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Evan Coartney

Professor Wallace
Community Health and Minorities
April 16
th
2014
CCAT House Observational Paper

Part One
Even though our class attended the CCAT House for several weeks (seven I believe), I
never got to go to the suboxone clinic and observe what happened inside there. Because of
this I dont have much knowledge about the patient and staff interaction within the unit but I
still managed to find out a great deal about suboxone during Nurse Kantes lectures a
pamphlets. Suboxone is a mixture that contains buprenorphine and naloxone which acts as a
treatment for opioid addiction. Buprenorphine is an opioid medication while naloxone is a
special narcotic that when administered reverses the effects of other opioid drugs.
Buprenorphine is a partial opioid agonist, this means that when then the buprenorphine is
administered it produces less of an effect than a full opioid (such as heroin, morphine,
hydrocodone, or oxycodone) when it attaches to the opioid receptor in the brain.
Buprenorphine tricks the brain into believing that it has ingested a full dose of opioid so it
lessens the withdrawal symptoms that occur from opioid addiction. Suboxone treatment is
considered a long acting medication assisted treatment because a dose of suboxone gets
caught in the opioid receptor for about twenty-four hours. This means that if a suboxone
patient takes a full opioid agonist within the twenty-four hour time frame after taking
suboxone, they will not experience a high or get pain relief from the drug. Naloxone is added to
the buprenorphine in suboxone treatment to discourage patients from trying to snort or inject
the suboxone. The naloxone doesnt get into the blood stream when taken correctly (by letting
it dissolve on the tongue); however, when a patient attempts to snort or inject the suboxone it
generates intense and severe withdrawal symptoms causing a great deal of pain to the user.
The main reason suboxone is recommended over other rehabilitation treatments such
as methadone is that it doesnt cause the patient to form an addiction to the drug. Because of
this suboxone users can gradually taper of their dosage of suboxone until they dont need it
anymore. Methadone treatment usually results in an addiction to methadone and greater
amounts of methadone are needed as a patient develops a tolerance to the medicine. Another
reason suboxone is recommended by the CCAT House is that taking more than the prescribed
amount of suboxone will not result in a high for the patient because it is not a full blown opioid
agonist. Methadone; however, can result in a high for the user if the patient takes more than
the prescribed amount because it is a full blown opioid agonist.
Part Two
The educational groups was probably my area of expertise, mainly because I presented
three different subject matters excluding the big presentation we did as a class at the end. The
subjects I presented while working in the educational group was the brain and memory games,
hepatitis A, B, and C, and the dangers of smoking. Each subject presented within the
educational groups had its own strengths, weaknesses, and challenges.
The first group I was part of during the educational segment was the brain and memory
games subject matter group. In my opinion this was probably the strongest presentation I was
part of during our visits to the CCAT House. The main strength for this particular subject matter
was that the patients didnt really know all the effects of drug abuse on the mind. Because this
was a new subject for them they were attentive and they asked plenty of questions during the
presentation. Another reason this presentation was strong was the interactive memory games
we created at the end. We split up the patients into four groups and they had to memorize as
many images as possible without talking then write them down on a piece of paper as a group
when the image was taken down. Not only was this game challenging, it made the patients
cooperate and work together to get the best score possible. It also brought out
competitiveness from the groups which made it more individual for them with bragging rights
and what not. The main challenge for the brain and memory games presentation was that it
was the first presentation done by our class at the CCAT House all year so we didnt really know
what to expect and neither did the patients. Unsurprisingly some of the patients were bored
and inattentive but that was to be expected as we were cutting into their free time and they
were forced to be there.
The second group I was part of was the educational group that focused on diseases such
as Hepatitis A, B, and C. The main strength of this particular presentation was that many
patients within the room had an experience with Hepatitis (because many used/shared needles
with other drug abusers) so they were curious to know facts about the disease. Due to the high
rates of hepatitis throughout the drug abusing community, we had a lot of questions during this
presentation and several members of the audience came up and asked us further
questions/shared stories about hepatitis transmission. The weaknesses within this
presentation in my opinion was the amount of information provided and the interactive game.
For this presentation we accumulated a lot of information and the PowerPoint portion took
about twenty minutes. During those twenty minutes we lost the attention of some of the
audience which was understandable. The interactive game was the other weak area regarding
this educational grouping. Even though it still provided a competitive atmosphere for the
patients, it was only ten questions and it took about five minutes to finish.
The third educational group I was part of was particularly challenging and not received
with much enthusiasm at all. We decided to do a presentation on the dangers of smoking to a
bunch of recovering drug abusers (most of whom were coming back from a smoke break).
Right when we first pulled up the PowerPoint presentation most of the patients groaned and or
laughed and immediately stopped paying attention. As one of the patients remarked we are
trying to recover from meth and heroin, you cant expect us to stop smoking too. Despite this
less than enthused reaction we went on and began presenting our PowerPoint data. About
halfway through people began pulling out their cigarette packs and placing them on the desks.
Due to the lack of attention, it seemed during this presentation that we were presenting to
ourselves and one lady who had stopped smoking two days before coming to the CCAT House.
