Fighting Addiction on All Fronts
Published: Monday, November 22, 2021 2:32 pm
Substance use disorder knows no racial, economic, sexual orientation, age or gender boundaries. Fighting it requires a concerted effort on all fronts.
The opioid crisis -- now one of the leading causes of maternal mortality -- continues to rage in Tennessee.
"There is a critical need to address access to care and provide comprehensive public health solutions for pregnant women and infants affected by the opioid crisis," said Stephen Patrick, MD, MPH, MS, a neonatologist at Monroe Carell Jr. Children's Hospital at Vanderbilt. "The stakes are high. For years we have been in the middle of an opioid overdose epidemic, but there are still far too many barriers to get treatment. Women are dying or losing their children to foster care as a result," he continued.
While VUMC has had clinical programming in place for many years dedicated to helping pregnant women with opioid use disorder and their infants, funding from the Centers for Medicare and Medicaid Innovation (CMMI), in conjunction with TennCare, will help to unite and expand these programs and provide additional resources. This new expanded program is called Firefly - lighting a path for moms in recovery and their infants.
Patrick, who serves as executive director of Firefly, noted it is one of nine state programs funded by CMMI to test optimal models of care for mothers and their babies. This $5.3 million grant provides funding over a five-year period to combat the nation's opioid crisis and address fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder. Each program is structured differently, with an aim to innovate and improve how care is administered to women and infants impacted by the opioid crisis, said Patrick. Vanderbilt's model has been developed in collaboration with the departments of obstetrics, pediatrics and psychiatry.
"We have to work to push through the system, break down barriers, enhance services and create resources to connect women," he continued. "The ultimate goal for this new program is to support families and optimize care for pregnant women with opioid use disorder and for opioid-exposed infants."
The program's recent launch is timely as Patrick noted families' challenges have likely worsened during the COVID-19 pandemic. Firefly will be based in the Center for Women's Health at One Hundred Oaks, where existing programs will continue to care for uninsured and privately insured pregnant and postpartum women with substance use disorders. Women in the new program will each be paired with a peer recovery specialist, a trained patient navigator and advocate with lived experience.
In addition to five peer recovery specialists, the new Firefly program will also include social workers, an outpatient lactation consultant, obstetric, pediatric and psychiatric professionals and a clinical program manager to help provide wraparound services that are responsive to the needs of this patient population.
For additional information about Firefly or to make an appointment go to fireflytn.org or call 615-421-8000.
TriStar Health facilities in Middle Tennessee and Southern Kentucky collected more than 850 pounds of medication during its "Crush the Crisis" opioid take-back events on Saturday, Oct. 23. The events took place at eight hospitals and one freestanding emergency room in partnership with local law enforcement and aligned with the Drug Enforcement Administration's (DEA) National Prescription Drug Take Back Day.
"I would like to thank every individual who utilized our events to dispose of their unwanted and expired medication," said Tama VanDecar, MD, chief medical officer for TriStar Health. "We were able to collect an incredible 858 pounds of medication, which is now out of people's homes and is no longer at risk of being abused."
Events were held in local communities from Smyrna to Bowling Green. TriStar Horizon Medical Center in Dickson collected the most medication with 316 pounds, followed by TriStar StoneCrest Medical Center in Smyrna with 104 pounds.
Adults in the Nashville area who have been struggling with addictions to heroin, prescription painkillers, or other opioids now have access to outpatient treatment with the September opening of South Nashville Comprehensive Treatment Center (CTC), which provides medication-assisted treatment (MAT) for adults ages 18 and older.
"The staff at South Nashville Comprehensive Treatment Center is excited to have the opportunity to serve the community in the greater Nashville area," said Regional Director Dustin Alvanas. "At South Nashville CTC, we are deeply passionate about helping adults achieve lasting recovery from opioid dependence."
Outpatient MAT at South Nashville CTC incorporates medication and counseling. Following assessment and consultation with one of the center's doctors, patients may receive a prescription for methadone, buprenorphine, or Suboxone. When used as directed within the context of a licensed MAT program, these medications have allowed people to address their opioid use without experiencing the powerful cravings and painful withdrawal symptoms that would otherwise occur.
In addition to medication, South Nashville CTC patients also participate in individual and group counseling to help patients identify and address the many factors that may have contributed to their opioid use and other self-defeating behaviors. During counseling, patients work to develop the skills and strategies that will empower them to achieve long-term recovery from opioid addiction.
The new center, located at 1420 Donelson Pike, is part of Franklin-headquartered Comprehensive Treatment Centers, which operates nearly 150 centers across the nation. For more information, go online to ctcprograms.com.
Brentwood-based Spero Health, a leading addiction treatment provider, opened four more clinics over the last few weeks with the latest being in the Ohio cities of Canton, Columbus and Sandusky, as well as Galax, Va. These latest clinics join a network of more than 60 Spero Health locations throughout Kentucky, Ohio, Tennessee, Indiana and Virginia.
Company officials said these new openings are in-line with organizational plans to continue to expand regionally throughout the year to address community needs for individuals to have local access to addiction treatment services close to home.
"Overdose deaths in Ohio and the United States set a new record in 2020, and unintentional drug overdose is now one of the leading causes of injury death ... surpassing motor vehicle crashes, said Steve Priest, CEO of Spero Health. "We've continued to see these numbers steadily increase across the country since the start of the pandemic. Initially people felt fearful and vulnerable with loss of social supports; that coupled with cheap access to deadly drugs, our communities were dealt a devastating blow causing many to lose their life. It is critical our communities have local resources and quick access to addiction treatment services, now more than ever, it's simply a matter of life and death." said Steve Priest, CEO of Spero Health.
