CODA opened an opioid treatment clinic in Seaside in January. The Signal spoke to Alison Noice, CODA’s executive director, about how the clinic has adapted during the coronavirus pandemic.
Q: When you opened up in Seaside, did you have any idea you’d be facing a pandemic less than two months later?
Noice: No idea. I have been with CODA for 10 years in April, and I took on the executive director role in September of last year. So I was joking with our former executive director, “Nobody told me leading an organization through a pandemic was listed in my essential job duties.” We’re actually faring pretty well.
Q: When the Seaside CODA facility opened, did you immediately draw patients, or did it take time to get off the ground?
Noice: We had our own goal to hit 100 patients in the first 90 days. COVID slowed us down a little, but this week we should hit that 100-patient admission mark.
Q: Is that 100 patients a day, or overall?
Noice: It’s 100 patients overall. It’s every day the clinic is open, which is six days. Our hours are 5:30 a.m. to 12:30 p.m.
Q: By midday the clinic is closed?
Noice: An opioid treatment program is really designed to minimize the intrusion in day-to-day life. That’s why the clinic tends to be open so early, so people who come to us get that out of the way and go on being functioning members of society.
Q: How many staff members work at the Seaside clinic?
Noice: At last count 14, 15. At any given point there’s someone at the front desk, a couple of nurses, a nurse practitioner, counselor staff.
Q: How are medicines administered?
Noice: An opioid treatment program administers any kind of medication that has been approved for the treatment of opioid abuse disorders. Buprenorphine is an oral medication. It’s a quick dissolving film. Methadone is sometimes in tablet, but almost exclusively liquid. Then there’s a third medication that we offer, an injectable long-acting medication called Vivitrol. It’s a medication people only have to take once a month.
Q: When did the pandemic start impacting clinic operations?
Noice: The week of March 23 is when we got the message from the federal government that our opioid treatment programs had to start adjusting medication protocols so people would come in less. We started pulling back on the volume of some of our group services. Those first three or four weeks were pretty rapid fire. We then started implementing what I call our “dose-to-go protocol.” The Center for Substance Abuse Treatment and the DEA (Drug Enforcement Administration) in concert define how much medicine the patient can take away from the clinic. The word came down we needed to make temporary adjustments to those orders so people could receive permission to take more medicine away from the clinic and see us less frequently.
Q: Is that working?
Noice: There are concerns about whether or not patients can safely manage weeks worth of medications at a time. We had to make thoughtful decisions to balance the safety of the patient, the safety of the clinic, but also the safety of the community. We wanted patients to have to be in the clinic less. But we wanted to make sure they could manage the medicines safely and that they weren’t risking the community.
Q: Have they been responsible?
Noice: Yes. They have. In Seaside, because the (building) space is so large, there are still a number of patients who see us three times a week. That’s given us plenty of opportunity to space them out during the day. We didn’t loosen the grip too much.
Q: Is this an especially trying time for people with abuse concerns?
Noice: Absolutely. If you think about what we know about substance use disorders and the core tenets of recovery, what’s happening right now is an increased separation from people, an increase in isolation. That separation and that isolation are pretty substantial triggers for a lot of problems: for mental health struggles, interpersonal violence, substance use and misuse. Recovery is a very social process. For the providers not to be able to have the kind of contact we’re accustomed to and to not have the resources we typically would be helping our patients rely on, it’s unnerving for a lot of us. As providers, we feel much more helpless. Treatment of substance use disorders is difficult in normal times.
Q: Do you see any special issues that have come up in this period?
Noice: We have a lot of folks who, if they’re not homeless, are insufficiently housed. Resources are slim all around. We’re relying on technology right now and I don’t believe our patient population has good access to technology. There was already a gap between the people who had resources and the people who didn’t. I’m worried that gap will widen now. We’re working very hard to adjust.
Q: How is your staff holding up during the pandemic?
Noice: We employ almost 300 people across all of our different programs. Over and over I have been impressed by what an amazing group of people work for this organization, their commitment to our patients, and really focusing on how do we keep the work happening, how do we stay available for our patients. It’s been quite beautiful through a really challenging time.
Q: Have you felt a financial impact?
Noice: The reality is the way our services are reimbursed, we rely on things like group counseling. We rely on a higher level of engagement with our patients. What this will ultimately to do to the organization financially is still a question mark.
Q: What are you looking forward to in Seaside?
Noice: As far as Seaside and the North Coast community goes, we’re focusing on getting our roots established, growing our partnerships with local hospitals and the public health department. I think we can use what we’re learning right now to get even better at engaging people who need us.