Substance Use Disorder Response

Transcription

1 Substance Use Disorder Response Teresa Koeller, MD, FASAM, Medical Director, Addiction Medicine Dan Cole, CMPE, Assistant Vice President, Medical Specialties

2 St. Elizabeth Physicians 518 Providers 372 Physicians 146 Advanced Practice Providers 1670 Associates (including providers) 40 Specialties & Services 117 Practices 30 Primary Care 3 Hospitalist Programs 11 Heart & Vascular 6 OB/GYN 1 Express Care, 4 Urgent Care 3 states / 9 Counties All eligible PCPs designated Level 3 PCMH Participating in the CMMI Comprehensive Primary Care Initiative Serving over 315,000 patients In 2017 Nearly 1.5 million visits Over $320 million in revenue Family Medicine Internal Medicine Pediatrics Internal Medicine/Pediatrics Addiction Medicine Bariatric Surgery Behavioral Health Breast Surgery Cardiology Colon & Rectal Surgery Dermatology & Aesthetics Electrophysiology Emergency General Surgery Endocrinology Gastroenterology December 31, Specialties & Services Primary Care 179 December 31, 2010 Specialty Care General Surgery Geriatrics Holistic Health Infectious Disease Medical Oncology Nephrology Neurology Obstetrics & Gynecology Ophthalmology Pain Management/Spine 239 December 31, 2011 Occupational Medicine/Business Health Hospitalists Express Care Urgent Care Number of SEP Providers December 31, 2012 December 31, 2013 Physiatry Podiatry Pulmonology Radiation Oncology Rheumatology Sleep Medicine Surgical Oncology Urogynecology Urology Vascular Surgery Wound Care 404 December 31, December 31, December December February 31, , ,

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4 Complications of Opioid Use Medical Complications: HIV Viral Hepatitis Syphilis Infectious Diseases o Endocarditis o Septic joints o Cellulitis/abscess Hypogonadism Local tissue damage Neonatal Abstinence Syndrome Overdose/Death Societal Implications: Loss of job Broken families Homelessness Legal problems, jail, felonies Loss of potential income/undereducation Illiteracy Lack of transportation Under Employment Societal & economic impact Cost: HIV- $600,000 per patient NAS $66,000/treatment Heart Valve Replacement- $170,000 Hepatitis $90,000/treatment 4

5 Northern Kentucky Heroin Overdoses St. Elizabeth Emergency Departments

6 HIV and HEP C Risk In Northern Kentucky Total HIV Cases: In 2017, a total of 18 people reported injection drug use among their risk factors, compared to only 5 in 2016 Northern Kentucky s Hep C rates are 19 times greater than the average rate in the United States. Of the 220 counties on the CDC s high risk list for an HIV and HEP C outbreak, 25% are in Kentucky. 6

7 St. Elizabeth Response Call to Action Reduce the Supply Strategies from Collective Plan St. Elizabeth Role Other Leadership Needed Law enforcement for dealers Community watch Patient education Provider education Law enforcement Legislators Establish a Regional Infrastructure Continue leadership team Community education Impact analysis Active role on leadership team Community education Submit data on impact Heroin Impact Response Leadership Team Advocate for Change Heroin legislation Naloxone distribution Payment for services Advocating for bills Narcan kit distribution SBIRT screenings Legislators Cabinet for H&FS Medicaid MCOs ST. E FOCUS AREAS Reduce the Demand: Prevent Treat Support Community education Prescription take-back boxes Drug abuse screenings Inpatient/detox Longer-term residential Medically-assisted Wraparound services Provider education Community collaboration Develop 12-step program Employment opportunities Housing Community education SBIRT screenings Prescribing education and standards IP/IOP/OP services Supported CHNKY Hazelden 12-step Add IP bed capacity Increase suboxone prescribers (MDs) Bridge Clinic Vivitrol / rapid detox Increase residential treatment options Treatment options in jail Mental Health First Aid Resource guide Hazeldon program Navigation services (staffed) Public health dept. Law enforcement Community pharmacies NorthKey Children s Home of NKY Transitions Brighton Center Others Community/social service organizations Economic development/ housing authorities NKY employers Protect (from Harm) Naloxone distribution Education to IDUs*, others Needle access Narcan kits in EDs IDU education Naloxone MD order set Addiction clinic(s) Legislators Cabinet for H&FS Public health dept. * Injection Drug User (IDU) 7

8 St. Elizabeth Response Prevention Treatment Support Restore/Replace Protect 8

9 SEP Partnered with Hazelden/Betty Ford Provide training and implementation of the COR 12 Treatment Model. Develop centralized program to provide medication assisted treatment in conjunction with 12 Step Facilitated therapy to the patient 9

10 Medication Assisted Treatment Goals Harm Reduction Decrease deaths, disease transmission Prevention or reduction of withdrawal symptoms Prevention or reduction of opioid craving Prevention of relapse to use of addictive opioids Restoration to or toward normalcy of any physiologic function disrupted by opioid use Potential Outcomes Decreases impulsive behavior Helps to develop structure Decreases criminal activity Increases retention in treatment Increases engagement in socially productive roles Increases employability Decreases overall chaos in patient s life/family MAT can help improve overall function of patients and assist living a normal and productive life. 10