More than 93,000 Americans fatally overdosed in 2020, a 29 percent increase from the prior year.
At the beginning of November, Nashville-based ReVIDA Recovery Centers CEO Lee Dilworth announced that the company is now accepting Humana Behavioral Health - Commercial and Medicare Advantage plans at all seven of its locations in East Tennessee and Southwest Virginia. This is the latest addition to ReVIDA's growing list of commercial, Medicare Advantage, and Medicaid partnerships to lower the cost of treatment for individuals living with opioid use disorder.
"Not too long ago, state Medicaid programs and commercial insurers were not willing to insure recovery treatment for substance use disorder, creating steep barriers for individuals in need of treatment," said Lee Dilworth. "That's why we've worked hard to contract with additional insurance plans who believe in evidence-based treatment like we do."
Additionally, ReVIDA is accredited with all three MCOs for TennCare and accepts commercial and Medicare Advantage patients for Blue Cross Blue Shield of Tennessee and UnitedHealth in Tennessee.
According to the National Center on Addiction and Substance Abuse, only one in 10 people struggling with opioid use disorder receives treatment due to barriers, including a lack of insurance or high out-of-pocket costs.
Researchers at Vanderbilt University Medical Center and the Tennessee Department of Health (TDH) have developed 30-day predictive models for fatal and non-fatal opioid-related overdose among patients receiving opioid prescriptions in the state.
The team applied machine learning techniques to statewide data sources that included details on 2,574 fatal and 8,455 non-fatal opioid-related overdoses occurring within 30 days of an opioid prescription. In all, the data involved just over 3 million patients and more than 71 million prescriptions for controlled substances. The team's report appeared Oct. 19 in the Journal of the American Medical Informatics Association.
According to TDOH, there were 3,032 overdose deaths in Tennessee in 2020, a 45 percent increase from 2019. Opioids, both illicit and prescribed, were involved in 79 percent of the state's overdose deaths in 2020, and 19 percent of Tennesseans who died of a drug overdose in 2020 had an opioid prescription in the 60 days before death.
To assess and engage the opioid overdose crisis, public health authorities in Tennessee have relied solely on current and retrospective descriptive data, without prognostication. According to the report's senior author, Colin Walsh, MD, MA, associate professor of Biomedical Informatics, Medicine, and Psychiatry and Behavioral Sciences, TDH will continue to study the predictive models with an eye to their potential deployment in the public heath response to the ongoing crisis.
The new models are not designed to guide interventions at the patient level. By predicting risk at the prescription level, the models are instead designed to allow aggregation of risk to practices and healthcare organizations, pharmacies, localities and counties.
"With these predictive models, Tennessee might bolster overdose prevention through better understanding of systems, communities and regions at highest risk before overdoses have occurred," Walsh explained. "If this were to prove useful in Tennessee, the tools and methods we've used could potentially be adapted by other states to support more targeted prevention."
Task Force Updates Focus, Seeks Public Policy Changes
The American Medical Association (AMA) issued a report in late September showing a 44.4 percent decrease in opioid prescribing nationwide in the past decade, including a 6.9 percent decrease from 2019-2020. Along with the sharp decreases in opioid prescriptions, new AMA data also show physicians and other healthcare professionals used the state prescription drug monitoring programs (PDMPs) more than 910 million times in 2020. The report also highlighted more than 104,000 physicians and other healthcare professionals have an "X-waiver" to allow them to prescribe buprenorphine for the treatment of opioid use disorder. This is an increase of 70,000 providers since 2017, yet 80 to 90 percent of people with a substance use disorder receive no treatment.
Despite these moves, the nation continues to see increases in overdose mainly due to illicit fentanyl, fentanyl analogs, methamphetamine and cocaine, according to the U.S. Centers for Disease Control and Prevention. In addition, state public health, media and other reports compiled by the AMA show that the drug-related overdose and death have worsened across the nation. Research and data from the National Institutes of Health, U.S. Substance Abuse and Mental Health Services Administration, and Indian Health Service underscore the continued challenges and inequities for Black, Latinx and American Indian/Native Alaskan populations.
"The nation's drug overdose and death epidemic has never just been about prescription opioids," said AMA President Gerald E. Harmon, MD. "Physicians, have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use PDMPs as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care."
To address the country's worsening overdose epidemic, the AMA's new Substance Use and Pain Care Task Force, which includes more than 27 national and state organizations, released recommendations to promote evidence-based policy measures. The recommendations are focused on actions that physicians can take, as well as public policy changes, that would ease the epidemic.
Steps include broad efforts to remove barriers and improve access to evidence-based care for patients with pain, a substance use disorder (SUD) or mental illness, as well as to increase access to harm-reduction strategies. The new task force also pledged to work more directly to address the changing drug overdose epidemic, focus on removing racial, gender, sexual orientation and other health-related inequities. The new task force combines the AMA's Opioid Task Force and Pain Care Task Force. The new name and recommendations reflect a broader approach to the problem.
"The name may have changed, but this task force continues the work of promoting policies that will improve outcomes and save lives. No single recommendation is a panacea, but taken as a whole, they would move our country in the right direction," said AMA Board Chair and Task Force Chair Bobby Mukkamala, MD. "Removing barriers requires policymakers to join us in establishing a more effective and humane approach. Failure to adopt these policies will prolong the epidemic and our patients' suffering."
Highlights of the recommendations include:
The full task force recommendations are available end-overdose-epidemic.org.