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"5-part plan to reverse the opioid epidemic"

 
A sound plan by Arthur Lurigio & Dr. Sidney Weissman that places treatment front and center.

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Opioid-related overdoses end the lives of more than 100 Americans each day on average. Here's a five-part plan to alleviate the opioid epidemic.

Addiction treatment

The first task in addressing opioid abuse is treating overdose victims. First responders must be equipped with and trained in the use of naloxone. Once victims are stabilized, their treatment can begin. Much scientific evidence shows that opioid use disorder (a medical condition that in common parlance would be called opioid abuse or addiction) can be effectively treated, with recurrence rates no greater than those for other chronic illnesses such as diabetes, asthma and hypertension. The Food & Drug Administration has approved three medications for treatment—methadone, buprenorphine and naltrexone—that block opioid cravings and effects. All three also significantly increase the likelihood that opioid users can recover to live healthy and sober lives.

Medications are most effective when they are combined with non-medical therapies, including short- and long-term residential programs and follow-up care that includes recovery management. Intensive outpatient programs help opioid addicts acquire the competencies and skills to resist future drug use. Offered in community-based settings with comprehensive long-term care, such programs ensure that recovery is an achievable goal, especially when they involve sober housing, supportive services (job development and training) and peer mentorship (e.g., Narcotics Anonymous sponsors).

Education

State and federal governments must fund educational programs that show the limitations and dangers of opioid use. These messages should be directed at the general public, customized to reach groups at a higher risk for opioid use disorders (e.g., rural residents) and crafted along the lines of public health advertising campaigns concerning the risks of tobacco and unsafe sex practices. Educational initiatives also should contain school-based platforms for youths 12 to 17, who are prone to opioid experimentation.

Furthermore, patients should receive informational packets with every opioid prescription to be reviewed with both their prescribers and the pharmacists. Strict adherence to dosage and prescription regimen requires the firm commitment of the physician and the patient to ensure that the type, duration and dosage of the medication are properly and prudently administered. Doctors must be fully informed about the dangers of over-prescribing. Opioid-based instruction should become embedded in standardized medical school curricula.

Medical students must also become familiar with varied pain treatment modalities that are based on established guidelines and evidence-based practices. Medical residents with direct patient care responsibilities should have hands-on training experiences with the administration of opioids. Physicians should be required to attend accredited continuing medical education programs on the latest guidelines for opioid prescribing.

Alternative therapies

Pain management practices should consist of options that work more effectively and are much safer and cheaper than opioids. Alternatives include guided imagery, meditation, over-the-counter pain relievers (such as acetaminophen, ibuprofen and naproxen), physical therapy, antidepressants, massage and manipulation and exercise. When all else fails, opioids should be used only when their benefits outweigh their risks. With few exceptions, opioid prescriptions should be limited to one-week supplies for each patient.

Prescription regulation

A CNN/Harvard University study published in March reported that in exchange for prescribing opioids some physicians have accepted large payments in the form of fees for consulting, speaking, educating and training engagements directed at other physicians. Whether these doctors were selected as spokespeople or so-called opinion leaders because they already wrote large numbers of opioid prescriptions or whether the money paid to them led to changes in their prescription-writing practices is unclear. In any case, the correlation between opioid prescribing and physician earnings is appreciable and troubling.

Recent changes in the development of accredited continuing medical education programs have curtailed this practice. Furthermore, states such as Ohio and Mississippi have sued major drug companies, including Purdue Pharma and Endo Health Solutions, for wantonly extolling the benefits of opioid painkillers while purposely downplaying their risk of addiction.

Supply reduction

Nationwide, computer networks should be established to track the issuance of opioid prescriptions, and those retrieving an opioid prescription should be required to show a valid ID card. Controlling prescriptions will reduce the quantity of drugs being deflected into illicit use. However, this alone will not substantially diminish the availability of opioids through other channels. For example, untold numbers of small labs in China are producing and mailing fentanyl and its derivatives to the U.S. The Chinese government must be enlisted in our efforts to stem this drug flow. New methods of enforcement also will be needed to reduce the smuggling of heroin, which comes mainly from Mexico and Afghanistan.

