Frequently Asked Questions for Patients

• What is Flex Care?

  Flex Care is a program of Evergreen Treatment Services (ETS) that provides adults with opioid use disorders treatment with buprenorphine from a medical prescriber. Flex Care also pairs prescribers with our Opioid Treatment Program to improve options for care when the clinical need arises. Together, prescribers and our Opioid Treatment Program can help patients start on buprenorphine, obtain ongoing medication, engage in high-intensity or low-intensity counseling services as required, administer urine drug screens, and aid in transitions to other opioid use disorder treatment medications if needed. This program enables patients and the medical community to significantly broaden treatment options needed to address the current opioid epidemic.

• What is Buprenorphine?

  Buprenorphine is one of three medications approved by the Food and Drug Administration for the treatment of opioid use disorders (methadone and naltrexone are the others). It stabilizes the brain chemistry by reducing cravings and withdrawal. Buprenorphine makes people feel normal, not high. Most people tolerate it well and there are relatively few side effects.

• How does Flex Care work?

  The Flex Care program provides excellent clinical backup for patients who may need more intensive services than can be successfully managed in a prescriber’s general practice. ETS medical and program staff interview potential patients to determine the right treatment program for them. A patient may start with treatment through daily dispensing of medication at an ETS Opioid Treatment Program clinic or, depending on the circumstances, the patient may start with weekly prescribed medication under the supervision of a prescriber. If treatment goes well and the patient is stabilized, the patient may remain under the care of the Opioid Treatment Program or with the prescriber in Flex Care for as long as they need treatment.

  Once stabilized, patients who are receiving buprenorphine daily under the care of the Opioid Treatment Program can move to weekly prescribed medication from a Flex Care prescriber, if preferred. The reverse is also possible: if patients struggle being stabilized on their weekly prescription from their prescriber – miss appointments, have repeated positive urine drug screens, lose or misuse their medication – our Flex Care team will assist with transferring the patient to an ETS Opioid Treatment Program for observed medication dispensing, intensified counseling, and other support services until the patient re-stabilizes. In this way, we can both meet the clinical needs of patients and support buprenorphine prescribers in the community with important specialty care.

• What services does Flex Care offer?

  We provide medication prescriptions managed by a medical team, urine drug screens, substance use disorder counseling, and coordinated care for primary and mental health needs.

• Why is Flex Care important?

  Overdose deaths and treatment admissions for opioid use disorders in Washington State have risen to alarming levels. Medication assisted treatment, combined with supportive services like counseling, gives patients the greatest likelihood of stabilization and recovery from their substance use disorder. Flex Care allows ETS to expand medication assisted treatment options to many more adults through the partnership between the prescriber and the Opioid Treatment Program.  This service is especially important in rural areas where few treatment options exist.

• What is medication assisted treatment?

  Medication assisted treatment (MAT) is the medical standard of care for opioid use disorders. MAT is an evidence-based intervention that recognizes the physiological effects that prolonged opioid use can have on a patient’s brain and body. Treatment begins with long-acting medications like methadone or buprenorphine so that the patient becomes medically stabilized from the highs and lows associated with active, illicit use.  Once stable, our patients may then address the difficult psychological, emotional, and environmental challenges that accompany recovery.

• How is Flex Care different from other medication assisted treatment programs?

  Flex Care increases our capacity to treat patients who are challenged to meet the strict travel requirements of an Opioid Treatment Program with a program that helps patients who may respond to a less intensive treatment setting. Patients in federally accredited Opioid Treatment Programs must travel six days per week to receive their medication from a dispensary – which can take hours out of their day. While methadone for the treatment of addiction can only be provided in this intensive setting, some patients are able to stabilize their disorder with less structure and intensity. For those who can succeed on buprenorphine, Flex Care saves patients daily travel for their medications, so they may be better able to work or go to school, take care of themselves, and take care of their families.

• How does Flex Care help medical prescribers?

  Before Flex Care, Washington prescribers treating people with opioid use disorders out of their medical practices had little or no clinical backup when patients were unstable and required high intensity attention. This has led to reluctance among many prescribers to treat our patients, and as a result, there are not enough prescribers needed to address the current opioid epidemic. By having the ETS Opioid Treatment Program serve as the clinical backup for patients receiving buprenorphine prescriptions from their prescriber, this should help prescribers treat patients in the privacy of their offices and know they have a specialty clinic for referrals just like they do for other chronic diseases.

• Where is Flex Care available?

  Flex Care is currently available at the ETS clinic sites in Olympia and Hoquiam. These clinics serve predominantly rural areas where opioid overdose rates are some of the highest in the state and qualified prescribers of buprenorphine are scarce. We hope to offer Flex Care soon at our Seattle and South King County clinics.

• Why does ETS use medication assisted treatment (MAT)?

  These treatments work and they are the current medical standard of care for the treatment for opioid use disorders. Medical research shows that patients enrolled in medication assisted treatment have significantly less risk of overdose, and the greatest likelihood of living in successful recovery. Research has also shown that MAT is tremendously beneficial – in terms of health care and incarceration costs – for communities that offer this treatment rather than allow people to go untreated. According to the National Institute on Drug Abuse, every $1 spent for treatment generates a $4- $5 return.

• How long do people have to be in medication assisted treatment?

  Science has proven that substance use disorders are a chronic, relapsing medical condition – much like diabetes or hypertension.  Like these diseases, some patients can successfully stabilize their condition with a course of medication and behavioral changes and then be vigilant against relapse.  Others need medication in order to remain stable.  Opioid use disorders are to be viewed the same way.  While some people may taper from their medication and sustain their recovery, many others need the medication to stay stable.  When patients are successful in MAT, you would never know it – just like someone who takes medication for many other medical conditions.

• What is Evergreen Treatment Services (ETS)?

  ETS is a nonprofit organization that runs medication assisted treatment facilities for more than 2,500 adults with opioid dependence in Western Washington. ETS also manages the REACH team, a street-based outreach program serving adults who are homeless and struggle with substance use disorders. Clinic services include the use of methadone, buprenorphine/naloxone (Suboxone), or buprenorphine (Subutex) medication. All patients are connected with our wraparound services that include counseling, random drug screens, and engagement with one of our medical providers.