TRUCKEE, Calif. – Amid the ongoing crisis of accidental opioid overdoses, understanding and utilizing local resources for substance use disorder rehabilitation has never been more critical.

“Many patients have told me that they were not aware this service existed and I hear all the time, ‘I wish I would have known about you sooner,'” Leila Jirari, Physician Assistant and leader of the addiction medicine service line at Tahoe Forest Hospital, said. 

According to Jirari, alcohol use disorder is the primary issue in Tahoe. She mentioned that “The alcohol culture in Tahoe is hard to escape from,” attributing it to the prevalent ski and resort culture, as well as cold and long winters.

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Jirari’s leadership has been crucial in expanding Medication-Assisted Treatment (MAT) to combat substance use disorders. Since taking over the program last March, she has been seeing five new patients a week. The integration of group and individual therapy at Tahoe Forest, along with anti-craving and withdrawal medications, addresses the 80% crossover between mental health and substance use disorders.

Sarah Redgrave, LCSW, provides individual therapy sessions for many of MAT’s patients and also leads recovery groups on Wednesdays and Thursdays.

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These disorders result from complex interactions among brain circuits, genetics, the environment, and individual life experiences. At Tahoe Forest, coordinated treatment approaches for addiction are proving as successful as those for other chronic diseases.

The program is grant-funded, offering services at no cost to patients, and most medications are covered by these grants. The clinic, and emergency departments in Truckee and Incline are well-stocked with harm reduction supplies, including naloxone (Narcan) and fentanyl test strips, which are available to anyone who walks in. 

Jirari warns of the dangers posed by novel synthetic opioids like ‘Iso and ‘Pyro (street drug names), which are currently circulating in the local drug market. These substances particularly are more potent than fentanyl and undetectable by standard test strips. She also highlighted that fentanyl can be placed in vape pens, increasing the risk of accidental exposure. Jirari expressed deep concern for her daughter’s safety, emphasizing how even seemingly pure drugs can be heavily contaminated. She noted that the drug market is rapidly evolving, making it challenging to stay informed about the latest substances.

“It’s like playing Russian roulette. You really can’t trust any substance,” Jirari said. 

The MAT team specializes in treating a variety of substance use disorders, including those involving opiates, amphetamines, cocaine, cannabis, and alcohol. They utilize several FDA-approved medications to alleviate withdrawal symptoms and psychological cravings, addressing the chemical imbalances caused by addiction. These medications include Acamprosate, Disulfiram, Naltrexone, and Vivitrol. 

For more severe withdrawal symptoms, the team uses medications such as Phenobarbital, Librium, Gabapentin, Baclofen, and Depakote. To treat opioid use disorder, they employ buprenorphine and a combination of buprenorphine with naltrexone. These medications are effective against opioids like heroin, morphine, and codeine, as well as long-acting opioids such as fentanyl, oxycodone, and hydrocodone. 

Buprenorphine suppresses and reduces cravings for opioids and is available in long-acting injectable forms like Sublocade and Brixadi. Tahoe Forest Hospital was actually among the pioneers in offering buprenorphine in the Emergency Department. Naltrexone blocks the euphoric and sedative effects of opioids, preventing the feelings of euphoria associated with their use.

When these medications reduce euphoric feelings, they serve as a deterrent to continued use, as the person won’t experience the same high.

Jirari is the sole provider seeing patients daily, supported by the urgent care and emergency department teams when she is unavailable. Her office is open on Tuesdays, Wednesdays, and Thursdays. If a patient misses an appointment, Substance Use Navigators can conduct home visits to ensure their well-being. These navigators, Emma Dennie and Sam Valois, play a crucial role, providing outreach at schools and local festivals, warming shelters, and homes, and assisting patients in accessing rehab, intensive outpatient programs (IOP), and therapy. 

“I adore all my patients. I wish I could get them all in the same room,” Jirari continues. “Now they have a home to go to. And we are their home.” 

Jirari maintains an open-door policy on her workdays, allowing anyone struggling with relapse or other issues to walk in for immediate assistance.

You don’t need to be an established patient at Tahoe Forest to access MAT’s services. Anyone aged 12 and up can receive help, with full confidentiality assured.

Collaboration has been key to MAT’s success. Jirari works closely with urgent care, emergency doctors, and hospitalists, meeting quarterly to discuss best practices. This teamwork has led to a significant reduction in hospital admissions for substance use issues, benefiting both patients and staff.

“This program helps with burnout and overall satisfaction of Emergency Department and ICU staff,” Jirari continues. “We have such good communication around our patients. It’s working.”  

Despite these achievements, Jirari acknowledges the challenges. Financial barriers, stigma, and the relatively new specialty of addiction medicine remain obstacles. She highlights the need for more awareness, both among the public and healthcare providers, about the evolving landscape of substance use and treatment options.

“Because so many people are financially burdened, healthcare is second. They don’t seek care because they don’t have health insurance or they make too much for Medicaid or MediCal. But they don’t make enough to cover themselves privately,” Jirari said.  

MAT offers a range of counseling and support services, including individual and group therapy sessions. The schedule for group sessions is as follows:

– Women’s Support Group: Tuesdays from 4 p.m.-5 p.m.

– Recovery Maintenance: Wednesdays from 4:30 p.m.-5:30 p.m. and Thursdays from 9:15 a.m.-10:15 a.m.

These sessions are held at the Tahoe Forest Levon Building, located at 10833 Donner Pass Road, Suite 201. Additionally, Recovery Resilience sessions are available every Monday from 4 p.m.-5 p.m. at Incline Village Community Hospital, 880 Alder Avenue, 2nd Floor.

If you suspect someone is overdosing, call 911 immediately. Even if you administer Narcan, it is crucial to call 911 to ensure the person receives proper medical care. The following resources offer Narcan:

– Tahoe Forest Health System and Incline Village Community Hospital: Text or Call (530) 606-0914

– Nevada County Public Health: Text or Call (530) 388-6364

– Yuba Harm Reduction Collection: Text or Call (530) 362-8163

– The Speedy Foundation: Text or Call (208) 471-8904

– Gateway Mountain Center: Text or Call (530) 426-2110

Direct referrals to the MAT program can be made through the Substance Use Navigator at (530) 606-0914.