By BETSY TAYLOR
PITTSBURGH — When Carmen Capozzi learned about his teenage son Sage's drug addiction from a health care provider, the father was told: You'd better get him help.
"There was no information," Carmen Capozzi said. "We didn't know what to do next." The family scrambled to get informed. Sage entered treatment programs more than once and counselors credited him for helping others through recovery. But Sage had a fatal relapse and died of a heroin overdose at age 20 on March 5, 2012, his father said.
Carmen Capozzi's voice wavered with emotion as he spoke here on a panel at the McGinley-Rice Symposium on Social Justice for Vulnerable Populations. He talked about his son and work being done through Sage's Army, a nonprofit he and others founded to raise awareness of the opioid epidemic, reduce societal stigma and promote a compassionate response to individuals struggling with drug addiction and their families. One thing Carmen Capozzi has learned: "There are multiple paths to recovery."
Spreading the word of those multiple paths was one important part of the symposium called "The Face of the Person with an Addiction," and held on Oct. 26-27 at Duquesne University School of Nursing. It brought together health care professionals, policymakers, scholars, students and others whose lives have been touched by addiction.
Sr. Rosemary Donley, SC, is the Jacques Laval Endowed Chair for Justice for Vulnerable Populations for the university's School of Nursing. She is principal organizer of the meeting. Presenters underscored that addiction is a treatable brain disease that strikes irrespective of age, race, socioeconomic status or gender. Sr. Donley said the event aimed "to encourage cooperative efforts for compassionate solutions" to an epidemic of addiction.
Pennsylvania had 4,642 fatal drug overdoses in 2016, an increase of 37 percent from the 3,377 such deaths in 2015, according to the federal Drug Enforcement Administration. The dramatic rise mirrors what's happening nationally as the U.S. is rocked by an opioid crisis. The Centers for Disease Control and Prevention say there were about 64,000 drug overdose deaths in 2016, with the sharpest increase related to overdoses connected with fentanyl, a potent and often deadly synthetic opioid.
Increased availability of naloxone
In response to the spike in opioid overdose deaths, there's been an effort in Pennsylvania to increase the community deployment of naloxone, a medication that counters the effects of acute opioid overdose. While traditionally administered by emergency medical responders, the drug is easy to use and can be safely administered by people with little or no medical background. In 2014, the Pennsylvania legislature moved to make the drug available without a written prescription. Forty other states have similar availability.
Some community organizations in Pennsylvania provide training and give out naloxone for free, in the form of a nasal spray or an auto-injector, in hopes that a bystander, family member or friend will have it on hand in an emergency. One speaker suggested that places with public bathrooms — including grocery stores and libraries — keep naloxone on hand because drug users shoot up in such spaces. Dr. Karen Hacker, director of the Allegheny County Health Department where Pittsburgh is located, said she'd heard of about "one overdose a week, at least" in public libraries with public bathrooms in that county.
Duquesne University President Ken Gormley on Oct. 26 welcomes participants to the McGinley-Rice Symposium on Social Justice for Vulnerable Populations on the university's Pittsburgh campus.
Photo courtesy Duquesne University
In an acute opioid overdose, a person may exhibit one or more telling symptoms including being unresponsive; having a blue color in fingernails and lips; slow, irregular or stopped breathing; and pinpoint pupils, where the center of their eye is small like a pinpoint. Other signs include slow heartbeat and low blood pressure. Naloxone should be administered as soon as possible, because brain damage can occur within a few minutes when the brain is deprived of oxygen, according to websites that provide information about the medication.
While naloxone is "effective in preventing death. It's not effective in giving a person back their life," said conference presenter Susan Overly, a nurse manager for Excela Health Westmoreland Hospital in Greensburg, Pa. Near death experiences from overdose, or the ongoing risk that the next shot may be deadly, is not always enough to make an addict seek treatment.
Health care systems are expanding their approaches to better encourage those with addictions into drug rehabilitation treatment.
The National Institute on Drug Abuse says even with treatment, relapse is "not only possible, but likely." It also says relapse doesn't mean treatment has failed. But treating chronic disease involves changing embedded behaviors, and with addiction success is not ensured.
