Using a multi-faceted approach, the BHN is doing its part to get a handle on the epidemic
The statistics are startling and
they seem to be getting worse
every day.
According to the Connecticut Office of the Chief Medical Examiner, Connecticut once again saw a year-over-year increase in the number of fatal drug overdoses with 1,038 in 2017 compared to 917 in 2016. It’s the first time the state has had more than 1,000 opioid-related deaths in a single year. The number has tripled since 2012. And, while the number of heroin related deaths decreased in 2017, deaths attributed to the powerful synthetic opioid fentanyl were on the rise with 677 reported last year.
This year isn’t looking much better. Since the beginning of 2018, suspected drug overdoses have led to more than 1,300 visits to emergency departments in Connecticut, according to a report by the state Department of Public Health released March 12.
Despite the grim news, there is hope that the tide could be turning in the battle against opioid addiction and overdose deaths. Recovery coaches in emergency departments, continued expansion of the MATCH (Medication-Assisted Treatment Close to Home) program, advocacy for needed state and federal funding for programs, and promotion of safe prescribing practices for physicians are just a few ways the Hartford HealthCare Behavioral Health Network is taking the lead in addressing the crisis.
Recovery coaches coming to Hartford Hospital
With the continued rise in opioid related deaths in Connecticut, Hartford Hospital and the Hartford HealthCare Behavioral Health Network (BHN) are taking action to help those battling addiction find recovery.
Hartford Hospital will soon have recovery coaches available seven days a week in its emergency department to help patients connect with services after they receive care in the ED. The successful program, a partnership with Connecticut Community for Addiction Recovery (CCAR), the Department of Mental Health and Addiction Services (DMHAS) and the BHN, is already in place at Backus Hospital, MidState Medical Center and Windham Hospital.
Recovery coaches work directly with patients after they receive emergency care for a substance use disorder, such as opioid addiction, or if they come in seeking treatment for a substance use disorder. They do everything from providing support in the ED to driving patients to their appointments. Recovery coaches have “lived experience” with substance abuse, which helps build trust with patients.
Through February, coaches in emergency departments have helped link 920 of 947 (97 percent) patients to care, which includes detox, community support, inpatient, outpatient, intensive outpatient and medication-assisted treatment.
“If a person isn’t interested in getting into treatment at that time, the recovery coach will give them their business card and will call the next day if the person is willing. And they’ll call for days, if the patient is willing to let them, to offer support and to try to get them into treatment,” said Hartford HealthCare Behavioral Health Network President Pat Rehmer. We realize that people don’t have to be jumping for joy to come into a treatment program; sometimes they’re still ambivalent. The onus is now on us to get them in the door and keep them engaged. The days of individuals ‘hitting rock bottom’ or ‘proving that they are motivated’ are really over. We need to design our programs to engage the individual.”
“Opioid addiction has truly become a health crisis in our state, particularly in the communities Hartford Hospital serves,” said Hartford Hospital President Bimal Patel. “Immediately connecting patients to treatment and services when they are at their most vulnerable is essential to long term recovery. The recovery coach program is a perfect example of collaboration with our community partners and coordination across Hartford HealthCare to address a major population health issue and give patients the care they need and deserve.”
Suboxone treatment coming to Backus, MidState EDs
Thanks to a grant from the state Department of Mental Health and Addiction Services, patients addicted to opioids will soon be able to begin Suboxone treatment in emergency rooms at Backus Hospital and MidState Medical Center.
Under the program, providers can start Suboxone treatment for people who come to the emergency department for an opioid overdose or if they come with an unrelated problem and mention they have an opioid addiction and are seeking recovery. The patient would then get a next-day referral to one of the Behavioral Health Network’s MATCH program sites where they would continue their treatment.
Suboxone is a medication that helps reduce symptoms of withdrawal and cravings from opiates for patients with opioid addiction. In the past, patients with opioid addiction wouldn’t start on Suboxone until they began a treatment program.
“Ensuring a next-day linkage to the MATCH program where patients can get ongoing Suboxone treatment and maintenance is key,” said Carrie Pichie, PhD, Hartford HealthCare Behavioral Health Network East Region Director of Ambulatory Care — which includes Natchaug Hospital and the psychiatric services departments at Backus. “The value of doing it right in the ED is that there is less likelihood that the person will use if they’re given that immediate transition over to Suboxone.”
Recovery coaches in Backus and MidState’s emergency departments help educate patients about the benefits of Suboxone and entering a MATCH program.
