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SEMO Behavioral Health: Treating addiction without painful withdrawals

Farmington Press - 10/28/2017

With southeast Missouri being particularly affected by the opioid crisis, service providers as well as state and federal departments are stepping up to the challenges posed by the situation.

The federal Substance Abuse and Mental Health Services Administration has awarded grants to states on the basis of need, with a total estimated funding of $485 million per year. Missouri was awarded about $10 million a year for two years.

The awards are known as State Targeted Response to the Opioid Crisis Grants, or Opioid STR for short. According to Southeast Missouri Behavioral Health Center's Director of Clinical Compliance and Physician Services Clif Johnson, southeast Missouri has been designated a high-need area for those grant dollars to go to work.

"For this area, meaning St. Francois County, Washington County, over through Crawford and Dent County, it's a target for extra funding," Johnson said. "We've received our second grant to help target the uninsured population that's becoming dependent on opioids because of the number of overdoses in general, not just deaths."

SEMO Behavioral Health Director of Administrative and Support Services Dan Adams said the focus of the second grant is slightly shifted from that of the first, though both were awarded to combat opioid abuse in the community.

"The focus of the first grant for this area was more targeting the illegal use of prescription opioids because it was really high," Adams said. "But it's changed so that heroin is as much a problem as prescription drugs."

The grant dollars came at the perfect time for SEMO Behavioral Health, as they had begun employing a new system of support for clients including medication-assisted treatment and telehealth services.

"The big term being used now is 'medication first,'" Johnson said. "So the focus is that if you come here, call in or walk in and you're an opioid user, you're going to get in front of a physician and get medication first. We're not going to mess with paperwork, assessments, or the regimens you go through when you go to see your physician. You're going to see a nurse for your vitals check and then you're going to get in front of a doctor."

Adams said the idea of providing opioid-dependent clients with medication as quickly as possible is because of past experience with those who were facing withdrawal symptoms.

"It's frustrating when you get somebody in and they start withdrawing," Adams said. "They know how to feel better so they'll walk out and use.

"With the old way you'd suffer through social-setting detox and then if you can make it four or five days and get through the diarrhea and vomiting, then we'd get you some help. But you realize we don't do anybody any good if they walk out. So we've got to keep them here and the way to keep them here is to make them feel better."

Johnson said clients who were not undergoing residential detox would often not return after the first visit because the withdrawal symptoms became too great to bear. The point of medication first is to quickly get a client onto medication that eases those symptoms so they are more likely to continue treatment and counseling.

"If they started feeling bad they might go and use," Johnson said. "And the problem is if they go use they may overdose and die. I mean, people are dying so we had to do something different as a treatment provider because this is something we haven't ever seen with people dying like this and the community afraid.

"Families are afraid, clients are afraid, law enforcement is afraid - they don't know what to do with all of these overdoses. That's why you see families and clients starting to get Narcan."

Once a client receives medication, often Suboxone, and are feeling better, Johnson said it is then easier to convince the client to take the steps to further resources.

"They have all the problems a normal substance abuse disorder client has," Johnson said. "They have family issues, children issues, job issues, legal issues and housing issues. But if they're not feeling good and they're craving, then you're not going to be able to deal with it. And if they're not alive, we're not going to get anywhere."

"It's Maslow's Hierarchy of Needs," Adams explained. "If somebody's hungry or thirsty, you're not going to talk to them about self-actualization. And if they're sick and vomiting, you can't say, 'Hey, you really need to change your lifestyle. You take care of the vomiting first and get them on medication."

Adams said a "perfect set of circumstances" occurred to produce the opioid epidemic existing today, especially for those who first became addicted to prescription opioids before moving on to heroin.

"We've had the perfect storm," he said. "Physicians that went through medical school in the late '80s and into the '90s were told to treat the pain, so there were a lot of prescriptions for opioids. There was research, mostly done by pharmaceutical companies that said if you're really in pain you don't become addicted.

"So you get that group, then after all the opioid abuse stuff came out, medical schools started teaching the opposite. So you have new doctors coming in the last five or six years who won't prescribe an opioid for a chronic condition. So they may come into a practice where there's been another doctor and they'll have patients that are really addicted to opioids for their chronic pain and they'll cut them off."

Adams said at the same time, a high grade of heroin has been coming into the country that can be effective without injection, allowing those with substance abuse disorder to avoid the use of needles.

Staff pointed out SEMO Behavioral Health Center was a particularly good candidate to receive grant funds because the service provider had already put in place much of the infrastructure for the programs being employed today.

"We were in a good position to get these grants and we could implement them quickly," Johnson said. "We could start treating clients immediately. We were the first to get the STR grant and we were literally the first in the nation to start seeing clients."

A key component of the center's effectiveness is the inclusion of telehealth, which allows doctors to connect with clients who are miles away via specialized communication equipment. This is particularly effective in rural communities where there is a shortage of physicians and a large number of potential clients.

"We've been so fortunate," Adams said. "We got our first telehealth equipment through a grant with the University of Missouri. We thought, 'Oh, this will be great for psychiatry.'"

The equipment was first used to connect autism specialists in Columbia with clients here in southeast Missouri, saving families hours of travel time and expense. When the idea arose to use the telehealth program to get opioid abuse clients quick treatment, the center received support from the Missouri Department of Mental Health, which Adams says is a national leader.

"So when we decided to do more telehealth, the Department of Mental Health was like, 'Yeah, we think outside the box. Let's go for it.' So we didn't run into the bureaucratic nightmares that a lot of state have. The Missouri Department of Mental Health has been great."

The Farmington SEMO Behavioral Health Center's Director of Services Rob Gould said the expanded resources allow the center to find a way to help someone affected by substance abuse disorder, one way or another.

"No matter what - if a client comes in, calls in, gets dragged in or the police bring them in, they're not going to get turned away," he said. "We will find a way to get you in no matter what program it is. We'll find a way to help."

Johnson said while the community has been very open and accepting of the work being done by SEMO Behavioral Health Center, there are sometimes still problematic attitudes encountered.

"Sometimes there's an attitude of, 'Why should we spend money on those people?'" he said. "There's that stigma, which I think keeps people from wanting to get help because they're thrown in that basket.

"It's a hard stigma to break through," he said. "And it's a shame that it takes a crisis like the opioid crisis to get people to kind of pay attention. But I think people are still thinking, 'Well, they just need to quit. Why should we spend all this money?' And that's a hard nut to crack."


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