Some people revived with naloxone refuse additional medical treatment at the time of the emergency. But others do receive continued medical care in an emergency room or inpatient unit. To encourage those individuals to enter treatment without delay, Excela Health Westmoreland Hospital began using a direct referral process in January known as a warm-handoff.
When someone is hospitalized with addiction symptoms, or has been revived from overdose, the patient is evaluated by a clinician who recommends next steps, and assesses whether the patient would benefit from inpatient or outpatient treatment. A clinician calls in a mobile case manager who visits the patient's bedside and talks to him or her about addiction treatment options.
The Westmoreland Drug and Alcohol Commission, which oversees fiscal and program accountability for services in that county for those with addictions, organized the system that uses the mobile case managers. Southwestern Pennsylvania Human Services employs the five mobile case managers that visit the hospitals, said Rachel Jackson, the hospital's manager of outpatient behavioral health.
In rural Westmoreland County where the hospital is located, a treatment bed isn't always immediately available before the patient is discharged. If a bed can't be found for a patient recommended for inpatient treatment, the case manager calls the patient daily to check in until a bed is open.
Initial successes encouraging patients into treatment programs led the system to expand the warm handoffs into its other hospitals, Excela Health Latrobe Hospital and Excela Health Frick Hospital, both in the rural county about 40 miles southeast of Pittsburgh.
Several symposium presenters spoke about the effectiveness of medication-assisted treatment combined with talk therapies. The National Institute on Drug Abuse says medication including buprenorphine, methadone or extended-release naltrexone are effective for the treatment of opioid use disorders and should be combined with behavioral counseling. However, even with medication-assisted treatment, individuals need individualized plans, speakers said. Some also supported more research to establish an average optimal treatment length in different care settings.
Pittsburgh Mercy offers clinics for behavioral health, medication assisted treatment
PITTSBURGH — Pittsburgh Mercy Health System opened a federally certified community behavioral health clinic in July. It is part of a two-year federal demonstration project to better integrate behavioral and physical health care with increased use of evidence-based practices and to improve access to behavioral health care for those with mental health issues and substance use disorders in southwestern Pennsylvania.
This "Comfortable Cup of Tea" artwork was created during Pittsburgh Mercy's "Mercy Week," to celebrate the legacy of hospitality of the Sisters of Mercy and their founder Catherine McAuley.
© 2017 Pittsburgh Mercy
The clinic model aims to break down silos related to patient care by using care teams, improving access to doctors, using peer support in treatment and encouraging individuals to share in decision-making and treatment goals.
Ray Wolfe, Pittsburgh Mercy's chief operating officer, said by email that about 200 of the Catholic health care system's 1,700 employees work on teams in the community behavioral health clinic. The teams include primary care physicians, psychiatrists, physician assistants, nurse practitioners and behavioral health and social services professionals.
There are four Pittsburgh Mercy locations where people can receive outpatient care, including mental health care. Wolfe said the community behavioral health clinic also functions "where needed." Many of the care providers are on mobile teams that work in neighborhoods where their patients live, providing case management, or the coordination of needed services, and physical and mental health treatment.
Pittsburgh Mercy also is in the early weeks of operating a medication-assisted treatment clinic at Pittsburgh Mercy Family Health Center, a primary care physician practice that integrates physical and behavioral health care.
Medication-assisted treatment combines behavioral therapy and medications to treat substance use disorders. The center is on Pittsburgh Mercy's South Side campus, adjacent to downtown. Clients can walk between buildings for medical and social services.
Care providers said part of the early work they're doing for the medication-assisted treatment program is letting patients know they can receive physical health care there and medication to curb cravings. Anyone getting the medication receives ongoing mental health treatment, said Kristi Seemiller, a substance use disorder care manager at the center.
The treatment plan varies depending on an individual's needs. Some patients may be referred to a partial-hospitalization program, a short-term day program that provides support to those in distress; others may receive a recommendation of individual therapy once a month.
Wolfe said, "We offer housing and employment assistance through case managers, individual and group therapy, partial hospitalization, art in therapy and social rehabilitation, all within the certified community behavioral health clinic and in collaboration with the medication-assisted treatment drug prescribing. For many the treatment is ongoing for some time, even years."
— BETSY TAYLOR
Copyright © 2017 by the Catholic Health Association
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