The opioid epidemic developed over several years and will take long-term, concerted and coordinated public health efforts to reverse the trend of new addictions and to treat victims in the recovery process. We must fortify our will to act before more lives are lost.

Arthur Lurigio is a professor of psychology and of criminal justice and criminology at Loyola University Chicago, where he is the senior associate dean for faculty, a faculty scholar and a master researcher in the College of Arts & Sciences.

Dr. Sidney Weissman is a clinical professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine. He is also on the faculty of the Chicago Institute for Psychoanalysis.

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Haymarket Centers’ Dr. Dan Lustig discusses the need for expanded treatment to meet the growing epidemic of babies born in withdrawal.

BY KRISTEN SCHORSCH
PHOTOS BY MANUEL MARTINEZ. ILLUSTRATION BY ANDREA LEVY.

Zabian Halliburton was born across the southern Illinois border on New Year's Day, arriving into the world at 8 pounds, 6 ounces and 21 inches.

By his second night, he was in withdrawal from the cocktail of meth and heroin his mother used while pregnant, as well as the methadone treatment she relied on to try to get clean. He spent the first week of his life weaning off drugs.

“He just turned red,” his mother, LaTanya Halliburton, 34, recalls. She's sitting inside a playroom while Zabian sips a bottle at the West Loop's Haymarket Center, one of the few places in Illinois where mothers and their kids can stay together during addiction treatment. “He was screaming and sweating like crazy.”

The opioid epidemic has unleashed a storm that's battering its tiniest victims, whether their moms used legally or not during pregnancy. The number of babies born with withdrawal symptoms—inconsolable crying, trembling and, in the worst cases, seizures—is skyrocketing across the country as opioid use grips their parents. A severe drought of treatment options in Illinois for pregnant women in the throes of addiction suggests there's no resolution in sight.

The burden to treat these babies is enormous—on the hospitals that care for them, on the state Medicaid program that largely incurs the cost, and on the generation of children who face little-understood long-term consequences.

LaTanya Halliburton, 34, feeds her nearly 3-month-old son, Zabian, in their room at the Haymarket Center in Chicago.

“It's unbelievable how much it has grown,” says Jodi Hoskins, a nurse who helps educate and support a network of hospitals in northern Illinois where babies are born. “It's almost as if it snuck up on people.”

It's hard to capture the full scope of how the opioid epidemic impacts babies. Hospitals across the state, the Illinois Department of Public Health and the federal government have different methods of gathering or interpreting data on cases of so-called neonatal abstinence syndrome. The data also lags several years, making it difficult to assess the fast-paced epidemic's impact on its most vulnerable casualties.

The number of victims in Illinois is likely much higher than reported. In this state, there's no standard clinical definition of the syndrome, the collection of symptoms that babies experience when withdrawing from substances. These days, that's often opioids. Some doctors and nurses aren't trained to recognize the signs and therefore don't test for the syndrome. In other cases, experts warn that physicians' bias could inflate the diagnosis among low-income babies of color and undercount white victims whose mothers can afford private insurance—labeling them with a seizure disorder instead.

For the past two years, a state task force has been studying how to combat the rise in NAS cases, but it doesn't plan to deliver final recommendations to the General Assembly until 2019. So doctors who watch their intensive care units fill up with quivering newborns aren't waiting. They are drawing from a playbook of successful programs around the nation. Some hospitals, meanwhile, are moving to open new neonatal ICUs.

 

Mercyhealth Hospital in Rockford cares for its sickest babies in a 52-bed NICU. Inside, it's as if a hush has fallen over the cluster of nurses, doctors and parents. The steady hum of alerts and machines typical on any hospital floor is faint here. The lights are dim. Taped to the door of a room where a nurse feeds a baby with a syringe is a sign that simply says “Shhh!” since babies going through withdrawal are extremely sensitive to stimulation like light and noise.

