A Look at America's Opioid Crisis: Iowa

Andrea Steen at an appointment with her substance abuse coordinator in Marshalltown, Iowa. She is taking Suboxone to mitigate her cravings, a treatment she heard about from a Facebook friend in Tennessee. “She could tell when I was high,” Ms. Steen said of her online friend. Credit Scott Morgan for The New York Times

MARSHALLTOWN, IOWA

HELP MAY BE THIN ON THE GROUND

Andrea Steen is one of the fortunate ones. For people in this rural community of 28,000 in Iowa, getting medication to help overcome opioid addiction used to require long drives to treatment centers.

That changed about a year ago when two doctors in Marshalltown were licensed to prescribe Suboxone, a drug that eases withdrawal symptoms and helps keep opioid cravings at bay. Now Ms. Steen is one of their patients, coming once a month to check in and renew her prescription.

This epidemic is different from those of the past in significant ways. One is that it has spawned a growing demand for medications that can help modify addiction’s impact.

One of them is naloxone, known as Narcan, a powerful antidote that has jolted hundreds of overdosed users back to life. Another is buprenorphine, typically sold as Suboxone.

By keeping users from experiencing cravings and withdrawal, Suboxone can make it easier for addicts to stay off heroin and other opioids. The number of doctors certified to prescribe buprenorphine has more than doubled since 2011, to about 36,000 from about 16,000, according to the Substance Abuse and Mental Health Services Administration. Yet the drug remains out of reach for many rural Americans.

Ms. Steen, 46, is among 20 patients who get Suboxone from the two doctors authorized to prescribe it in Marshalltown. Until last summer, she said, she abused Vicodin and morphine relentlessly. She would steal them from her disabled husband, who would try in vain to hide them. But sometimes she couldn’t root out the pills fast enough, and she would experience what every addict dreads most: withdrawal.

She heard about Suboxone from a friend in Tennessee whom she met through Facebook.

“She could tell when I was high,” Ms. Steen said. “Her husband was on Suboxone. She was trying to help me.”

Ms. Steen started on Suboxone in July, initially making weekly visits to Dr. Nicole Gastala and Dr. Timothy Swinton, the family practitioners here who prescribe the drug. Then it was every other week.

Unlike methadone, which also helps treat opioid addiction but must be taken under supervision at special clinics, Suboxone can be taken at home. Some doctors fail to follow Suboxone patients closely, or to test their urine to make sure they are not abusing or selling the medication or using other drugs. But the protocol here is strict.

Besides her doctor visits, Ms. Steen must attend group therapy and have regular urine tests.

She has mostly stopped craving opioids, for now.

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By Abby Goodnough via The New York Times