The USET/Mohegan Tribe s Prescription Opiate Abuse Project

Transcription

1 The USET/Mohegan Tribe s Prescription Opiate Abuse Project Presenters: Irene Miller, NP; Director of Family Services Charles Two Bears Strickland, Vice Chairman; The Mohegan Tribe Council of Elders ACKNOWLEDGEMENTS Many individuals and agencies contributed to this audit of The Mohegan Tribal Community and its response to prescription opiate abuse. A special thank you is extended to: Chief Lynn Many Hearts Malerba Council Chairman Kevin Red Eagle Brown Council Member Mark Matahgha Brown Jeff Hotsky, Chief of Mohegan Police Connie Hilbert, Executive Director of Health and Human Services Khristine Lariviere, Mohegan Pharmacy Manager Carrie Janus, Purchased/Referred Care Manager 1

2 ACKNOWLEDGEMENTS (Continued) We would also like to thank the numerous Mohegan tribal members who participated in focus groups and individual interviews. Their willingness to share their experiences with substance abuse disorders and chronic pain and their journeys of recovery proved informative and enlightening. Project Team: Audrey Allen, NP; Adult and Adolescent Therapist Richard Bennink, LCSW; Adult and Adolescent Therapist Eric Kokchí is ín Maynard, Sober House & Recovery Coordinator Irene Miller, NP; Director of Family Services Charles Two Bears Strickland, Vice Chairman of the Council of Elders Donna Van Sickle, Behavioral Health Clinical Services Office Coordinator In Appreciation: Our thanks to Christy Duke, MPH and Kate Grismala, MS of USET, Inc. for their role in making this study possible. We also want to recognize the contributions and support from the USET Social Services Committee. PRESCRIPTION OPIATE ABUSE PROJECT Introduction Praxis Model Gaps Integrated Model Best Practices Chronic Pain Opioid Addiction Pain Management and Addiction Recommendations 2

3 INTRODUCTION Prescription opiate abuse has reached epidemic proportions In the past 20 years the number of written prescriptions for opiates has tripled Opioid related deaths have also tripled in that time period Native Americans have the second highest death rate from opiate overdoses The Mohegan Tribe is located in Connecticut. Between 1997 and 2007 in Connecticut 2,900 drug intoxication deaths occurred; 77% involved opiates (reported for all races) Methadone, oxycodone and fentanyl most cited The American Academy of Pain Medicine reported that on average opiates help with pain 58% of the time 3

4 PROJECT The study completed by The Mohegan Tribe addressed prescription opiate abuse among tribal members and their families. The framework for this project was based on the Praxis Model: Description of Praxis Model Components of Praxis Model Description of Methodology Gaps AUDIT QUESTIONS 1.Is the Tribe adequately addressing prescription opiate abuse? 2. Are we helping our tribal members with drug abuse and addiction? 4

5 GAPS Gaps were found in four areas: 1. Education Provider Client Family Community 2. Finance Methadone Clinic Payment Policies GAPS (CONTINUED) 3. Coordination of Care Inconsistent use of the PDMP Pharmacies Providers Over-prescribing; lack of following best practices 4. Culturally Appropriate Care Lack of culturally focused rehab options Lack of training/education for substance abuse certification 5

6 FAMILY SERVICES INTEGRATED MODEL Our approach to addiction and co-occurring illness: Integrated western and culturally based traditional healing practices Make up of the Substance Abuse Team is critical to success Native and non-native staff who have made efforts to learn and understand each other s approaches to healing Above helps us to develop a treatment plan that best fits the individual s needs and preferences 6

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12 PAIN Pain is difficult to measure, subjective, and may be physical, spiritual and/or emotional. There are also cultural overlays of how to express pain, to whom and where. The focus of this study is on chronic pain as opposed to acute pain, which by definition lasts longer than six months. A simpler definition for chronic or persistent pain is pain that continues when it should not. (International Association for the Study of Pain, 2004) 12

13 Chronic Pain: Evidence Based Practice Interdisciplinary team approach Complete evaluation Patient pain scales Provider requirements with opiate prescribing Non-pharmaceutical approaches Mental health components Pharmacological intervention 13

14 Opioid Addiction: Evidence Based Practice Screenings CAGE-AID test for Opiate Risk SASSI (Substance Abuse Subtle Screening Inventory) SBIRT (Screening, Brief Intervention, and Referral to Treatment) Range of treatment options Comprehensive assessment Frequent modification of plan Various modalities Medication assisted treatment Pain Management and Addictions: Evidence Based Practice Elements of opioid agreements Drug monitoring program Physical therapy TENS (Transcutaneous Electrical Nerve Stimulation Unit) Acupuncture Massage Meditation Cognitive Behavioral Therapy 14

15 Recommendations 1. Interdisciplinary team 2. Individualized plan 3. Thorough diagnostic work-up 4. Mental health evaluation 5. Culturally-based healing 6. Treatment contracts 7. Alternative non-pharmaceutical options 8. Medication-assisted treatment 9. Follow-up treatment 10.Community education regarding opiates and addiction 11.Provider education 12.Pain clinic laws 13.Prescription Drug Monitoring Program 14.Substance abuse certification training 15.Pharmacy and therapeutics committee Additional Information The following are websites where additional information can be found regarding prescription opiate abuse and its management: Center for Substance Abuse Treatment (CSAT) National Alliance of Advocates for buprenorphine treatment National Alliance of Methadone Advocates National Institute of Drug Abuse NIDAMED Interactive teaching videos for doctors, e-learning prescription drug abuse National Institute of Health and Drug Abuse Providers Clinical Support System for Opioid Therapies Providers Clinical Support System- Medication Assisted Treatment Medication assisted treatment is a project that provides training, mentoring and going educational activities for those offering office-based treatment of opioid dependence. 15

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