percent.
“I would probably still be on OxyContin because I know I couldn’t have done it by myself, and I don’t know where I would have turned,” Pagel said.
Though the Addiction Recovery Center’s MAT clinic is still in its infancy, Tamang already has expansion on his mind.
“I think it will grow quite a lot,” he said. “We are going to take as many people as we can and expand as appropriately as we can to try the meet the need of this community because nobody else is doing it.”
If he ever needs to point toward an example of success, Tamang said he knows where to turn. Pagel is ready and willing should the moment ever arrive.
“I hope I can give someone some hope that they can kick it, too,” she said. “I’m not embarrassed about it. It was something that happened to me. I took ownership of it. I really felt that I was making the decision and he [Tamang] was going to help me. I could not have done it without his help.”