Mercyhealth has some of the highest numbers of babies born with withdrawal symptoms in Illinois. The hospital estimates it treated about 65 babies with NAS in 2017. Dr. Gillian Headley, director of the NICU, and Sandy Damon, a neonatal nurse practitioner, don't quite know what's causing the spike in their area. But they tick off a few observations. Babies are being exposed to higher amounts of opioids in the womb than they were years ago, and more pregnant women are using another drug in addition to opioids, particularly marijuana. These factors can make babies' withdrawal symptoms last longer.

But taking a broader lens, the county that surrounds them is struggling. Winnebago County, which includes Rockford, has some of the highest rates of ER visits and hospitalizations for opioid overdoses in the state. Nearly 1 in 4 kids are poor. A quarter of residents don't finish high school, according to new research.

The former Rockford Memorial, which in 2015 joined Janesville, Wis.-based Mercy Health System, has experienced an influx of neonatal abstinence syndrome cases, partly because it takes transfers from 15 hospitals and is equipped with specialists. In search of advice on how to best confront NAS, Mercyhealth turned to the Vermont Oxford Network. The nonprofit, which focuses on bolstering care for newborns and their families, is a go-to resource for hospitals around the country. In Rockford, nurses now aggressively wean newborns from the morphine that they're initially given to help their tiny bodies cope with severe withdrawal symptoms. They encourage moms to breastfeed, and they plan to add at least two certified nursing assistants to solely focus on babies going through withdrawal.

“(NAS) babies aren't high-tech. They're not on (ventilators to help them breathe). They don't have an IV in general,” Damon explains. “But they are extremely labor-intensive.” Think of a nurse constantly cradling an inconsolable baby in one arm while trying to take care of one or two others.

The hospital's efforts have helped shorten the stay of NAS babies to around 22 days, down from about 30. Next year, Mercyhealth plans to open a NICU with all private rooms (including a futon for guests) inside a new $505 million hospital. Now some babies are monitored in a large open space with rows of tiny beds, while others are put in smaller rooms that fit two to six babies. Chairs are perched nearby for parents to sit with their newborns, but there's little privacy or a bed to sleep next to their babies overnight.

“We really think that we will find that the private room makes it more likely their moms will spend more time with them” and hasten the babies' recovery, says Pam Allen, the NICU's nurse manager.

In 2016, 391 babies in Illinois were born with neonatal abstinence syndrome. The number may sound small until you consider that nearly 3 of every 1,000 babies were born with withdrawal—a 53 percent increase over six years, according to the state Public Health Department. The rate is climbing fastest in rural counties, while decreasing in Chicago. It's highest among white babies and those on Medicaid, though 14 percent were on private insurance, signaling that the syndrome isn't just happening to the poor.

In 2016, these babies stayed in the hospital around 13 days and cost nearly $34,000 each to care for, compared to a two-day stay and a tab of about $4,400 for newborns without the syndrome. (Mercyhealth says this mirrors its experience, too). In total, treatment for NAS babies in Illinois cost nearly $24 million in 2016.

Nationwide, new research on Medicaid NAS cases shows they climbed more than fivefold from 2004-14, to around 14 per 1,000 births. The decade long cost: $2.5 billion. Vermont has the highest number of cases, with about 55 of every 1,000 babies in 2014 born with withdrawal signs, the most recent federal data shows.

While some doctors shy away from treating pregnant women on opioids, others are better informed. The drugs of choice to safely help women quit heroin and other opiates during pregnancy include methadone and buprenorphine. The concern is that, if women stop using altogether while pregnant, they can have a miscarriage.

Starting with the mothers is crucial to truly help the babies of the opioid crisis, says Dr. Mishka Terplan, an addiction specialist and obstetrician in Richmond, Va. The barriers for pregnant women to seek addiction treatment are plenty: feeling guilty and ashamed for using drugs while pregnant; having no one to watch their current children if they need to stay at a treatment facility; dealing with doctors who judge them; fearing they'll lose their babies to authorities once they're born. (The Illinois Department of Children & Family Services says it doesn't typically separate moms and babies if women have legitimate prescriptions for drugs they use while pregnant, and doctors say women in treatment also don't usually lose their children.)

