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End opioid epidemic with big changes

To end the opioid epidemic, let’s break the system.

A silo approach – with health care, the pharmaceutical industry, the criminal justice system and local government confined to separate camps – has only prolonged the crisis. Now, we need a radical rethinking of how communities can come together to treat people with substance-use disorders to get us out of it.

In New Mexico, we have weathered our own opioid crisis for many years and are starting to see signs of progress. For the first time since 1999, New Mexico dropped off the list of top 10 states for overdose deaths in 2016 and our state recently received high marks from the National Safety Council for requiring prescriber education, implementing prescribing guidelines and improving data tracking, among other areas.

But, like communities across the country, we know there is more, much more, to do.

Unfortunately, there is not one quick-fix, magic-bullet solution. But the good news is that solutions are out there, and we know what they are.

Here is the bottom line – we need to care for people with substance-use disorders with the same proactive and consistent approach we use to care for patients with any other condition.

At Presbyterian – a not-for-profit integrated health system with nine hospitals, a medical group and a health plan in New Mexico – we took this to heart when we embarked last year on a dramatic overhaul of care for people with substance-use disorders. Born in response to the opioid epidemic, our Integrated Substance Use Disorder and Community Collaborative Initiative is designed to strengthen our approach and improve outcomes for patients, families and members affected by substance use disorders.

Major components include:

• An integrated in-patient addictions medicine consult liaison team available for consultations for patients living with substance-use disorders who are hospitalized for any reason. In addition to a physician, nurse practitioner and physician assistant, a peer support specialist offers recovery support and works with patients to identify recovery resources, including in underserved rural areas.

• Education for clinicians across New Mexico, not just at Presbyterian, on how to identify and treat individuals with substance-use disorders. This includes no-cost continuing education on chronic pain management, safer opioid prescribing and Suboxone certification.

• A weekly addiction-and-chronic-pain-focused Project ECHO program to mentor and support clinicians across our state in offering treatment to their patients.

• We are also working to screen for substance-use disorders at every point of entry into Presbyterian and are creating an opioid stewardship program to define standards for opioid prescribing, monitor opioid practice and reduce variation by giving direct feedback to providers on how they are treating pain.

These solutions are not ours alone; many health systems are grappling with similar questions and finding novel solutions.

For example, the Improving Addiction Care Team (IMPACT) at Oregon Health & Science University developed a promising model that includes an in-patient addiction medicine consultation service, quick access to substance-use disorder treatment after hospitalization and a residential care model that integrates antibiotic infusion and addiction care.

The Connecticut Community for Addiction Recovery (CCAR)’s Emergency Department Recovery Coach pilot program places trained recovery coaches on-call for hospital emergency rooms to help patients and families during an emergency room visit resulting from an adverse drug reaction or other alcohol- or drug-related medical issue.

In our experience, peer support and strong community connections are critical. Our inpatient intervention team benefits from the experience of a team member who has faced addiction firsthand and can also help patients with practical steps like residential treatment options or resources for safe housing. We plan to hire more recovery specialists to support and engage Presbyterian patients with medical crises related to substance use.

In the last year, I have also worked closely with community and faith-based recovery groups to provide information and training to help them help those they serve. We all share the same goal – to ensure people with substance use disorders know they will be treated with respect and compassion when they come to us.

We will not curb this epidemic with the same approaches we have always used.

It is time to think big and be radical. It is time to challenge systems that have ignored or mistreated people living with the illness of addiction. It is time to overhaul old thinking and truly help those with substance-use disorders lead healthier lives.

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