Fighting Today s Opioid Epidemic

Fighting Today s Opioid Epidemic

Establish in 1966 as a Public Health Department Location: Rock Falls, IL/Whiteside County Population: Whiteside County 2015--57,079 Serving Rural IL: Primarily Whiteside, Lee, Ogle, Carroll Counties 2,655 Square Miles! Public Health Department with a FQHC FQHC (2006) Medical Dental Behavioral Health Employees Public Health: 140 FQHC: 92

Public Health: To improve the health status of Whiteside County through prevention, collaboration, and clinical education and regulatory intervention. Community Health Clinic: To provide primary and preventative medical, dental, and behavioral health care across the region. We will serve individuals from all life cycles with dignity and respect in a caring environment.

Payer Source (2016): Medicaid: 54% Medicare: 11% Uninsured: 17% Private Insurance: 18% Patient Incomes (2016): 100% Poverty and Below: 63% 200% Poverty and Below: 90% Over 200% Poverty (no discount): 10%

IL Statistics: In 2014, more people in IL died from an opioid drug overdose (due to heroin and prescription opioid pain relievers) than from homicide or motor vehicle accidents. 2016 Total Opioid Related Deaths=1,826 More than 100 overdoses in Lee and Whiteside County in the last 5 years. 37 deaths tied to heroin and opioid pain medications. 2014 to 2016, CGH saw a 76% increase of substance abuse cases coming through the ER. KSB has averaged 136 substance abuse cases from 2014-2016, which costs the hospital $1.76 million

Does It Work? Allows the patient to regain a normal state of mind, without drug induced highs and lows. Focus on recovery vs. using drugs Decreases cravings Reduces Withdrawal Symptoms Best results when used along with intensive therapy and peer support.

Provider (Prescriber) Physicians 8-Hour MAT Waiver Training Physician Assistants/Nurse Practitioners 24-Hour MAT Waiver Training pcssmat.org Great Resource! MAT Medical Case Manager (Medical Assistant) Takes patient vitals, prepares them to see the prescriber, observes and collect urine drug screen, assists prescriber with refills, and assists with any medical questions or concerns then patient may have.

MAT Case Manager Completes patient Mental Health/Substance Abuse Assessment, liaison between medical and behavioral health departments, schedules MAT patient appointments, leads weekly MAT staffing, keeps communication between community providers open, monitors urine drug screens, and provides therapy as needed. Clinician Provides weekly individual therapy for the MAT patient and keeps the MAT Case Manager informed on issues or concerns. Group Therapist Provides weekly group therapy to the MAT patient.

Suboxone (Buprenorphine and Naloxone) Prescriber=Waivered M.D., P.A., N.P. Initial patient limit is 30, after 1 year 275 patient cap Partial Opioid Antagonist Binds to receptors without the perfect fit Must be opiate free for 24-hours before induction Daily Dosing Closely Monitored Medicaid, Medicare, Private Insurance Uninsured= $$$

Vivitrol Prescriber=Anyone who can prescribe medication Any healthcare professional can administer Complete Opioid Antagonist Blocks receptors 100% Non-habit forming Must be opiate free for 7-14 days Injectable, lasting 28 days No Reversing Fewer obligations Medicaid, Medicare, Private Insurance Uninsured= FREE Samples! No patient cap

Research and COLLABORATION Understanding restrictions and regulation Determining what populations to serve Referrals for pain management or pregnant women Mission Statement: To reduce the stigma and impact of substance abuse and mental health issues on our community and surrounding communities, by providing a holistic treatment approach to those individuals and families suffering from opiate addiction so that they may develop healthy recovery skills in order to maintain sobriety and be a proactive member of society. First patient inducted in March 2016

Total Patients=72 Suboxone=58 Vivitrol=14 Today s Stats= 38 Suboxone=24 Vivitrol=14 Successful Discharges=4 Met program expectations Remained sober Reached personal goals Completed a safe taper

Referrals Self, Family, Other Behavioral Health Agencies, Community Resources, Probation, etc. Assessment Completed Patient is scheduled to meet with the MAT Case Manager (LCSW) to complete a comprehensive mental health/substance abuse assessment Prescription Monitor Program Checked Complete all MAT paperwork CONTRACT Labs Completed MAT Case Manager and Medical Provider Consult Determination of medication and treatment agreed upon Patient is scheduled for MAT induction or Vivitrol Injection

7-10 days opiate free Injection is scheduled around day 10 Patient is seen by any medical provider for a 30 minute medical appt. Injection is given Counseling appointments made Recommendation of at least once a month Next injection scheduled Progress monitored by MAT Case Manager and Medical Assistant

Introducing Suboxone to the patient. 2-4 Day Process Meeting with medical provider, medical assistant, and MAT case manager Daily drug screens Decreasing Withdrawals COWS Vitals Appropriate Dosing Other Medications? Relapse Prevention Planning Scheduling future appointments

Patient begins to follow therapeutic treatment plan and Suboxone dosing is adjusted until stable. 2-4 Week Process Weekly Counseling Weekly Groups/Support Meetings Weekly Prescriptions Follow-Up contact with MAT case manager Drug Screens

Dosage is maintained and patient is following their therapeutic treatment plan, until tapering begins. 2 Months-Discontinuation of Suboxone Weekly Counseling, unless determined otherwise by MAT team. Weekly Groups/Support Meetings Weekly Prescriptions, unless determined other by MAT team. Weekly drug screens Medical appointment every 6 months Labs Taper plan developed

Medicaid, Medicare, Private Insurance, Self-Pay Medical Appointments Provider Individual Counseling Therapist MAT Case Manager Group Therapy Mandatory Labs Urine Screenings

Getting Patients Into Inpatient Treatment Safe Passages Housing Transitions Fire House of God Transportation Public Transportation System Hours of Operation Late Nights Narcan Donations

Can a public health department initiate a medication assisted treatment program? YES, with some thinking outside the box!

Reimbursement: Medicaid, Medicare, Private Insurance for medical appointments, therapy appointments and groups Hospitals: Opioid Addicts historically over utilize ER; a study done at the WCHD indicated that reducing ER visits for 10 patients by 1/month for a year saved over a 1/2 million dollars! Community: Groups like Rotary Grants/Foundations Local Mental Health Board/708 Board

Nurse Practitioners (Family Planning?) Share/borrow provider from hospital/clinic Use MAs for case managers Collaborate with a local mental health agency for therapy/group therapy

COST Licensed Therapist LCSW/LCPC) $60,000 MA $25,000.4 Prescriber (Physician or NP) $40,000 $125,000 plus benefits & overhead REIMBURSEMENT 30 people year with a payment source, should be able to recoup on the average from payers: Provider (25 visits) $48,000 Individual Therapy (52 visits) $78,000 Group Therapy (52 visits) $46,000 $172,000 (will not pay for everything, but not bad!)

IDPH : Illinois-Opioid Action-Plan (more to come) Jails Hospitals/ER Mental Health Agencies FQHCs

www.saukvalley.com http://www.dph.illinois.gov http://www.naabt.org http://www.census.gov http://www.city-data.com