Sunday, July 16, 2017 1:00 am
Gaps mar treatment of opioids in region
RON SHAWGO | The Journal Gazette
When she talks about battling the opioid crisis, it's not a stretch for Dr. Deborah McMahan to turn to sewers and roads.
Just as pipes need repaired and highways updated, more infrastructure is needed to bring a 20th-century drug recovery system into the 21st century, she says.
And there are gaps in the region.
More family doctors and nurse practitioners are needed to identify and address addiction, said McMahan, Allen County health commissioner. A system of peer support for recovering addicts should also be developed.
But chief among the needs, local authorities say, is transitional residential housing for those needing intensive care. While Park Center plans a 78-bed facility next year, it will house only people in the criminal justice system, a fraction of those who likely need care, its CEO says.
What has emerged as the best way to treat addiction is medication-assisted treatment. MAT – the use of alternative drugs to normalize brain chemistry, counseling, peer and family support – is promoted by the U.S. Department of Health and Human Services as an effective detox method. Typically, suboxone, vivitrol or methadone substitutes for heroin and is gradually reduced as the patient receives counseling and peer support.
It is developing into a treatment model similar to any chronic disease such as congestive heart failure or diabetes, McMahan said. It is a multi-discipline system with medicine, counseling and intense outpatient treatment.
In the six to eight months it takes for the body to experience pleasure naturally, local authorities are trying to find ways to augment the recovery through peer support and care recovery coaches who walk people through their challenges, she said.
“In the 21st century you just have to be so flexible because this crisis is today and will be there in the next 10 years, but who knows what we're going to see next year,” said McMahan. “And you need to have that capacity of the public-private sector to be able to work together to problem-solve and implement solutions quickly, and I don't think we have that now.”
More family doctors could do the medication part of the treatment and refer patients to others for counseling. McMahan said. That would increase the capacity to do MAT.
Dr. Daniel Roth, who operates Summit Pain Management in Fort Wayne, said he practices MAT but few other local physicians do. About eight to 10 do some form or MAT, but the need is for 30 or 40, Roth said in an email.
“Primary care physicians could be very effective in this role, but conversely, PCPs get asked to do so much already,” he said.
MAT got a local boost this month when the Bowen Center in Fort Wayne was named one of five new opioid treatment programs. In addition, methadone treatment for opioid addiction will be covered starting Aug. 1 for most Hoosiers on Medicaid and the Healthy Indiana Plan. There are now 13 methadone clinics in the state.
At Bowen, new clients will see an intake coordinator who will get background information, and a nurse practitioner who will perform a physical exam, said Kurt Carlson, CEO and president of Bowen Center, headquartered in Warsaw.
A psychiatric exam will determine level of need and if the client is a good candidate for treatment, he said. Then the dose of methadone the client will take daily is determined.
Group therapy sessions will be required probably twice a week, along with at least one weekly individual outpatient session, Carlson said. Some will need community-based services, so a case manager will work with them in the community and home. The goal is to eventually wean them off methadone.
But like Carlson said, some will never come off.
“There will be a small percentage of people that are like that,” he said, “and we just need to recognize that as we try to do the drug holidays, to do the reductions and all that. That's just the reality for their biological system.”
McMahan said developing a peer support recovery model is also in the works. More people need to be trained. Unlike an Alcoholics Anonymous meeting, peer support is more one-on-one, a coach for as long as needed, she said.
And more transitional housing is essential, especially for those in the criminal justice system who have little or no family support, she said.
“And that's not just a kumbaya sort of thing,” McMahan said. “We cannot afford to have all these people not functional. It's just not economically sustainable, so we need to do what it takes to come along side people in an evidence-based way and help them through this crisis, just like we would if they had cancer or just like we would if they had congestive heart failure.”
Roth said he's unsure how many local inpatient centers would be needed for people with addictions. “It's a lot more than we have, that's for sure,” he said.
Park Center's 78-bed residential treatment facility will be on Rupp Drive in the triangle park bordered by Coliseum Boulevard East and Trier and Hobson roads, said Paul Wilson, CEO of the mental health agency. It is expected to open about March. Until then, Park Center will open 15 treatment beds in August at its offices on Carew Street.
“That will be a start at the residential addictions gap,” he said. “That probably is the biggest gap.”
The treatment facilities will be supported by the state's Recovery Works program, Wilson said. The program pays for addiction and mental health treatment for convicted felons sent to community corrections instead of jail or prison.
The Rupp Drive project will have 22 beds for longer-term residential care. The rest will house those needing a lower level of care, which Wilson terms sober-living. The longer-term stay is more attune to old 28-day treatment programs. The lower-level care is akin to 12-step programs, he said. Wilson said a lot more of the latter are needed.
All are for people who find themselves in the court system.
“Oftentimes people do well in their sobriety if there's somebody watching over them and holding them accountable, and there's also treatment,” Wilson said. “But what that doesn't reach out to is people who have yet to come in contact with the court. So in terms of the overall need, there's still significant gaps at this point in time.”