Here's perhaps the biggest hurdle: finding a treatment center. Shannon Lightner's office within the Illinois Department of Public Health reviews deaths of pregnant women, including overdoses. “We see women coming forward during their pregnancy begging for help because of their addiction, and they don't know where to go,” Lightner says, adding that emergency room doctors and nurses often don't know where to refer women for treatment. “They end up overdosing and dying.”

Since the Medicaid public health insurance program covers nearly two-thirds of babies born with withdrawal symptoms in Illinois, a state intern gathered data on opioid treatment centers available for pregnant women. Her preliminary findings: Only 36 percent of counties have some resource.

Cook County, which has the largest population in the state, offers the most options, while large swaths of western and southern Illinois remain deserts—a big problem given that pregnant women using methadone typically require it every day. A potential culprit: unappealing low reimbursement rates that don't fully cover the cost of care.

Haymarket Center knows this well. The nonprofit Chicago addiction treatment facility fields one to two patients a week who trek from the East St. Louis area, like LaTanya Halliburton. “You have pregnant women who are a priority population for the state, but you're not seeing major expansions of treatment to the degree to meet the epidemic,” says Dr. Dan Lustig, Haymarket CEO.

To get help here, Halliburton, who first used drugs at age 11, traveled about 300 miles in a cab from the hospital with her newborn son. She plans to rent an apartment back home in downstate Alton near a methadone clinic this spring, with young Zabian in tow.

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CHICAGO (CBS) — While nearly 80 people were killed by opioids in DuPage County last year, when it comes to treatment, some tell CBS 2’s Charlie De Mar “not in my backyard.”

“The sad thing is with heroin, when you have a relapse, you often don’t get another chance,” said Patti Clousing, who’s adopted son Keenan died of a heroin overdose in 2014. “It tore his life to pieces — and it did tear our family apart, too.”

Keenan was 19 when he overdosed.

And just miles from Clousing’s Wheaton home, the Haymarket Center is looking to move in, providing a 16 bed residential and outpatient drug rehab facility.

“You have individuals already in the community that are impacted by addiction that aren’t getting treatment,” said Dr. Dan Lustig, who runs Haymarket.

The addiction treatment center is decades-old; it’s largest location is in Chicago.

“This is an opportunity to bring medical care to a population that deserves it and needs it now,” Dr. Lustig said.

DuPage County saw 51 opioid drug deaths in 2015. In 2016, that number jumped by 53 percent to 78 deaths, and, once totaled, 2017 will be nearly 80.

“This type of facility, while necessary, is not appropriate for that area, especially with the kids right next door here,” said Dan Wasser, a Wheaton resident.

The proposed site, currently not zoned for residential use, would sit next to a daycare and homes. Some, like Wasser, worry that the facility will negativity impact the community.

Clousing, however, thinks the facility in that area could save lives.

“Haymarket will save lives. And it won’t just save lives — it will save a family.”

Special residential zoning would be needed before Haymarket could ever move in. Public comment continues at city hall next Tuesday.

Narcan, the drug that reverses the effects of an opioid drug overdose, has helped fight the epidemic. It has saved 380 lives in DuPage County since 2013.

Click on any image to watch the news story

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Haymarket Center is the ONLY accredited program working with local law enforcement and the national Sex Trafficking Hotline to help find support and treat these women who experience extreme trauma and circumstances that no one should have to endure. 

Please RSVP to Cortney Ryan by Friday, January 5, 2018.

For questions or to RSVP, please contact Cortney Ryan at 630.833.7722 or email CortneyRyan@WinningSystemsInc.net You may email this form to Cortney Ryan or mail with payment to: Haymarket Center, c/o 105 S. York, Suite 500, Elmhurst, IL 60126

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Illinois launches drug-addiction hotline, but barriers to treatment persist

Illinois officials have announced the launch of a telephone helpline meant to connect people suffering from opioid addiction or other drug problems with treatment providers, part of an effort to reduce overdose-related deaths by a third over the next three years.

