WASILLA — Wasilla drug recovery advocate Serena Espinoza sat in a doctor's office last month, chewing gum like her life depended on it.
She was detoxing and it was being streamed live on Facebook.
Espinoza was fitted on camera with an experimental device that some say represents a new way to beat opioid addiction.
The Neuro-Stim System Bridge is a gadget a little bigger than a half-dollar implanted behind the ear that targets painful withdrawal symptoms by sending electrical feedback to the brain.
It's applied for five days, generally in combination with a cocktail of nonnarcotic "comfort" medicine that can range from Ibuprofen to anti-nausea and sleep drugs Zofran and Trazodone. Then patients start getting regular shots of Vivitrol, which blocks opioid receptors in the brain, coupled with counseling and other support.
Espinoza spent the better part of the past 20 years battling addictions to meth, cocaine, prescription painkillers and heroin.
At the start of the last month's Facebook video, Espinoza sat with friend Terria Walters on an exam bed at Algone, a medical provider in Wasilla.
Unknown to her doctor, Espinoza had spent the last three weeks on a rapid taper off high doses of the opiate treatment medication Subutex, which she's taken since she found out she was pregnant four years ago and stopped using methadone, OxyContin and Dilaudid.
Her joints ached. The lights were too bright. Sweat poured off her.
"It's embarrassing, guys," Espinoza told the camera, grimacing. She later said every nerve in her body felt like it was on fire.
Dr. Maria Freeman gently pressed the device into the skin near Espinoza's ear.
Within 10 minutes or so, she started smiling and talking, like a weight had lifted.
"I can't explain it to you," Espinoza said this week. "You go from feeling (terrible) and being sick to the symptoms start to lift … It's almost like a fricking miracle."
Awaiting FDA approval
The NSS Bridge is cleared by the Food and Drug Administration to help target pain but not approved specifically for treating acute opioid withdrawal. So the devices, which cost about $550 each, aren't covered by insurance or Medicaid.
They aren't widely used in Alaska or around the country. Just three providers apply the device for opioid detox in the state: Algone in Wasilla, where Espinoza received hers; Jyll Green, an advanced nurse practitioner in Anchorage; and North Country Medical in Fairbanks.
The developer, Innovative Health Solutions, is seeking FDA reclassification for use of the device to treat opioid withdrawal later this year, vice president of sales, Brian Carrico, said in an email. He declined to comment until the review is completed.
State officials say they back proven medically assisted drug treatment protocols, but are tracking the Bridge.
Providers and grant recipients working with the Alaska Department of Health and Social Services primarily use medication-assisted therapy, "which is an evidence-based best practice in treating opioid addiction and maintaining recovery," agency spokesperson Sarana Schell wrote in an email.
That therapy combines counseling and other support with medications such as buprenorphine, methadone or naltrexone to reduce or block opioid cravings, Schell wrote.
Devices like the Bridge that stimulate the periauricular percutaneous nerve are being explored as a possible withdrawal tool, she wrote. Officials at the DHSS are "following the emerging data from the clinical evaluations and the science as well as the FDA review closely."
'It can't make your decisions for you'
Paul Finch, a Fairbanks physician assistant, started applying the Bridge about a year ago at Turning Point Counseling Services and then opened North Country Medical in October.
Finch said he's applied the device to at least 60 patients from as far as Anchorage and Juneau. More than half have succeeded through the detox phase, he said. Some come back more than once to try the Bridge despite the cost.
It takes experience to manage opioid withdrawal syndrome, Finch said. "It takes a nimble, passionate provider to do that. You can't just put it on and expect it to do everything. It can't make your decisions for you."
The Bridge calms the brain, giving it "a taste of normal it hasn't had in a long time," he said. The device alleviates anywhere from 75-95 percent of his clients' detox symptoms. He prescribes a mix of comfort meds to help.
But different people cope differently, depending on their mental, physical or spiritual health, he said. Before the Vivitrol shot after seven days, "there's nothing to address the cravings. That's where some people really struggle."
The Bridge isn't perfect. The cost can be a barrier. A formal study is needed to move it from an experiential data level to quantifiable research, Finch said.
"There's not studies and there needs to be," he said. "We're all doing off-label stuff because we're in a war, we're in the trenches."
The device is getting more distribution in Mat-Su through a new program known as the Lazarus Project.
Faith-based nonprofit Fallen Up Ministries obtained a $15,000 grant from the Mat-Su Health Foundation to pay for 25 Bridge devices.
"It was a really low-cost way to try and help with what's become an epidemic," foundation spokesperson Robin Menard said. "That's a really small grant and it's turned out to be so far really successful."
Since March 12, the project has applied the bridge to nine people.
Walters, an addict in long-term recovery who founded Fallen Up Ministries, met Espinoza in 2005 at the Mat-Su Pretrial Facility in Palmer. Walters helped Espinoza detox from OxyContin.
Espinoza is a board administrator for Fallen Up Ministries. She also serves as vice president of R.E.A.L. About Addiction, an Anchorage recovery advocacy group.
Fallen Up screens applicants before they're accepted into the Lazarus Project.
More than 100 people have expressed interest, Walters said. Many don't qualify. Having a safe place to live without other opioid users is the biggest stumbling block, she said.
Participants need to agree to Vivitrol shots for six months and treatment. The group works with treatment providers Set Free Alaska, Akeela and Alaska Family Services.
Patients get peer support from Fiend 2 Clean or Fallen Up. MyHouse, a nonprofit for homeless youth, is also involved. Anyone interested in information about the program can call 907-815-SAVE.
Espinoza was 22 days off her Subutex medication as of Thursday. She's doing well, she said. She still has symptoms of withdrawal: chills, sweats, no appetite.
The lethargy that left her wanting only to sleep is fading and her energy is slowly coming back. She's well aware of the challenges of staying in recovery after the immediate detox is over.
"We can prove the device works, because it does, but keeping someone in recovery and holding them accountable is the hardest part," Espinoza said.