“All of our social workers and nurses are well-versed in Suboxone,” said Jessica Collins, RN, LPC, Director of Behavioral Health Services for MidState and The Hospital of Central Connecticut. “The recovery coaches and Suboxone treatment become an option when the patient is ready to begin their recovery journey. Some people simply aren’t ready. But for the people who are ready, the recovery coach can talk to them more about the benefits of treatment like avoiding that feeling of being sick and some of the withdrawal symptoms by starting the medication immediately.”
Hartford HealthCare has MATCH locations for patients 16 and over in Enfield, Mansfield, Old Saybrook, Killingly, Groton, Norwich, Glastonbury, and Meriden.
U.S. Rep. Rosa DeLauro hears concerns at Rushford roundtable
Better care coordination, job training for social workers and expansion of the recovery coach program were some of the suggestions during a roundtable discussion on March 12 led by Connecticut U.S. Rep. Rosa DeLauro (D-3rd District) at the Rushford facility in Middletown. The event was attended by more than 30 addiction experts, law enforcement officials and recovering addicts.
Although there is $7 billion allocated in the current two-year federal budget to help fight the crisis, the Trump administration is planning to cut the budget of the Office of National Drug Control Policy, or ONDCP, by $340 million. The administration has said the ONDCP would remain as the White House drug policy agency, but the money would be funneled through grants from larger agencies.
DeLauro, who told the crowd she would “fight like hell” to ensure funding for crucial programs remains in place, said she was attending the meeting to hear where resources would go best. “Tell me what I don’t know,” she said.
Some advocates suggested expanding the successful recovery coach program from beyond hospital emergency departments. Recovery coaches are assigned to respond to requests for substance use treatment on an on-call basis in the emergency departments at Backus Hospital, Windham Hospital, MidState Medical Center and soon Hartford Hospital. The results have been impressive with patients connecting to care more than 95 percent of the time.
Rushford Medical Director J. Craig Allen, MD, said it’s crucial to keep patients engaged in their recovery after they begin treatment.
“We have effective treatments and capacity in our programs; it’s sustaining engagement that’s the challenge. Easy availability of low cost, super potent fentanyl means lapses in treatment can be fatal.” said Allen. “With better care coordination utilizing recovery coaches, peer supports, and/or navigators, we’ll be able to multiply our success and start to curb the number of deaths we’re seeing.”
Rushford’s Dr. Dinakar first to be certified in addiction medicine
Rushford psychiatrist Hassan Dinakar, MD, is the first Hartford HealthCare provider to be certified in Addiction Medicine (ADM) under the American Board of Preventive Medicine (ABPM). The ADM subspecialty was approved by the American Board of Medical Specialties (ABMS) in 2016.
“The new designation by ABMS reinforces the recognition of addiction as a preventable and treatable disease, helping to shed the stigma of misunderstanding that has long plagued this line of medical work. This provides another ABMS option for physicians interested in specializing in the treatment of addiction,” according to the American Society of Addiction Medicine website.
“In addition to the new ADM designation, providers specializing in addiction treatment can be certified in Addictions as a Psychiatry sub-specialty or by the American Board of Addiction Medicine,” said Rushford Medical Director J. Craig Allen, MD, “Dr. Dinakar is now certified under all three, and with Psychiatry I guess you can say he is quadra-boarded.”
“To be accredited by the ABMS is a big step,” said Dr. Allen. “For patients, it means they are assured that the provider has demonstrated an expertise in prevention, treatment and ongoing management for addictive disorders. It may also mean that some insurance companies and regulatory agencies will require this type of certified expert status to be eligible for reimbursement.”
Hartford HealthCare to host American Society of Addiction Medicine event
Hartford HealthCare will host the seventh annual “ASAM Educational” on Thursday, May 17, at 6 p.m. in Heublein Hall at the Hartford Hospital Education and Resource Center.
The event is a competition between medical residents challenged to illustrate how substance use disorders (SUDs) impact their patients and their practice. Each contestant submits their 10-slide, 10-minute presentation. During the dinner portion of the evening, a poster board session allows the audience to talk informally with each entrant about their projects. The top three early career doctors go head to head live on stage in front of the panel of judges for monetary awards and an all-expense paid trip to the Cape Cod Symposium on Addictions held in September in Hyannis, Mass.
Eligible contestants must be in a Connecticut medical/surgical residency or fellowship and should email their intention to compete to ctchapterasam@gmail.com. All are welcome to attend, and it is free with prior registration. To register as an attendee, send an email to the same address ctchapterasam@gmail.com.