The helpline, which is available 24 hours a day by calling 1-833-2FINDHELP, will put a caller in touch with a trained screener who will search for state-licensed options near the caller’s neighborhood or hometown, said Maria Bruni, head of Illinois’ Division of Alcoholism and Substance Abuse.

The idea is to streamline a search that can be time-consuming and frustrating, and can lead the unwary to treatment centers that might not be suitable, Bruni said.

“It’s nice to have a single state resource where people can call and know the information they’re receiving isn’t geared toward getting them into a (specific) program,” she said. “It’s really trying to match them with the treatment they’re seeking.”

Treatment specialists interviewed by the Tribune welcomed the helpline as a needed tool for drug users and their families, but some said it will be only so useful at a time when the state has steadily decreased funding for treatment.

“We need to get these folks to the right treatment, treatment we know is reputable, but then we’ve got to be able to get them in the door,” said Sara Howe of the Illinois Association for Behavioral Health, which represents treatment providers.

Massachusetts was one of the first states to establish an addiction helpline, and it now gets about 2,000 calls a month. Officials with the Massachusetts Department of Public Health, which runs the service, say call-takers try to assess a person’s needs and ancillary issues, from transportation to family obligations, before suggesting options.

“While geography and finances may be barriers for some, we help people navigate those and any other barriers by ending every Helpline interaction with a viable next step for the consumer to support their treatment and recovery,” a spokeswoman said.

Bruni said Illinois’ model works in a similar way. Screeners, provided by a contractor, access a database of treatment providers, counselors and doctors who offer medications such as buprenorphine, a drug that wards off withdrawal symptoms and blocks the craving for heroin and other opioids.

They can then offer choices to callers depending on where they live, what they’re seeking and what kind of insurance — if any — they have. For now, Bruni said, the screeners are just giving out contact information, but the long-term aim is to be able to instantly connect a caller with a treatment center.

She acknowledged that the state will not be able to ensure access for every caller, particularly in rural areas where treatment is scarce. And uninsured callers seeking to get into residential programs, the most expensive mode of treatment, could still face significant barriers.

But she said many people who need help should be able to find it promptly.

“With outpatient, there’s very little wait time, if any,” she said. “With methadone, right now, we’re seeing short wait times. Most are accepting referrals the same day.”

Dan Lustig, CEO of the Chicago-based Haymarket Center, said one important effect of the helpline should be steering desperate and inexperienced people away from “patient brokers” who direct clients to pricey, out-of-state treatment centers.

“What’s happening now with families is they don’t know where to turn,” he said. “(Brokers) end up sending people to very expensive programs that aren’t effective. What this helpline will do is provide another tool to point people in the right direction.”

Gabriela Zapata-Alma of Thresholds, which treats substance abuse and mental illness throughout Illinois, said the helpline will also assist providers who now serve as informal search engines for people seeking treatment.

“So many times people call our treatment center, and our location is far from where they live,” she said. “I will spend so much time on the phone with them looking for places closer to their home. We never want to give people referrals that don’t pan out.”

Though the helpline will not increase the availability of treatment, the state is tapping the same $16 million federal grant that’s paying for it to add medication-assisted treatment in parts of the state where it is not available, Bruni said.

“We’re hoping early in 2018 to get that done,” she said.

jkeilman@chicagotribune.com

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Today is #GivingTuesday

This is your chance to aid the children born in addiction and their families.

The "Face of Hope"

 Cheryl's Story 

Wholly Innocence Childcare

With the support of our friends, Haymarket Center has been able to deliver 1,800 babies drug free and save thousands of lives 

#GivingTuesday kicks off the charitable season, when many focus on their holiday and end-of-year giving.

Haymarket Center is raising resources for the completion of a new & improved childcare center, supporting children and the entire family in their treatment and recovery.

YOU can be a part of helping someone change their life!

Join with us today in supporting the services that Haymarket Center provides.

