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Black Hills Doctor Offers Medication Assisted Treatment for Opioid Addiction

Mar 01, 2019 06:00AM ● By Alyssa McGinnis

By Alex Strauss

There is no longer any debate about the fact that America is in the midst of an opioid crisis. There are now more Americans addicted to these potent drugs - both nationally and in our own region - than at any time in history. But exactly how to address the crisis is still a topic of considerable debate.

Despite research suggesting that one in ten people will relapse after a combination of detoxification and psychosocial treatment, therapy and abstinence-based programs are still the most common approaches. But one treatment protocol is emerging as the gold standard for lasting freedom from opioid addiction: medication assisted treatment or MAT.

“MAT is basically utilizing FDA approved medications to allow a patient to not have the physical symptoms of their addiction while they go through counseling,” explains Regional Health family medicine physician Stephen Tamang, MD. Multiple studies of MAT have found that over 80 percent of patients maintain sobriety as long as they are on their medication.

Inspired by these success stories, and with Regional’s support, Tamang underwent the DEA-mandated training to become certified to prescribe Suboxone, the most common drug used for MAT, to his opioid-addicted patients at Regional Health Medical Clinic. [See Sidebar]

Meeting the (Unexpected) Need

MAT is highly regulated and MAT patients require significant time and resources, which is why, Tamang suspects, no one else in his region had ever tried to offer it.

“I have had colleagues say they would love to offer this but they are already booked out three months,” says Tamang. “And these patients require a lot of care. Many don’t have health insurance and federal guidelines mandate how often they should be seen, dosing, frequency of drug screens, handling comorbidities, etc. It’s not complicated, it’s just arduous.”

Under federal guidelines, a MAT provider can treat only 30 patients in the first year. That number jumps to 100 after a year. Physicians who have prescribed buprenorphine to 100 patients for at least one year can apply to increase their patient limit to 275.

This month, one year after Tamang treated his first opioid dependent patient, the MAT program at Regional Health has become so large that it requires five providers (each of whom will be able to treat 100 patients after a year), four nurses, a social worker, an administrator, and a lab tech to run it.

“When I started, it was primarily to help people get off of opioids. I was woefully ignorant of the number of functional heroin users in our area, many of whom had tried multiple times to quit,” says Tamang. Today, these street drug users make up about half of Tamang’s MAT practice while the other half are people addicted to prescription painkillers.

“These people are not criminals, but they can also be very protective, just like street drug users, because they know what happens to them when they go off their medication,” Tamang observes. “I had an older man tell me, ‘These drugs have made me steal and lie to my wife’.”

A Fast Growing Program

At first, Dr. Tamang offered MAT only at Regional Health Medical Clinic.

“As I started doing MAT here, it became obvious that one of the resistance points for patients was that they don’t want to do all the counseling,” he says. “But this is an integral part. So we realized that we needed to partner with counselors.”

With Regional’s blessing, a partnership was formed with Addiction Recovery Center of the Black Hills, a program with 16 drug addiction counselors. That partnership led to a two-tiered system called Project Recovery which offers MAT at both Regional Health Medical Clinic and the ARC.

As the program grew, its evidence-based approach caught the attention of the South Dakota State Department of Social Services Division of Behavioral Health, which has offered support, in the form of both funding and consulting.

Meanwhile, Tamang and his colleagues are working to get the word out about MAT. They have formed an alliance with social workers in Rapid City’s longstanding Cornerstone Rescue Mission to help identify addicted individuals who want treatment. Patients receive free transportation to and from treatment. The next goal is to get the work into the prison.

“This is the most fulfilling, rewarding work I’ve ever done,” says Tamang. “This takes people who are lying, stealing, or buying drugs and makes them functional again. I can’t tell you how many people have told me they got their kids back, got their job back, or saved their marriages.”

MAT patients are also screened for infectious diseases (Dr. Tamang has identified 5 cases of Hepatitis C) and are helped to get on Medicaid, if they qualify, for more consistent healthcare.

“The bottom line is that MAT works and it works best with a systems approach,” says Dr. Tamang. “I can tell you from personal experience that it is way harder to do this work on your own. You need some infrastructure behind you. But when you have great partners backing you, like Regional Health, Cornerstone, the ARC, and the state of South Dakota, you are able to make great strides.”

“It takes some efforts to get it set up, but once you do, it is a beautiful thing.”

What is Suboxone?

Suboxone is the brand name for a combination of buprenorphine and naloxone. Administered as a sublingual film, it is the most common drug used for MAT.

Buprenorphine is a long-acting, high-affinity partial agonist at the mu-opioid receptor. It prevents withdrawal and cravings and blocks other opioids from binding, preventing abuse.

There is a low risk of overdose with buprenorphine and it does not produce a high in the opioid dependent.

Combining it with naloxone (as in Suboxone) blocks the intranasal or intravenous abuse of buprenorphine. Buprenorphine is the only opioid authorized under the Drug Addiction Treatment Act of 2000 for the treatment of opioid use disorder.

Watch a video explaining more about MAT