11 Medication Assisted Treatment Drug Options Methadone full agonist Buprenorphine partial opiate agonist at the mu receptor. Slow dissociation from mu receptors, long duration of action. Milder withdrawal symptoms on discontinuation Oral Naltrexone opioid antagonist Long-Acting Naltrexone Injection 11

12 Three Medication Pathways 12 Step Facilitated Groups in Conjunction With Abstinence-based Agonist Therapy Naltrexone 12

13 First Pathway Short Term Medications Detox Residential Treatment Intensive Outpatient Treatment Outpatient Therapy Sober Living Therapeutic Techniques Cognitive Behavioral Therapy Motivational enhancement therapy Contingency Management 12 Step Facilitated Therapy 13

14 Current State St. Elizabeth Physicians Addiction Medicine and Recovery Program 1 FT Board Certified Addictionologist, 1 FT APRN and 8 PT Moonlighter MDs 3 Independently Licensed Clinical Counselors performing o 12 Step Facilitated Groups o 2 Pregnancy Groups, 10 Adult Groups Individual Counseling and Assessments Developed relationships with o community behavioral health programs o residential treatment and detox Created enterprise wide education programs on SBIRT Case Management Baby Steps Program for treatment of chemically dependent pregnant women ED Bridge Program Peer Support SUN Behavioral Health Provide Vivitrol treatment for clients of drug court Addiction Services Council Help Line 14

15 Future State St. Elizabeth Physicians Addiction Medicine and Recovery Program Intensive Outpatient Treatment Family Groups Inpatient Evaluation and Treatment Residential Treatment Telemedicine Ambulatory Detox Develop Vivitrol program with jails Methadone OTP Develop system-wide Peer Support 15

16 Moving our community from shock to programming and hope Addiction is a chronic disease, not a moral failing and one that must be addressed comprehensively across multiple service systems to be effective. We have set six community wide goals: Goal 1: To convene and connect across system to create realistic, sustainable solutions. We need to better align our efforts. Although much has been accomplished, we need to dig deeper into the roots of addiction in order to prevent it from happening, or intervening early in the trajectory of use with effective treatment. Goal 2: Prevent the adoption of unhealthy behaviors among 9-25 years old. We need to address childhood adversity. We have learned that toxic stress or traumatic events in childhood are a significant risk factor for substance use disorders. Goal 3: Decrease the infectious diseases associated with drug use. We must have the tools to prevent the spread of diseases & increase access to health care services. Goal 4: Decrease premature deaths due to drug overdoses. We must broaden our reach to meet people where they are. The effectiveness of Quick Response Teams we will replicate that work into all areas where possible. Goal 5: Provide evidence-based treatment specific to each person s SUD to restore health. Health care providers must identify and manage people most at risk for addiction. Patients who call the NKY Helpline, and those who enter an emergency department for a SUD-related issue, must be appropriately and quickly assessed to be referred to the right treatment facility that is unique to their needs. These places are touch-points for screening, prevention services, and referral to treatment. 16 Goal 6: Provide comprehensive supports to people recovering from substance use disorders to restore self-sufficiency and to quickly address recurrences. Recovery support must be prioritized and coordinated. Recovery support has been disjointed and we must make the alignment and coordination of community-based recovery services a priority.

17 NKY Board for Transformative Leadership for Substance Use Disorders Outcomes NKY Hub for Transformative Action (NKY ASAP, Health Departments, HIRT, ODCP/SEH) Impact Zone Positive Youth Development Health and Protection Patient-Centered Care Restoration and Recovery Strong Families Resilient Children Supportive Communities Fewer Overdoses Deaths Infectious Diseases Easy Access to Biopsychosocial Care Disease Management Support for Re-entry Personal Empowerment Career Development 17 Supporting Strategies: Advocacy, Communication, and Measuring Progress

18 What can your community do now? 1. Acknowledge that your community has an issue with Substance Use Disorder 2. Support residential recovery programs 3. Support and help grow community educational programs 1. Town hall meetings 2. Awareness education on the complexity of the epidemic 4. Consider syringe access programs 5. Consideration of stigma and empathy education 6. Consider distributing Narcan to first responders and families of SUD population 7. Assisted people in recovery with 1. Employment opportunities 2. Transportation 3. Housing post residential treatment 4. Childcare assistance while in recovery 5. Life skills assistance 8. Support and collaborate with detention center and jails on educational programs 1. Nurturing families program 2. Vivitrol\Medication Assisted Treatment programs 3. Post release safe recovery assistance 18

19 Presenters Speaker Information: Dan Cole, CMPE St. Elizabeth Physicians, Assistant Vice President, Medical Specialty Teresa Koeller, MD, FASAM St. Elizabeth Physicians, Medical Director, Addiction Medicine and Recovery Center 19