Comprehensive approach to opioid addiction and the role of primary care

 

It is well established that Kentucky has a significant substance use disorder crisis specifically related to the proliferation of opioids.  In 2015, more than 1200 Kentuckians lost their lives to drug-related overdoses. Statewide, the Commonwealth experienced double-digit increases in 2015 overdose rates: 17 percent in Kentucky and 31 percent in Jefferson County (KY ODPC 2015 Report).

Addiction is a chronic disease of brain reward that has biological, psychological, social and spiritual manifestations. Therefore, treatment requires individualized care and creating multiple pathways to recovery. At Centerstone Kentucky, 70 percent of all adults contacting our rural center locations are seeking evaluations related to issues with opioid use disorder, and more than 80 percent of adults seeking help at the Centerstone Addiction & Recovery Center (formerly JADAC) present with issues related to opioids.

Most of our clients began the process of addiction with prescription pain medications and progressed to heroin. The process of recovery is just that, a process and the journey often requires initial participation in clinical and medical services coupled with ongoing environmental and recovery support services often leading to a lifelong recovery.

Addressing the Epidemic

Recovery Oriented Medication Assisted Treatment (MAT) was launched in April 2016 and introduced the addiction medicines of Buprenorphine and Vivitrol as adjunctive support to the full continuum of clinical services. This continuum includes medical detoxification, residential treatment, Intensive Outpatient Programming and continuing care coupled with high-intensity wraparound recovery support services provided by case managers and peer support specialist.

Recovery Oriented-MAT is a comprehensive approach, which treats heroin and opioid use disorders by treating the biological symptoms of addiction with addiction medicine. This allows individuals to stabilize so they can engage in the treatment process, which improves their chances for sustained recovery. The psychological, social and spiritual aspects of the disease are addressed through evidence-based practices consisting of counseling, behavioral therapies and recovery support services.

Co-occurring Concerns

Many of our clients benefit from our services addressing co-occurring mental health concerns and assertive linkage to the full continuum of community based mental health, children and family services. Research indicates when treating substance-use disorders, a combination of medication and behavioral therapies is most effective.

Centerstone Kentucky’s Recovery Oriented Medication Assisted Treatment program follows the framework of Hazelden’s COR-12 approach and implementation model “Integrating the Twelve Steps with Medication Assisted Treatment”. The COR-12 framework is focused upon time limited use of addiction medicine that allows for engagement in treatment and connection to recovery.

This approach of blending Medication Assisted Treatment (MAT), with wrap around services and supports, helps to better address brain chemistry changes created by addiction, reduces physical cravings, provides therapeutic interventions and helps to prohibit relapse. By investing resources toward the most successful interventions to curb the rising tide of addiction we ultimately save dollars and, more importantly, save lives.

-Scott Hesseltine is vice president of Addiction Services at Centerstone.

 

The role of primary care

Molly Rutherford, MD of Bluegrass Family Wellness in Louisville, Ky. discusses the importance of direct primary care in tackling substance abuse.

Medical News: What is the role of direct primary care in identifying and addressing behavioral health concerns, especially around substance abuse? 

Molly Rutherford: Diagnosing substance use disorders takes time, something that is lacking in primary care in the traditional healthcare system. Direct Primary Care (DPC) allows the time necessary to diagnose substance use disorders and fosters the doctor-patient relationship, builds trust and therefore opens the door to someone admitting a problem with addiction. The five-minute (sometimes less) encounter in the traditional system impairs a physician’s ability to diagnose most complex illnesses, especially mental health problems such as substance use disorders.

MN: Compare treating substance abuse to treating other chronic health diseases.

MR: Lifestyle and behavioral counseling is helpful for Substance Use Disorders (SUDs) and for diabetes, but patients with diabetes or other chronic illnesses tend to be more honest about behaviors.

People in active addiction engage in deception daily and it can take some time to build trust so that patients in recovery feel comfortable admitting a lapse. Every time I am able to stabilize a patient on medication, I know that patient is less likely to die, even if he/she relapses. That’s a great feeling that most primary care physicians don’t get to experience daily.

MN: What steps does Kentucky need to take to provide more (or better) resources for Kentucky’s physician community to tackle the drug epidemic?

MR: Kentucky should come out in favor of Medication Assisted Treatment (MAT), support physicians who do the work, educate the criminal justice system about MAT and encourage drug courts to support MAT.  We need to renew trust of physicians in Kentucky.

Kentucky should pass legislation allowing physicians to opt out of Medicaid. This would allow people with Medicaid to benefit from DPC and other direct pay treatment and still have referrals, prescriptions and other orders honored.

Indiana has a “referring, ordering, and prescribing” status for their Medicaid providers. Because of administrative burden, increased overhead, and low reimbursement, it is very difficult for independent practices to sustain a business and bill Medicaid. That’s why the hospitals are buying up practices left and right.

 

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