Dr. Randall Riggs, a psychiatrist, and Kimberly Stankovich, a veteran chemical dependency counselor, have opened an outpatient clinic east of downtown Spokane that they say is using an empathetic and healing approach to treat opiate-dependent patients.

The clinic, named InKARE, opened in December in a commercial building at 611 E. Second, taking over a leased space formerly occupied by On-Top Realty Inc. Riggs and Stankovich are equal owners in the clinic, with Riggs serving as CEO and Stankovich as COO.

Stankovich says she spends about half of her time at InKARE and about half of it at Gateway Counseling of Spokane, a chemical dependency outpatient treatment facility that works closely with InKARE on patient treatment. 

The only other employees at InKARE for now are a receptionist and a bookkeeper, but the clinic’s space includes room for other health care professionals, and Riggs says he envisions it probably adding another physician, physician’s assistant, or advanced registered nurse practitioner at some point.

He refers to InKARE as “a vertically integrated outpatient treatment facility,” meaning it’s able to provide under one roof virtually all of the services that opiate addicts might require. Those services, he says, range from opiate detoxification, prescription medication support, and psychiatric evaluations, to individual and group counseling, behavioral therapy, and life skills coaching. 

“All addiction has as a root cause a desire to get away from something. People want to get away from some unpleasant feeling,” Riggs says, adding, “Your problem is not the opiates. Your problem is what you’re using the opiates to get away from.”

InKARE’s treatment approach seeks to get to the heart of what led to the addiction, while at the same time gradually weaning patients off the opiates that have taken control of their lives, typically using a medication called Suboxone, he says.

Stankovich, who estimates she’s counseled between 3,000 and 3,500 people suffering from chemical dependency, says, “You really need to address the underlying issue.” 

She and Riggs say their ultimate goal, rather than to perpetuate the revolving-door experience that they believe typifies some traditional treatment efforts, is to get their patients off of all chemical dependency and restabilized in a normal life. That process typically can take from six months to a year or longer, they say, but Stankovich says the end result can be professionally rewarding.

“It’s nice to see them awaken from the cloud they’ve been in,” she says. 

InKare charges a $250 fee for an initial evaluation, plus a $25 lab fee, and $150 for each additional visit, also with the accompanying lab fee. Most of the patients it sees have insurance coverage that help defray treatment costs.

The patients who come to InKare are there voluntarily, rather than under court order, and almost all of them have jobs, Riggs and Stankovich say. They say their patients include doctors, lawyers, teachers, business owners, and college students—ranging in age mostly from mid-teens to mid-40s—and more than half of them became addicted to opiates after having taken the drugs initially to alleviate pain, such as after surgery or suffering injuries.

Riggs says the most commonly abused opiates probably are hydrocodone, oxycodone and heroin. Addicts often resort to the latter drug when they’re no longer able to obtain the prescription medications to which they originally became addicted.

He and Stankovich describe opiate dependency as a miserable and debilitating condition that can be fatal if not treated, with fatalities typically occurring due to unintentional overdose.

In a news release last year, the Washington state Department of Health said fewer people in the state died from prescription pain medication overdoses between 2008 and 2012, after an eightfold increase in the last decade.

The number of such deaths in the state fell from 512 in 2008 to 388 in 2012, but that was tempered by an increase in heroin deaths, which rose from 146 in 2008 to 231 in 2012, the agency said, citing the most recently available data. 

Most prescription pain medications contain powerful drugs known as opiates or opioids, which are potentially addictive, and prescriptions written for such medications have increased dramatically since the late 1990s, leading some people to misuse and abuse them, it said. Some who became addicted to prescription opioids have transitioned to heroin because it’s cheaper and more readily available, especially in nonurban areas, the agency said.

Riggs says one of the sad aspects of the addiction is that addicts are never able to achieve the intense high they did initially, and their quest for more drugs ultimately becomes all about keeping from becoming ill with withdrawal symptoms, rather than about getting high.

InKARE says on its website that the speed with which someone can stop opiates seems to depend on several factors. Those factors include the patient’s genetics, level of physical activity, motivation to quit, skills of living and interacting with other people, the length of opiate dependence, and the presence of physical and psychiatric illness. Those factors need to be identified and dealt with if treatment is going to be successful, the website says.

Riggs has an extensive background in general psychiatry and psychotherapy, locally since 2005 and before that in the Puget Sound area. 

He says he regularly encountered the problems created by substance abuse, and the puzzle of how to help addicts became a challenge for him, motivating him to learn as much as possible about the condition. In recent years, he says, he’s focused on assisting people who suffer from opiate use disorders.

He describes InKARE as being at “the mom-and-pop stage of development” and says he expects it to grow as an increasing number of patients are referred to the clinic for help.