Besides the lack of interest in the subject matter, the other weakness with this presentation
was the interactive activity. Originally we planned on giving a pre-test to determine the
patients knowledge level about the dangers of smoking and lung cancer; however, the patients
came in late so we started the presentation late at about 5:15 so we decided to scrap the pre-
test. The PowerPoint presentation didnt last as long as anticipated so we started the
knowledge test a little earlier than expected. The test was only 10 questions and took about 2
minutes to do so our presentation ended up running about fifteen minutes short. After our
presentation ended most of the patients immediately went outside and started smoking so it
was pretty evident that this particular educational group didnt hit home to them. The general
apathy displayed by the patients is why I would have to say that the smoking educational group
was by far the weakest.
The last educational group I was part of was the whole classs presentation on cancer,
pregnancy, and nutrition/exercise. In my opinion the biggest strength of this presentation was
the interactive Jeopardy game. For this interactive game we split the room up into two teams
and pitted them against each other in a game of jeopardy until time ran out. We had three
categories with nine questions in each one with increasing difficulty in the questions. Due to
the potential for arguments and discord we opted not to allow for steals (when a team gets a
question wrong and the other team gets to answer), which turned out to be a good idea after
all. The game was competitive and encouraged all the patients to pay attention during the
presentation so it worked really well. This interactive game was probably tied with the memory
games as the best liked game by the patients. The one weakness of this educational group was
the sheer volume of information we threw at them in the short time frame. During about 35
minutes we covered multiple types of cancer in-depth, pregnancy, and healthy
nutrition/exercise habits. Due to the amount of information not all of it was retained and some
of the jeopardy questions went unanswered. Other than that I felt that the classs educational
group was a great success.
Overall the educational groups were a great experience as they allowed us the
opportunity to interact with patients by answering their questions. Educational groups also
helped me out as it forced me to partake in more public speaking, which is one of my
weaknesses.
Part Three
Out of all the weeks I was at the CCAT House I was only on the North and South units
one week each. Interviewing the patients and staff on the wings was an interesting experience
because you got to see the people in their normal settings.
On the North unit I able to sit in on patient and nurse interactions and interview one
patient and one nurse. The nurse I interviewed had worked in the healthcare field for over
twenty five years and had worked as a nurse at the CCAT house for about two years. She told
me that mainly a day in the life a nurse at the CCAT House entails seeing patients and assessing
their physical/mental health and giving them their required medicine on schedule. She said
that the hardest part of working at the CCAT House is seeing patients give up on treatment and
leave without handling their addiction. The patient I interviewed was a young woman who had
recently given birth to a baby girl. During the course of my interview it became apparent that
she didnt know of the resources offered in the area until child services essentially forced her to
come for treatment in order to keep he baby. After sitting in on a few patient/nurse meetings
it was evident that they generally didnt know of the resources at their disposal that could help
them kick the habit. The nurse/patient interactions were interesting to watch because the
nurse would always manage to turn the conversation away from them asking for drugs into
explaining their reasons for seeking help in the first place.
On the South unit I wasnt able to interview any patients; however, I was able to
interview a few nurses and Joe (the all-star employee). Both the nurses I interviewed had been
in the healthcare profession for over twenty five years and they had worked at clinics all around
Ohio before finally coming to the CCAT House about a three years ago. Much like on the North
unit the nurses were responsible for checking the mental and physical health of patients, doing
urine screens, and dispensing medicine at the appropriate times. As with the nurse on the
North unit, both these nurses said the hardest part working at the CCAT House is watching
patients give up on treatment early and go right back out on the streets and relapse. Joe was a
very interesting person to interview. He was originally an addict back in Pakistan and he told
me that he was about to celebrate his 14
th
year of sobriety in March. Back in Pakistan he used
to work on a mobile treatment clinic that traveled all over Pakistan giving treatment to addicts
across the nation. He came to the CCAT House as a volunteer and has worked his way up all the
way to a paying job as a caretaker essentially.
Part Four
Although this isnt part of the paper I just wanted to include a few ways to make the
trips to the CCAT House a little bit better for next years class. I understand that the schedule
was distorted by the multiple snow days but I know that some people never got to experience
one of the four groups (personally I never got to experience suboxone but I did educational
groups three times). By experiencing every group it would give students a better understanding
of all that goes on within the CCAT House. Really the only other thing I would comment on is
the lack of patient interactions while on the North and South units. I was lucky enough to see
some of the checkups on the North unit but I know most of the time patients were listening to
the presentations in the Proctor and Gamble room. This limited the amount of interactions we
could have with patients in their natural atmosphere with the nurses and each other. Other
than that I didnt have any criticisms or complaints about what we did there.
Overall going down to the CCAT House was a great experience and I learned a lot about
drug abuse within the community. Teaching in the educational groups was especially beneficial
because I learned important information about health and well-being while researching for my
PowerPoint section and it was a good experience getting to present our findings to the patients.
Most importantly during our trips there it changed my perception about drug addicts and it
made me realize that addiction isnt a choice it is a disease.