How to Treat Substance Abuse with a Model of Ongoing Care

President Trump recently unveiled his three-pronged opioid plan to help address the opioid epidemic, yet programs on a more local level are already making a big difference.

Enter Family First Health, a federally qualified health center located in southcentral Pennsylvania. Family First Health is treating patients with substance use disorders in the context of primary care with medication-assisted treatment (MAT) and a robust support team of case managers, recovery support specialists, and a dedicated licensed clinical social worker.

Pennsylvania is navigating one of the highest rates of opioid overdose deaths in the U.S.  Recently in York, PA, there were 13 overdose deaths linked to fentanyl in only 10 days.

Bell

“As information about the opioid epidemic surfaced, Family First Health began assessing and adjusting our current prescribing practices,” says Debra Bell, MD, medical director of Center of Excellence: A Substance Use Program. “In conjunction with that, we considered how we could support individuals dealing with substance use disorders in the primary care environment.”

A key element to that was embracing substance use disorders as chronic, relapsing diseases and treating them as such, according to Bell.

“This includes creating a model of ongoing care, which allows us to regularly engage with our patients,” she says. “Another key element was the start of prescribing MAT to patients in October 2016 through funding from a federal grant. That work quickly grew, and Family First Health received designation as a Pennsylvania Center of Excellence to allow us to expand our reach and support to individuals with substance use disorders.”

For more on programs combatting the opioid epidemic, read: “Four pain management programs curbing the opioid epidemic.”

Here, Bell details for Managed Healthcare Executive (MHE) Family First Health’s approach and its noteworthy outcomes.

MHE: When did the program begin?

Bell: We officially began this work in October 2016 and have continued to build out the support team necessary to keep our patients engaged in care. The care that patients receive at Family First Health includes MAT for substance use disorders, as well as all other primary care needs such as chronic care and acute visits. The idea is that we treat substance use disorders as the chronic, relapsing diseases they are.

MHE: What are the outcomes of this program?

Bell: As of February 28, 2018, we have seen more than 300 unique patients for substance use disorder treatment. Of those, 80% of these patients are part of our Center of Excellence. Each month, we consistently add 20+ new patients who are being seen at Family First Health for substance use disorder treatment.

MHE: Why should providers be interested in this approach?

Bell: Simple changes in providers' language and approach can make a significant impact in improving the lives of individuals struggling with substance use-and the lives of their families. It’s a matter of shifting the conversation from using derogatory terms like “addict” and “junkie” to take a less confrontational approach and more of an affirming approach. This change allows patients to establish a more therapeutic relationship with their provider that empowers individuals to improve their lifestyles overall. 

MHE: What is your best advice for providers regarding treating patients with substance abuse?

Bell: Substance use is a chronic relapsing and remitting disease similar to the chronic disease of diabetes where patients can gain success but still continue to struggle. Those who struggle with addiction do not always “look” like someone who would have a problem with this disease; therefore, screening as a consistent practice with a plan to refer to treatment as indicated, can make a significant impact. Our current opioid crisis is widespread and multifaceted. Each provider can make a difference by choosing to be part of the solution by changing prescribing habits, by screening, and by being part of a team that is providing MAT and linking to treatment opportunities in the community.