Chronic Pain and Addiction Treatment in North Dakota

How is chronic pain treated when someone also has a substance use disorder?

In North Dakota, as elsewhere, chronic pain in a person with a substance use disorder is usually managed by pain clinicians and addiction clinicians working from one shared plan. Coordination can mean sharing records with your written consent, agreeing on who prescribes which medicines, and talking to each other whenever a dose changes.

Decisions about medicines and therapies sit with the treating clinicians and the patient together. Options can include buprenorphine, which treats opioid use disorder and also relieves pain, methadone through a licensed opioid treatment program, non-opioid pain medicines, and non-drug therapies such as physical therapy.

Taking pain medication for a long time and being physically dependent on it is not the same as having a use disorder. A use disorder involves things like cravings, loss of control or continued use despite harm, and only a clinician can make that assessment.

Programs listed for dual diagnosis care in North Dakota may also address the depression or anxiety that can come with long-term pain. Any taper of a long-term opioid or benzodiazepine prescription should be planned with the prescriber, since sudden cuts can bring withdrawal and a flare in pain.

Benzodiazepines are not a pain treatment, and taking them together with opioids adds a risk of dangerously slowed breathing. North Dakota providers listed under buprenorphine and Suboxone clinics can explain whether they treat people who use both.

Is it safe to stop or reduce pain medication on my own?

Stopping or sharply cutting a long-term opioid or benzodiazepine prescription on your own can be unsafe, so any taper should be planned with the prescriber. Sudden changes can bring withdrawal symptoms and a flare in pain, and benzodiazepine withdrawal can be medically serious. A planned taper sets the pace, the follow-up visits and what happens if pain returns.

Distance from a clinic in western North Dakota should not push anyone into an unplanned stop. ND Medicaid telehealth policy allows audio-only visits for substance use disorder services when a patient cannot or will not use video, and some North Dakota telehealth programs list follow-up by phone or video. People worried about benzodiazepine dose changes can compare benzodiazepine treatment listings in the state.

What North Dakota rules might I meet during treatment?

Patients in North Dakota may meet prescription monitoring by their prescriber, separate licensing for opioid treatment programs, and broad access to naloxone. Prescribers can look at a record of controlled medicines filled under your name, and any current limits on opioid prescribing for chronic pain are best asked of the prescriber directly, since rules can change.

Methadone in North Dakota is given only through opioid treatment programs, which hold a separate license from the HHS Behavioral Health Division and are overseen by the State Opioid Treatment Authority. Those programs are in Fargo, Bismarck, Grand Forks and Minot; see methadone clinics in North Dakota.

Naloxone is easy to get across North Dakota. The Board of Pharmacy says pharmacists can prescribe it, ND Medicaid members can get over-the-counter naloxone at no cost at enrolled pharmacies under a statewide standing order, and the Behavioral Health Division offers a free two-dose kit by phone at (701) 328-8920. A 2015 Good Samaritan law protects people who report an overdose emergency from listed drug charges.

How do I pay for pain and addiction treatment in North Dakota?

Most people in North Dakota pay through North Dakota Medicaid, private insurance or state-funded help administered by the HHS Behavioral Health Division. Medicaid Expansion began on January 1, 2014 and covers adults up to 133 percent of the federal poverty level, with Blue Cross Blue Shield of North Dakota managing benefits for expansion members. Ask the plan which levels of care and which medications for opioid use disorder it covers, and browse programs that take Medicaid.

Private plans fall under federal parity law, which generally requires substance use benefits to be no more restrictive than medical benefits; ask about prior authorization and visit limits for both pain and addiction care. People without coverage can look at state-funded rehab in North Dakota, which the Behavioral Health Division supports with federal block grant money.

What should I ask a North Dakota program before starting?

Before starting, ask whether the program treats pain and substance use together, whether it can start or continue medication for opioid use disorder, and whether it will coordinate with your pain prescriber. Useful follow-ups cover levels of care, payment and insurers, accreditation, languages and the groups it serves. Many people begin with outpatient care in North Dakota, while others compare opioid treatment listings statewide.

Where the listings sit

Nine in ten North Dakota programs listing pain and addiction services sit within 25 miles of a river, a median of 6 miles away, and the Heart River is named most often. Bismarck Municipal Airport is the most common nearest airport, a median of 6.6 miles off, and four in five are within 30 miles of one. Half sit within 25 miles of a named upland such as the Altamont Moraine, at a median elevation of 1,265 feet, with listings near Bismarck, Williston, Grand Forks and Dickinson.

Free help in North Dakota starts with Recovery Talk, a 24/7 peer support line at (701) 291-7901, the national treatment referral line, and 988 for anyone in crisis. More options are on the North Dakota treatment page and the national pain and addiction guide.