                                            #HopeStartsAtHaymarket                   #GivingTuesday

Haymarket Center is tax exempt under section 501(c) (3) of the Internal Revenue Code; contributions to Haymarket Center are deductible to the fullest extent of the law on tax returns.

HAYMARKET CENTER HONORS 2017 FATHER MAC AWARD RECIPIENT REPRESENTATIVE LOU LANG

Irika Sargent, CBS Chicago Anchor serves as Master of Ceremonies 

Please Bring an Updated Resume’.

Responsible for overall management of six or more clinical programs. Provides direct supervision to Clinical Program Supervisors. Requires a Master’s Degree in Human Services plus Licensure (LCSW, LCPC). CADC preferred. Knowledge of family-based treatment and evidence-based interventions, knowledge of area funding sources. Excellent verbal and written communication skills and ability to provide effective supervision. Must have 3 years’ experience in management and substance abuse.

CLINICAL PROGRAM SUPERVISOR

COUNSELORS

Facilitates and monitors physical and emotional health status of patients and provides appropriate referral when assessed to need medical, psychiatric, dental evaluation/care. Requires high school diploma or equivalent, bachelor’s degree preferred. CADC certification required. Ability to handle multiple assignments at once, provide effective supervision. Excellent verbal and written communication.

The mission of Haymarket Center is to aid people with substance use disorders in their recovery by providing comprehensive behavioral health solutions.

www.AltonDailyNews.com

Opioid Epidemic Squeezes State Finances

Illinois’ opioid epidemic is sure to put a squeeze on the state’s already shaky finances, if it isn’t already.

 A report from credit rating agency Standard & Poor's said growing costs from opioid addiction won’t immediately diminish any state’s credit rating, which in Illinois is just above junk status, but for states struggling to maintain budget balances, any increased costs will be unwelcomed.

Jeffrey Collord from Chicago area substance abuse treatment centers Haymarket Center said a recent study from Gov. Bruce Rauner’s opioid action plan released in September found that 11.7 percent of people with substance abuse problems were able to get help.

“That means that 88 people out of every 100 who need substance abuse treatment could not get it,” Collord said.

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 That indicates costs to treat opioid addiction could explode in Illinois.

 S&P’s report author David Hitchcock said for states with structural budget imbalances like Illinois, it will be tough to find the funds.

 “It’s a marginal increase,” Hitchcock said of the possible increased opioid costs compared to the overall state budget, “but one that makes it just that much more difficult for them to balance their budget. They’ll have to find some other place in their budget to cut to make up for any increase of any sort.”

 Just how much costs could grow is difficult to tell. The biggest impact will be on spending for law enforcement, jails and prisons, Hitchcock said, and that will crowd out other services.

 “Because if you incarcerate more people, treat more people, have to pay more Medicaid expenditures, that’s a fixed costs that has to be paid before other things that are discretionary,” he said.

 The crowding out effect isn’t just from opioid costs, but also from the state’s mounting pension debt and backlog of unpaid bills.

 Illinois already has major structural deficits. The state’s unfunded pension debt and state employee retiree healthcare costs total more than $200 billion. The Illinois comptroller’s office reports the state’s backlogged bills are more than $16.5 billion. And Rauner’s office said the fiscal 2018 budget lawmakers passed over his veto is already $1.7 billion out of balance.

 Collord said Illinois is already lagging behind.

 “Illinois has struggled to maintain a maintenance of effort requirement, that’s like a match, that Illinois has to meet in order to get the federal funding for substance abuse treatment,” Collord said.

 Hitchcock’s study highlighted Illinois as one of more than 20 states across the country that saw a statistically significant increase of more than 5 percent in opioid overdoses from 2014 to 2015.

 The Illinois Department of Public Health said nearly 1,900 people died of opioid overdose in Illinois last year.

www.AltonDailyNews.com

CBS Chicago talks to Haymarket Center client about gaining access to treatment.

Take some time to see the report and interview HERE

If you have any questions, please contact Cortney Ryan at 630.833.7722

or

Email: CortneyRyan@winningsystemsinc.net