Poulsbo’s prescription pill rehab first one in the state

Nicholas Wyatt (left) and Narinder Duggal operate the state’s first opiate rehabilitation program in the state at Poulsbo’s Liberty Bay Medicine. - Leila Arciero/Staff Photo
Nicholas Wyatt (left) and Narinder Duggal operate the state’s first opiate rehabilitation program in the state at Poulsbo’s Liberty Bay Medicine.
— image credit: Leila Arciero/Staff Photo

POULSBO — It’s never zero percent when it comes to the number of people who can become addicted to their prescribed pain pills.

Narinder Duggal, M.D., knows this from running his own practice, Liberty Bay Internal Medicine, which deals with complex pain issues. Seeing the amount of addiction first hand, sparked him to begin a comprehensive outpatient drug rehabilitation program for opiate derivatives.

“Every doctor should fully recognize that if they prescribe pain medicine there will always be a potential for addiction. It’s incumbent to either direct patients to where they can get help or treat that patient,” Duggal said.

The most commonly known opiate derivatives are opium, morphine, codeine, heroin, dilaudid, hycodan, percodan and metopon. There is only a 3 to 15 percent rate of addiction among people prescribed pain pills, but they must be treated.

“We can’t just abandon these people. We have to help them somehow,” Duggal said.

Combining the drug Suboxone — the first approved opioid medication for the treatment of opiate addiction — with psychotherapy and physical needs, Duggal has created the first integrated opiate outpatient addiction clinic in Washington State.

“What Poulsbo and the peninsula have is the leading evidence-based, medically, pharmaceutically reviewed clinic for addiction medicine when it comes to opiate addictions,” Duggal said.

In addition to the drug and mental therapy, there is a large focus on physical needs for the patients. Being an addict drains more than your bank account, it also takes a large toll on your health, Duggal said.

“(Addicted patients) are almost at the highest risk of nutritional deficiency because they’ve been spending their money and their resources obtaining a drug as opposed to eating right and sleeping right,” Duggal said. “The nutritional aspect that we added to our program is novel around the country, actually. We’re leaders in the world of medicine and in addiction medicine, to incorporate the aspect of strengthening the immune system and enhancing the body in order to recover, by giving back to the body the nutrients that have been depleted.”

To cope with the advanced nutritional needs of addicts, Duggal, who is a physician and a pharmacist, co-created Synergy Therapeutics RX with Nicholas Wyatt, a pharmacist, which provides supplements and phytopharmaceutical products at an elevated amount.

“We try to use the best of medicine, the best of science and the aspect of the nutrition,” Duggal said.

It’s rare to consider the nutritional and living arrangements of patients as closely and professionally as this rehabilitation clinic does, they said. Duggal and Wyatt work with patients to give the best rehabilitation for their addiction and to reacquaint them to their bodies and minds.

“Our goal is to empower each person by using both their innate healing potential as well as using their brains to heal the body and vice versa and then to use the medication as appropriate to help them move in a direction that they can become functional and back to society,” Duggal said. “A drug doesn’t cure you, a drug will only assist you. Your body cures itself.”

Finding a way for patients to tap into their body’s natural “morphine” is also a goal engrained in this rehabilitation program, Duggal said, as patients are encouraged to incorporate exercise and healthy living into their daily lives. Sleeping well, eating right and exercising are key.

Rehabilitation is also more than just recovery, it is also about living, Duggal said. Working with outpatient therapy, the addict is not in a controlled environment. Connecting with the patient and understanding their life and their situation is important.

“The patient can continue to live their normal lives, they don’t have to put everything on hold for three months,” Wyatt said. “For the most part we try to work with the patient, work with their schedule and then provide the medical advice that they need. Drug therapy is very easy — you can do it almost in a textbook fashion — but then it’s the added things that come along with it: the psychothearpy and tailoring the therapy to the work schedule.”

Patients can vary in age and socio-economic status. They come from all walks of life and all different backgrounds. The program relies on the patient to fuel the fire for their own recovery. The clinic presents pieces to the addicts’ own rehabilitation and it is up to the patient to want to put those pieces together, Duggal said.

“We have done a very thorough job of trying to take the best of technology and science and medicine, nutrition and behavior therapy and incorporate it to outpatient rehabilitation for patients who are dependent on opiate-like drugs or opiate derivatives, whatever they might be,” he said.

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