URBANDALE, Iowa — Dr. Alan Bollinger has dedicated his career to helping people overcome addiction.

"When you look at a lot of these people, they've been horribly abused," he said.

Bollinger is a medication-assisted treatment provider at a primary health care clinic in Urbandale, Iowa. Bollinger uses a combination of counseling and buprenorphine to treat people living with addiction.

"If you look at the way people are treated, in general, for their addictions, a lot of times it's stigmatized and the focus is on the behavior rather than on the person, and that makes it difficult to get well," he said.

"Like the rest of the country, we have seen more opioid use and more overdose related to opioids over the last 20 years, and we're also like the rest of the country seeing fentanyl in more than just the opioid drug supply," said Dr. Alison Lynch, a psychiatrist, family physician and addiction medicine specialist at the University of Iowa.

The university has played an essential role in training providers on prescribing buprenorphine, using nearly $4 million from the state’s share of the opioid settlement money.

Lynch said they’ve trained 250 prescribers in the eastern part of the state and more than 100 medical students.

However, one of the biggest hurdles is helping rural health care providers overcome the stigma of using the medication, which is an opioid. Lynch said buprenorphine attaches to opioid receptors in the brain but does not give the effect of being high.

"They don't have to worry about finding another opioid. They don't have to worry about cravings. They don't have to worry about going into withdrawal," she said.

The progress being made is measurable. According to a study from the University of Washington, 40% of rural counties in 2016 had at least one prescriber of buprenorphine. In 2020, the number increased to 63%.

The federal government is putting in money too. In September, the Health Resources and Services Administration announced $104 million would go to rural communities to combat the opioid epidemic, including $10 million for MAT programs.

"The mental health crisis, the substance abuse crisis, they're the same thing and the truth is there's one crisis, and those two things are symptoms. The real crisis is relationship crisis," said Bollinger.

He hopes that, along with the dollars coming in, people's minds will change when it comes to addiction. He believes a changing mindset, along with treatment, is how the crisis can come to an end.

Advocates say there's a huge need for expanded access to medication as the number of victims affected by opioid use disorder continues to rise.

Looking at pictures of Adam Black in a bodybuilding competition, you'd never know that he's 7 years in recovery from opioid addiction.

“I hit a spiritual bottom and everything around me was falling apart. I couldn’t keep anything together in my life, the drugs become everything to you,” said Black.

When those drugs truly become everything to you, Black says, you "lose yourself."

He describes running out of money and says, "I couldn’t feed my addiction anymore, so I started breaking into unlocked cars, stealing change, trying to feed my addiction and, being an addict, I couldn’t do anything right, couldn’t even be a criminal right.”

He went to prison for three years, and then he ended up in the hospital.

“(I) Got heart surgery. I was like 150 pounds at the time, that was one of my rock bottoms, right there, that changed my life, that I can’t keep going this way.”

It was then that he was able to change. It wasn't overnight, but eventually he found Groups Recover Together, and received medication-assisted treatment.

He says, “I don’t have cravings anymore. I’m able to maintain a job, a family, everything I was working so hard to get, I’m able to have that now, and I owe it all to Groups.”

Dr. Gus Crothers is an addiction medicine specialist. He treats people with substance abuse disorders.

“The treatment is a combination of medication, counseling, and lifestyle changes. And those are the same core treatments we use for managing any chronic disease," said Crothers.

He says one of the treatments has tight, and some say, outdated restrictions. It's known as the "X-Waiver" and it requires doctors to get extra training before they can prescribe buprenorphine.

It's a legal hurdle that dates back to the early 2000s.

“When we have such an access gap to medications, people are thinking we should get rid of the data waiver and get rid of those restrictions that limit access to treatment,” Crothers said.

We asked the Department of Health and Human Services about the waiver, which has become confusing for some.

The Trump administration removed the X-Waiver shortly before President Joe Biden's inauguration. Recently, the current administration reversed that decision. A spokesperson for HHS says the previous announcement was made prematurely, but they are committed to "examine ways to increase access to buprenorphine."

Which means, doctors still need extra training to prescribe the treatment, which people like Black say, is life-changing and lifesaving.

“I still take the medication. I’m weaning down as we speak. I sponsor a couple of other guys, I check in with 3 or 4 other people at our group. You can’t do this alone, you need to be there for the people who are going through this," Black said.

You can't go it alone, and Black says, you can get help.