The Journal of the Arkansas Medical Society Issue 6 Volume 115 | Page 8

regularly attending therapy and regularly attending
some type of community-based support group –
Narcotics Anonymous, for example.
“One of the largest longitudinal studies ever
conducted in the United States, The Adverse Child-
hood Experiences Study, is considered the gold
standard when it comes to trauma and trauma-
related care in this country,” explained Vega. “Re-
searchers in this study found a significant correla-
tion between underlying psychological or emotional
trauma and substance use. If you’re only going to
address the substance use with medication, you’re
not addressing the underlying issues that contrib-
ute to their use.”
• Stockton Medical Group is based in North
Little Rock, with clinics in Hot Springs, Texarkana,
Fayetteville, and Jonesboro. Doctors like Charles
Cale, MD, use Suboxone ® in their treatment. “We
use the pills and the strips,” he said. “The patient
comes in and has a drug screening, sees the coun-
selor, and then they come see the doctor to get
their scrip, and they’re off for a month.”
Excerpted from AMA Opioid Task Force report at end-opioid-epidemic.org. Used by permission.
tion. “There are few in the state who are providing
MAT, so many of our patients drive hours for treat-
ment and others never seek treatment because of
these barriers to care,” said Michael J. Mancino,
MD, program director for CAST. A board-certified
psychiatrist, Dr. Mancino also serves as medical di-
rector for Recovery Centers of Arkansas. For more
than a decade, he has provided MAT – previously
at the VA and now at UAMS. In addition, Dr. Mancino
helps other physicians through his direction of the
MATRIARC (Medication Assisted Treatment Recov-
ery Initiative for Arkansas Rural Communities) pro-
gram. (See resource listing at article’s end.)
• ARcare began in 1986 under the mission
of Steven Collier, MD, to serve “the least, the
last, and the lost.” Now one of the largest feder-
ally qualified health centers in Arkansas, it serves
patients, regardless of their ability to pay, in 44
family practice clinics around the state. A primary
care-based organization, ARcare employs more
than 60 physicians, physician assistants, and
advanced practice nurses and consults with Dr.
Shelby (an interim position) for its MAT patients.
Prescriptive authority for MAT patients also comes
from Sharon Meador, MD, (Little Rock) and Todd
Anderson, APRN (Searcy). ARcare is currently in
the process of opening a third MAT program in
Jonesboro. ARcare, dba as KentuckyCare, also
provides MAT in partnership with Four Rivers Be-
havioral Health and KentuckyCare’s medical di-
rector John Brazzell, MD, serves as the prescriber.
The FQHC approach to care became possible
because of funding through the Health Resources
and Services Administration. “A couple of years
back, HRSA released funds and encouraged FQHCs,
because we are in rural areas, to begin providing
opioid treatment,” said ARcare Director of Behav-
ioral Health Frank Vega, LMFT. That encouragement
led ARcare to a partnership with and adoption of
the Hazelden Betty Ford treatment model, COR-12
(Comprehensive Opioid Response with the Twelve
Steps), which employs Suboxone ® treatment and
counseling services.
While MAT must, by law, include some mea-
sure of counseling and behavioral treatment, clinics
vary in what they require and offer. ARcare believes
in stringent counseling requirements for patient’s
best interests. “We require all patients involved
in our program – before they see a physician – to
see a social worker or counselor. They go through
a complete behavioral assessment to determine
if they’re appropriate to receive MAT and willing
to participate in required activities. We require
128 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
In addition to Dr. Cale, the Fayetteville clinic
employs four physicians – one a psychiatrist. “We
each have a cap of about 275 patients per doc-
tor, and we’re all nearly capped out,” explained
Dr. Cale. “It starts with 30 the first year. It used to
go up the second year to 100, but that has gone
up. I don’t why there’s a cap. There’s a real need
for this treatment.”
The in-house counseling is a mandatory part
of each patient visit at Stockton Medical Group.
“Our patients can also come in for counseling any-
time they need to between visits,” added Dr. Cale.
“It’s a big part of treatment, because’ there are two
addictions going on – one physical, one mental.
The mental morphs into a disease.”
• Quapaw House, Inc. is a comprehensive
behavioral health organization that provides resi-
dential and outpatient MAT to patients with alco-
hol and drug addictions (largely opioids). The clinic
utilizes a variety of buprenorphine-naloxone medi-
cations – the most common being Suboxone ® –
based on each patient’s situation. “We utilize Sub-
oxone ® strips [in most cases of OUD], but Subutex ®
is used for pregnant woman or people with a bad
reaction to naloxone,” said CEO Casey Bright, who
went on to share additional situations and suited
medications used by the clinic.
Quapaw House has also developed a primary
care clinic in recent years. “It allows our clients to
have primary care practitioners that understand
addiction in general as well as their own journey
into recovery,” explained Bright. “Quapaw’s MAT is
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