Maggie McKay (Host): How much do you know about OUD or opioid use disorder? Have you ever even heard of it? Well, today, physician assistant, Randi Kent, will tell us about Clean Slate and how they treat OUD.

 Welcome to Stoughton Health Talk from Stoughton Health. I'm your host, Maggie McKay. Randi, thank you so much for joining us today.

Randi Kent, PA: Yeah. Thank you for having me.

Host: So, let's just start with what is OUD?

Randi Kent, PA: OUD or opioid use disorder is a chronic brain condition, and I'm really glad you asked that, because I think a lot of people assume it's a willpower condition, right? But it is actual chronic brain disease where people use opioids despite what it's doing to their life.

Host: And what are opioids? Like, where are they found?

Randi Kent, PA: Yeah. Opioids can be found really from a prescription from a doctor. They have common names, as Vicodin, hydrocodone, oxycodone. Lately, in the news, fentanyl, heroin, all of those fall under the realm of opioids.

Host: And what are the treatment options available and suggested?

Randi Kent, PA: Treatment options have a wide range. And I think at Clean Slate here, we focus more on the outpatient side, which I usually talk about a little bit more, but there is a residential side. So, if someone has severe opioid use disorder, sometimes they have to go into rehab. As some people say, that's residential. There are different programs, such as IOP and PHP, which are also partially inpatient, partially outpatient, depending on which one you get into. I could talk about that for hours.

But mainly, outpatient-wise, you know, I see patients in my clinic. There are two medications approved for opioid use disorder that are either opioids or partial opiates. And then, there is one medication, which is a blocker. So, mainly at Clean Slate, I prescribe those, and then we refer out for therapy. Those medications are used to treat opioid use disorder, and many patients do extremely well with those.

Host: And you mentioned the outpatient. How long does that take generally? Is everyone different?

Randi Kent, PA: Yeah, that's a great question, and probably the number one question I get a lot of the time on a first visit. There's no minimum, there's no maximum time. Now, when we see someone in our clinic, I will typically recommend about a year of stability or sobriety before we talk about tapering off these medications. Suboxone in particular is probably the number one medication I use nowadays with the fentanyl epidemic. That one, you become dependent on, so you will feel withdrawal without it. But the nice thing about that one is you don't develop a tolerance. So, I have some patients that are on that medication for, you know, five or 10 years. And I have patients that want to be on it for six months and talk about tapering, but there's pros and cons to those. The research mainly says about a year or two before we start the tapering process, but that's not a hard and fast rule.

Host: So, it's definitely a journey. How can we as a community address the stigma of OUD?

Randi Kent, PA: Yeah, stigma. Stigma is huge with people in community, in recovery, people that have no idea what opioid use disorder is. I think a lot of people assume those that use opioids are choosing to do that, or they don't want it enough to be sober. And I think just knowing that this is a condition, we do have diagnostic criteria for people to get diagnosed with this. I compare it a lot to diabetes. So, diabetes is a medical issue, but we don't lock everyone in a room with a treadmill and vegetables and say, "Okay, take care of it," whereas we're not going to tell people with opioid use disorder, just go to meetings and therapy and you'd be great. Some people do super well with that, just like some people with diabetes do super well with the lifestyle changes. But we're lucky enough to have these medications to help treat opioid use disorder. And I'm lucky enough to use them in my everyday practice. That's the one thing I'd say to people, is this could be, you know, your brother, sister, cousin, doctor, that's coming in for these conditions.

Host: Right. And you kind of touched on this. But for in-treatment, how long is it recommended to stay in treatment? You said like, what, a year or two?

Randi Kent, PA: Yeah. Typically, in-treatment in our practice, we recommend at least a year, but it does depend on the person. So, someone can choose to get off of medication sooner, can choose to stay on medications longer. That year is not hard and fast. As far as meetings, therapy, kind of outside resources, that's really dependent on what that person is okay with. Some people love to have that recovery circle until the end of their life, and other people really want to focus more on other tasks of life and put that on the back-burner. It really depends on how well the patient is doing.

Host: Randi, what's the demographic of your patients that you see?

Randi Kent, PA: Oh, gosh. Probably not what most people would expect. My demographic can range from someone that's struggling with housing issues to someone that's unhoused. It can range to someone that is a CEO of a company. I have 18-year-olds, I have 70-year-olds. It really is a wide range. And I think that's really important to note too, is unfortunately opioid use disorder does not discriminate on who is affected by this.

Host: And just to be clear, you said a lot of people assume that people are choosing to take opioids, but you treat anybody no matter what the origin of taking them is, correct?

Randi Kent, PA: Correct. So, some people are predisposed to this genetically. Some studies say that genetics play a role. Other people suffered unfortunate trauma that predisposed them to have an opioid use disorder problem. And other people, like many of the documentaries out nowadays, were prescribed, you know, oxycontin as a prescription, where this was okay because it was from a prescription, when in reality this led to feeling sick or reaching to the street to some substance that people say they would never try. It doesn't really matter how you got there. At the end of the day, if you have opioid use disorder, we will treat you.

Host: In closing, is there anything else you'd like to add that we didn't cover for somebody considering looking into treatment?

Randi Kent, PA: I would just say if you're even questioning whether you should reach out for help, or if you're questioning if a family member maybe is struggling with this, reach out. At Clean Slate, we can get you in very, very quickly. And just because you come here, it doesn't necessarily mean that we're going to start you on a medication right away.

If you'd like to talk about the problem and get a diagnosis or not get diagnosed with this, come on in. We have openings right away. I'd be happy to talk with you. I love my job. I love helping people, and we can't help you unless you reach out. So, do not be afraid. We are a no-judgment zone, judgment-free zone, I think people say, so feel free to reach out whenever you're ready.

Host: Thank you so much for sharing your expertise and explaining it so understandably.

Randi Kent, PA: No problem. Thank you for having me.

Host: Of course, again, that's Randi Kent. For more information regarding Clean Slate, visit cleanslatecenters.com. And for more information on a variety of health-related topics, visit stoughtonhealth.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Stoughton Health Talk, a podcast from Stoughton Health.