GLEN ULLIN — Rhonda Schmidt provides a unique service in Morton County.
Since March, the family nurse practitioner at the Glen Ullin Family Medical Clinic has provided medication-assisted treatment for opioid dependence. The treatment has so far served about a half a dozen patients who come from Beach, the Dickinson and Killdeer areas, and Grant and Morton counties.
Schmidt said the treatment's availability in Glen Ullin, population 713, is important for people who can't commute regularly to Bismarck for treatment.
"It's not something I guess I'd ever thought about doing, but it's a challenging but rewarding type of a service," she said.
Elgin-based Jacobson Memorial Hospital Care Center, which operates the Glen Ullin clinic, also offers the medication-assisted treatment at the Richardton Clinic in Stark County.
Opioids were involved in about 67% of the more than 70,000 drug overdose deaths nationwide in 2017, according to the Centers for Disease Control and Prevention. North Dakota had 68 drug overdose deaths in 2017, down from 77 in 2016.
Schmidt started in October 2018 at the clinic in Glen Ullin after working at the Richardton Clinic. At the time, she was researching pain management and noticed a trend.
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"As I got into the pain management, I realized that a lot of these people are not using the medication for managing their pain -- it's an addiction," the Glen Ullin native said. "And I was hoping then by treating the pain management, I could also try to help those that were addicted to it and would benefit from the Suboxone."
Suboxone is a prescription drug that contains buprenorphine, which helps curb opioid cravings.
Qualified patients must be in withdrawals at the time of starting medication-assisted treatment. They will meet with Schmidt every two or three days for about a week until they reach a "maintenance" period, she said. The length of treatment depends on the patient.
Schmidt is one of about 120 buprenorphine prescribers in North Dakota and the only one in Morton County, according to the U.S. Drug Enforcement Administration's Omaha Division.
Prescribers must undergo training to become registered through the DEA and the Substance Abuse and Mental Health Services Administration to provide the drugs containing buprenorphine because it's a federally controlled substance. The prescribers are limited in how many patients they can take on. Schmidt is limited to 30.
Small and rural communities aren't immune to the opioid epidemic, said Bill Stockmann, diversion program manager for the Omaha Division.
"The trend for more rural areas is, I think, the opioid crisis is making these small towns and counties more aware that they do have people living in their communities that are addicted, either to heroin or to prescription medication, and that the treatment is needed," he said.
Rural areas shouldn't be an unexpected place to find treatment options, according to Pamela Sagness, director of the North Dakota Department of Human Services' Behavioral Health Division.
"I think it speaks to the awareness that addiction affects everyone and that we really are normalizing and reducing the stigma associated with addiction," she said.
The 2019 Legislature passed a law authorizing "medication units" for North Dakota's licensed opioid treatment programs to increase access in other communities, such as rural areas. Those programs are in Bismarck, Fargo and Minot. They offer more services, such as counseling and assessments, along with treatment.
"We're really hopeful that the three opioid treatment programs will consider creating those medication units based on where they have clients that are driving far distances," Sagness said.
Schmidt has seen about 90% success in her patients. She keeps in touch with Dr. Melissa Henke, the medical director of Heartview Foundation in Bismarck, who she said has been helpful for guidance.
Heartview, which has an opioid treatment program, has worked with other rural clinics throughout North Dakota to help them get started in prescribing buprenorphine, according to Henke.
"We just want to make sure that they have all of the information before they get started so that they're confident and comfortable," she said.
Other rural buprenorphine prescribers in North Dakota include ones in Beulah, Cando and Carrington. Improving access to medication-assisted treatment has been important in mitigating the opioid epidemic, Henke said.
"I just think what Rhonda's doing out in Glen Ullin is fantastic," she said.
Reach Jack Dura at 701-250-8225 or firstname.lastname@example.org.