Dayton area hospitals join opioid epidemic battle


By Eric Schwartzberg and Denise G. Callahan - Dayton Daily News (TNS)



BUTLER COUNTY — Area hospitals are battling back to the opioid epidemic in a variety of ways: creating community education programs, partnering with the departments of health to increase education around and delivery of Narcan, operating opiate-free emergency departments/physician practices and installing medication drop boxes in emergency departments.

They’re also developing standard educational programs for prescribers, screening patients in emergency rooms to identify those at-risk for dependence and determining which patients need treatment provided together with community partners

In addition, hospitals are working to train staff physicians in addiction medicine and educating hospital care teams in use of clinical protocols, including alternatives in opiate pain management with several evidence-based non-opiate options.

“Call it what you will — a national emergency, addiction crisis, drug epidemic — regardless of the terminology, we are experiencing the biggest drug epidemic to ever hit our country,” Larry Graham, president for Behavioral Health Services at Mercy Health. “If we fail to address this crisis effectively, we will be facing losses over the next decade on par with the Civil War.”

Mercy Health, since launching SBIRT (Screening, Brief Intervention and Referral to Treatment) at Clermont Hospital in December 2015, has expanded it to other Mercy Health Cincinnati emergency departments and across the Mercy Health footprint in Ohio and Kentucky, which includes its Fairfield hospital.

System-wide, it has screened 110,000 patients, Graham said, providing interventions by late July for 1,475 patients at risk for alcohol/drug dependency and alcohol/drug dependency treatment referrals for 803 dependent patients

In addition, Mercy Health has engaged the wider community as it advocates “a three-pronged approach rooted in common sense and science to respond to the crisis,” Graham said. The first element is Narcan distribution.

The Mercy Health Foundation donated $500,000 toward the Narcan Distribution Collaborative, a $2 million study to determine how many lives easy access to Narcan can save locally.

“Yes, nasal naloxone costs money and it can be controversial,” he said. “‘Doesn’t it just let people use drugs with a safety net?’ is a common argument from detractors. However, science doesn’t support that as an actual trend and Narcan saves lives. When someone overdoses on heroin, they are effectively dead. Narcan reverses that. You can’t get someone into recovery if they’re dead.”

Another element is treatment-on-demand, providing short-term, hospital-based detox for those patients who need it before transitioning them to outpatient providers for long-term medically-assisted treatment and related support services.

“Our attention to-date has been fixated on reducing overdoses and the number of people dying from opioid use disorder — and rightfully so — every life taken by this epidemic signals ten more that are shattered elsewhere,” Graham said. “At Mercy Health, we believe that we will ultimately be successful when we shift our focus on increasing the number of people living with opioid use disorder — as functional, contributing members of society, working toward their dreams.”

Fort Hamilton Hospital’s F.O.R.T. (Fort’s Opiate Recovery Taskforce) identifies through law enforcement, those in need and will visit the house and provide a quick assessment.

“The battle against opioid abuse is a community effort that collaborates with law enforcement and recovery resources to reach out to those struggling with addiction in an effort to move them to treatment,” said Jennifer Mason, EMS coordinator at the hospital and F.O.R.T.’s founder.

Fort Hamilton Hospital also is developing protocols in its emergency department for warm handoffs of patients directly to local treatment facilities, according to Dr. Marcus Romanello, the hospital’s chief medical officer.

The hospital, which is part of Ketting Health Netwrok, has partnered with the local recovery agency community, as well as fire, EMS and law enforcement in a collaborative effort to assure those who are seeking help end up finding it. Working collaboratively with Hamilton Police Department, the team was awarded a $100,000 grant from the attorney general’s office to fund the police officer assigned to the team.

The challenge is reaching those addicted at the perfect time in their life that they seize a moment of clarity and make the difficult decision to enter treatment,” Mason said.

“Often it takes six to eight episodes of entering treatment before the addict is able to tap into the skills needed to avoid relapse,” she said. “We have learned it takes a community effort for someone to stay clean.”

In Butler and Warren counties, Atrium Medical Center has sought to address the overdose epidemic in a number of ways. The hospital collaborates with the City of Middletown on a heroin response team and has hosted 13 heroin summits to date. In addition, people have disposed of more than 500 pounds of unused medications in receptacles in Premier Health hospitals just since April, including about 100 pounds at Atrium Medical Center alone, according to Premier Health spokesman Ben Sutherly.

“We believe that the success that has been seen in reducing deaths from opioid overdoses in recent months in Ohio can be credited in part to the collaboration among many community partners and a growing awareness that addiction is a disease best addressed through a public health approach,” Sutherly said. “Substance abuse evolves over time — overdose deaths resulting from prescription opioids, for example, are declining, while deaths from illicit fentanyl, carfentanil, cocaine and methamphetamine are on the rise.”

Premier Health hospitals have treated 74 percent fewer overdoses in its emergency departments systemwide in the first eight months of this year compared to the first eight months of 2017.

Hospitals aren’t alone in their battle against opioid abuse. Facilities like Beckett Springs in West Chester offer assessments 24/7 to individuals who need help with their addiction and mental health issues.

“Because we have no waiting lists, we can provide these assessments and get individuals linked up with treatment immediately, right at the time that they are ready to get well,” said Darcy Lichnerowicz, director of Business Development at Beckett Springs, who previously served as director of assessment.

Beckett Springs also works closely with local organizations to provide immediate access to treatment for individuals who need high levels of care to treat and manage their addiction.

It partners with the Butler County Addiction and Recovery Services Board, offering crisis hotline services to Butler County residents. In addition to the hotline, it’s an active partner in the Heroin Hopeline program, with two care coordinators in the community who works with individuals who need help getting linked with treatment services and getting basic needs met to help them rebuild their lives, Lichernowicz said.

The three health departments in Butler County have been fighting the opioid epidemic on a number of fronts and now are dealing with residual side effects of the body ravaging plague.

Middletown Health Commissioner Jackie Phillips said the health departments have been in on all of the efforts from the get-go trying to arrest the problem. Quick response teams, needle exchanges, data collection, Narcan distribution and training, the list goes on.

The syringe exchange program is inherently controversial, but Phillips said it is not just a needle exchange. It also does testing for Hepatitis C and HIV, education and treatment referral.

“We consider that harm reduction and we consider that being the first line of treatment,” Phillips said. “You have to keep people healthy and alive in order for them to find recovery and treatment… You are able to put your hands on individuals, talk to them give them referrals, look at them face-to-face to see if they’re jaundiced or have infections or need other medical care.”

Phillips said the health department is moving into addressing the residual effects the epidemic is having on families, primarily children. It has been working with the Butler County Education Services Center, Butler County Children Services and school districts to provide trauma training.

“I’m looking at all the families that have been touched by opiates that are probably traumatized, especially the kids,” she said. “To me I feel like it’s really, really something we need to start touching on. I talk to a lot of school officials that say there’s a lot behavioral issues. It’s because (children) really don’t know what to do with all that fear, that trauma, that anger.”

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By Eric Schwartzberg and Denise G. Callahan

Dayton Daily News (TNS)

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