By Amber Miles
Arizona is ramping up its efforts to combat opioid addiction after Gov. Doug Ducey declared it a public health emergency, and a new outpatient clinic in the Airpark is taking a unique approach.
Blue Door Therapeutics entered the fight in May and purports to be the first clinic in the world to treat opioid addiction by combining traditional, naturopathic and alternative methods with medical cannabis.
Opioids are a class of drugs that includes heroin as well as prescription painkillers like oxycodone and fentanyl. Approximately 60 percent of drug overdose deaths involve opioids, according to the Centers for Disease Control and Prevention, which estimates 91 Americans die from an opioid overdose every day.
“It’s very rare now not to be someone who’s been touched by this,” says Blue Door medical director Dr. Frank Lovecchio, who has treated substance abuse disorders for more than two decades.
Although some physicians may view opioid addiction as a “lack of will,” Blue Door treats it as a disease, Lovecchio says, and “there’s different ways to treat diseases.”
Blue Door clinicians treat opioid dependency and addiction in an outpatient setting, offering a variety of treatment options that they combine to create individualized plans for each patient. Their “multi-pronged approach” includes traditional medication-assisted treatment and counseling, as well as naturopathic therapeutics like nutritional supplements and alternative methods like acupuncture or cryotherapy, Lovecchio says.
The clinic also incorporates physician-monitored cannabis.
“We really work to look at the whole person,” says the CEO and co-founder of Blue Door, Dr. Gina Mecagni Berman, who became board certified in addiction medicine in 2015.
Prior to that, Berman worked as an emergency room physician for 10 years and served as medical director at Giving Tree Wellness Center, a medical marijuana dispensary, where she counseled patients on treatment options for their conditions and noticed patients used cannabis to get off other medications – predominantly opioids, she says.
Berman began to assemble the Blue Door team in January 2016 and received approval from the Arizona Department of Health Services in March 2017. A couple months later, Blue Door opened its temporary location in North Scottsdale after raising more than $2 million dollars in private placement funding. A permanent location is expected to open in North Scottsdale this fall.
The clinic serves anyone struggling with opioids – from slight physical dependency to severe addiction – except pregnant or pediatric patients, Berman says, because those individuals require a level of care that Blue Door cannot provide.
Berman says physician-monitored cannabis can help individuals struggling with opioid dependency or addiction by contributing to the alleviation of sleep problems, constipation, depression and withdrawal symptoms.
Cannabis can also provide an alternative to opioids for pain relief in patients with chronic pain, according to Blue Door medical director and co-founder Dr. Ravi Chandiramani.
As recent as a year and a half ago, Chandiramani says, he would have viewed the use of medical cannabis to treat opioid addiction as the substitution of one drug for another, but he changed his position after learning more about cannabinoids, the chemical compounds in cannabis that act upon cannabinoid receptors in human cells.
“Education really is key in having people understand,” Chandiramani says.
“You can argue that, you know, cannabis is substituting one drug for the other, but… that is what traditional treatment typically is,” Lovecchio says, explaining traditional treatment for opioid use disorder involves giving a patient methadone or buprenorphine for a short period of time.
Physicians at Blue Door cannot prescribe cannabis or issue medical marijuana cards, but they can identify patients who may benefit from the treatment and then recommend it, Lovecchio says.
Addiction is not a qualifying condition for a medical marijuana card in Arizona, so patients need to have a condition that does qualify in order for Blue Door to consider recommending medical cannabis. Blue Door physicians then may recommend it if a patient is willing and does not have any other conditions that might complicate its use, such as cardiovascular disease or hypertension, Berman says, noting that cannabis can temporarily increase blood pressure and heart rate.
Blue Door will not incorporate cannabis in the treatment plans of patients who do not qualify for medical marijuana under Arizona law. Chandiramani adds that patients who have had negative side effects from cannabis in the past or who do not want to use cannabis also will not receive a cannabis recommendation.
“Not all patients want to use cannabis, and they definitely don’t have to,” Berman says.
Having so many tools at Blue Door enables the physicians to create an individualized treatment plan – with or without cannabis – that optimizes the care of each patient, Chandiramani says.
Recovery from opioid dependency or addiction requires intensive care, according to Berman, so Blue Door physicians are available to their patients after regular business hours via consultations or text messaging.
Blue Door also works toward involving a patient’s support system while adhering to HIPAA regulations and respecting patient privacy. Providers cannot broadcast that an individual has come to the clinic, but they do require patients to sign a waiver that allows Blue Door to share information with at least one other person, such as a friend or family member, Lovecchio explains.
Blue Door fills a “huge need in the medical community,” Lovecchio says, because “it’s very, very tough to be addicted to medications in Arizona and get help.” Nationally, Arizona ranks 50th of 51 for prevalence of mental illness and access to care, he explains, citing 2014 data from Mental Health America. This ranking indicates Arizona has a high prevalence of mental illness and a low rate of access to care.
“Two years from now,” Chandiramani says, “I’m confident that I’m going to be able to say that this was a game- changer.”