When people with an opioid addiction call Susan Whitmore's Kansas City non-profit, they're taking the first step toward recovery: admitting they have a problem.
So it's frustrating for Whitmore when people who have finally gotten to that point are stymied by what seems like a more straightforward step: finding a doctor who can prescribe drugs that are essential to many addicts quitting opioids.
According to a recent study, Missouri has very few medical providers with the federal permission needed to prescribe drugs like Suboxone. Whitmore, the president and CEO of First Call KC, said that makes it harder for groups like hers to get people help, especially if they don't have insurance.
"Even if someone might find a prescriber, they might not take them on as a patient,” Whitmore said.
Suboxone is the most common trade name among drugs that contain buprenorphine, a medication that eases withdrawal symptoms by delivering diminished doses of opioids.
Addiction experts say it's a necessary part of recovery for almost anyone who's been addicted for a long period of time. But buprenorphine also comes with a risk of abuse, and because the target consumers are addicts the federal government tracks it closely and requires doctors to get a special certification before they can prescribe it.
They need addiction treatment training to get the certification and then have to abide by strict record-keeping requirements with the U.S. Drug Enforcement Agency after.
The study published last month by Avalere Health, a Washington, D.C., consulting firm, found that the number of certified providers has not kept up with demand for addiction help as the number of opioid-related deaths grows steadily.
The problem is particularly acute in Missouri, which in 2016 had the nation's worst ratio of certified providers to opioid overdose deaths, with 286 providers and 919 deaths.
Randall Williams, the director of the Missouri Department of Health and Senior Services, said the state has more prescribers now, but there's still a shortage.
“It’s something we’re very committed to increasing,” Williams said.
Williams said he thinks "physicians and providers are intimidated by the whole process" of being a Suboxone prescriber, but in the long term more will become comfortable with it. In the short term, he said, telemedicine might be one way to get people the help they need.
Williams recently returned from a trip to Washington state to look into a company called Ideal Option. It has clinics in eight states staffed by nurses and physicians assistants who do in-person examinations, then connect via Skype or other videoconferencing programs with physicians who have the buprenorphine certification and can prescribe it remotely.
"It’s incredibly efficient,” Williams said. “We think in a state that’s as rural as Missouri, this has a tremendous potential and we’re in the process of trying to see if it would be a good fit.”
The shortage of Suboxone prescribers is less acute in Kansas, according to the Avalere study.
Stacy Chamberlain, the program director of Behavioral Health Group's Overland Park treatment center, said her company has one on staff and no waiting list for medication-assisted treatment.
But some are not that fortunate.
"Depending on the part of the state — western Kansas, of course, no, there aren't enough (providers)," Chamberlain said.
During a recent tour of treatment facilities, Kansas Lt. Gov. Tracey Mann said that would be something discussed by a new substance use task force established by Gov. Jeff Colyer. He said telemedicine might be part of the equation there, too.
Whitmore said it's a good idea, but only if the people getting Suboxone prescriptions are also connected to in-person counseling by qualified staff. She also said Missouri should create more incentives for addiction treatment for people who are uninsured or insured through government programs like Medicaid.
Whitmore said it can take up to five years for the opioid receptors in a person's brain to return to normal after addiction and during that recovery time they're at high risk for an overdose if they relapse because they will have lessened their tolerance.
“Especially if they’ve been addicted to opiates for a long time," Whitmore said, "it’s very difficult to sustain recovery.”