Officials discuss growing opioid addiction epidemic

ANNAPOLIS - Medical and behavioral health practitioners and law enforcement officials, invited by U.S. Sen. Ben Cardin (D-Md.) and Congressman John Sarbanes (MD-03), met at Anne Arundel Medical Center on Friday, April 8, to discuss the growing issue of opioid addiction throughout the state of Maryland and how to best serve those in need.

"When we think about opioid addiction and opioid overdoses we have to keep reminding ourselves that addiction is in fact a disease. A patient suffering from this disease deserve patient center and care, they deserve empathy, they deserve attention, and the communities that we all live in deserve prevention as well," said Victoria Bayless, president and chief executive officer at AAMC. "We also know that with the disease of addiction rarely do people suffer from addiction alone. They usually have some other mental illness they are suffering from."

Professionals in the fields of mental health and substance use issues participated in a roundtable discussion overviewing current practices some organizations and systems have implemented as well as where professionals think improvements could be made.

Mentioning the need for a more integrated care system in order to better deal with substance use issues and mental illnesses, Cardin said the current care system does not have an addiction effective system. He said emergency rooms and primary health care systems are not reimbursed for "being able to deal with integrated and mental health services."

"Someone who is in need today will most likely end up in a prison rather than getting the type of community care that they need," he said.

Ray Hofmann, AAMC division director for mental health and substance abuse, said when there's a lack in reimbursement for services by insurance groups, services don't survive.

"You can pilot something but it's not going to be sustained and it's not going to be widespread if it's dependent on grant funding," he said.

Cardin and Sarbanes said a bipartisan effort is underway in Washington to tackle the opioid epidemic.

In February, President Barack Obama announced $1.1 billion in funding over a two-year period would be added to his Fiscal Year 2017 budget request to aid in stopping substance abuse throughout the country. At the end of March, Obama announced additional substance abuse initiatives, which included expanding access to treatment, establishing a mental health and substance use disorder parity task force, preventing opioid overdose deaths, expanding public health-public safety partnerships to combat the spread of heroin, investing in community policing, tackling substance use disorders in rural communities and implementing syringe services programs.

Queen Anne's County Sheriff Gary Hofmann said arrests are not the solution to the national opioid epidemic. With more of a focus on education, awareness and enforcement, Hofmann said his department is focused on spreading the word about opioid use and misuse.

If a community member has a substance abuse issue or a family member of a user has questions on what resources are available, Hofmann encourages individuals to come into the Office of the Sheriff for information about community outlets. He said the department has reached out to community partners in medical professions to create a pamphlet, which will be launched next month, that every police officer who goes out on a call will have. The goal of the pamphlet is to get information to the substance user early on and to help steer them to a medical facility or treatment center.

Hofmann spoke about the department's 24-hour drug take back program where residents can drop unwanted medicine off for proper disposal. Hofmann said the department will dispatch an officer to a resident's house to recover substances with no questions asked without charging the individual for possession.

In Anne Arundel County, which has taken a similar approach to Queen Anne's in dealing with arrests for substance users, a 24-hour crisis outreach program has been established where a mental health clinician as well as a mental health trained police officer will respond to certain calls together.

"An overdose or problem does not occur from 8 a.m. to 4 p.m.," said Jen Corbin, Anne Arundel Crisis Response director, about the uniqueness and success of its program.

Corbin said the team is finding success in offering the substance user information about recovery and prevention outlets before they leave the hospital after being admitted.

Once they leave the facility, Corbin said, "doing cold calls the day after an overdose" to give them information was yielding little success. Reaching the individual when they are "clear enough to make a decision" is where they are finding commitment for treatment from them.

Since July, she said, about 90 people have been linked to recovery houses through their efforts.

Among the challenges with treating substance use and mental illnesses from the perspective of the healthy care provider, Helen Reines, executive director at Pathways (a care facility for teens and adults suffering with substance use and mental health issues), said many users have little to no insurance. Because many people they help are on Medicaid, she said, placement into other facilities can be difficult, "most of the time impossible," because the insurance plan does not have in-patient detox benefits or an in-patient rehab benefit in a set acute facility, she said.

In the past 14 months, Pathways, a 40-bed facility, has alone redirected more than 3,000 patients to other resources. Many of the patients in Pathways, Medical Director Elizabeth Winter said, were individuals initially prescribed pain medication who later became dependent on them. Because these prescription medications are expensive to purchase illegally, she said, users turn to heroine for a cheaper alternative.

Though the Center for Disease Control is recommending new prescribing guidelines, Winter said, many physicians feel attacked and blamed for over-prescribing the medication initially. As well as educating the patients about the medication, Winter said, "We also need to be educating other physicians about pain management and prescribing and things like that in a way that's nonjudgmental and non-blaming."

As well as a lack of facilities throughout the state to place substance users for treatment in a timely fashion, Dr. Jinlen Chan, Anne Arundel County Health Officer, said she believes there is a lack of sufficient workforce development, such as trained counselors, psychiatrists or social workers, to provide the needed care. Chan said she and other professionals have a hard time hiring qualified people and that the pay rates are not sufficient for those needed positions. "That is related back to reimbursement rates and such."

"I think all the various agencies that are connected to reimbursement methodologies out there really have an open mind now about how to start making some changes," Sarbanes said. "It's about taking the health care dollar and figuring out how to redistribute it across the continuum of care."

Follow Mike Davis on Twitter: @mike_kibaytimes.