Spectrum Health Systems on the Opioid Epidemic
Heidi DiRoberto, LMHC and Amy George presented on the opioid epidemic in Massachusetts, its causes, and treatments. We also covered Naloxone (Narcan) and learned that it can be purchased just about anywhere, and can help someone survive an opiate overdose.
For questions or follow-up, contact
Heidi Di Roberto, LMHC
Spectrum Health Systems, Inc.
585 Lincoln Street, Worcester, MA 01608
(508)-854-3320 ext. 1143
Heidi: Spectrum Health Systems, 40, 45 years, the opiate epidemic is not new to us, very accurate. Since about 2001, we’ve seen a spike in overdoses and the growth in opiate use. We’ve got some little interesting things here. So every day in Massachusetts at least two people die from an opiate overdose even since I created these slides. Those numbers don’t include big cities like Worcester, Springfield, and Boston. When you see on the news that 1,400 died from opiate overdoses last year, that doesn’t include Worcester who’s responding to – I think there was somebody back there that said that they’re hearing one each shift in a small town. U Mass is responding to like 4 each shift, each day so about 12. Not all of them are dying luckily, but the numbers that we’re seeing don’t even talk about Worcester, Boston, or Springfield where the opiate epidemic has been going on for a long time.
Every day throughout the whole country, more than 100 people die from opiate overdoses, again probably not taking into account major cities because they have separate department of public health. It will take a while to report those statistics to their states. These are preventable deaths. How many people – I missed I was in technology stress when people raised their hand how many people that they know who have been addicted to opiates? It’s everybody, right? I heard the term junkie and I went ugh but like it’s just like a bad word for me, but these are our friends, these are our neighbors, these are your tenants, these are people in our community that you would never have thought 15 years ago would have had a substance use problem.
There’s a reason that now we’re seeing much more people than you would have ever thought before. In about 2001, 2002, JCAHO, which is a commission that accredits hospitals, came in and said doctors weren’t addressing pain correctly, and so they started addressing pain. With that, they started addressing pain with more Percocet and then came OxyContin and regular old folks were getting hooked to these pills, and then that age-old story, right? We’ll talk about it is the natural progression. I got into an accident. I got hurt at work. I was on these pills, and before I knew it, I had a serious problem. Then heroin becomes this much cheaper alternative.
So common opiates, all opiates are derived from an opium plant. Opiates have been around for a very long time. You’ll probably know them as morphine, codeine, heroin, hydrocodone, oxycodone. You’ll hear some people talk about buprenorphine or Subutex, fentanyl, methadone, tramadol, just to name some of them.
Drug addiction, here’s a case for you. You’ve got a 20-year-old college female student. She’s taking OxyContin at parties. I think you said $30 pill. It was a great time, have a little alcohol, go into the club, whatever. But before you know it, opiates are an addictive substance, so if you take them for a short period of time every single day, your body will become addicted to them. She really likes it. She starts using it more often. She’s craving. She’s getting sick in the mornings. Quickly they’ll become physically addicted. They’ll have flu-like symptoms if they don’t use and they’ll start using more often.
Then her functioning changes. She starts missing school. She quits work. She becomes moody and irritable and she switches to heroin because heroin is a fraction of the cost. Then her addiction really gets out of control, right? She fails out of school. She gets arrested, violates probation due to ongoing use. Pretty similar story to people that you know, I’m sure. Why doesn’t she just stop using?
Female Audience 1: It’s an addiction.
Heidi: It’s an addiction and she just can’t, right? I really feel like when I come to these things, Rich, you did what I wanted you to do. That’s all awesome. I want people to really understand that this is a disease and it’s not something that people could just quit. We wouldn’t be here. There wouldn’t be all the treatment facilities. There wouldn’t be people trying to save these people’s lives, but their brains, they get taken over. They’re hijacked and everything changes.
Not everybody uses becomes addicted, right? But crossing the line from abuse to addiction, you lose control. You become compulsive. You use despite the consequences. You think how can a mother do that when she has two beautiful children or how could a guy do that to his wife, right?
At some point, their brains just they lose that executive functioning to make the appropriate choices for their lives and they have kind of have like a PTSD. Anybody know what PTSD is? If you’ve ever been dope sick, right, or if you’ve ever been sick from an opiate, it’s a trauma. They never want to feel that way again. They feel like they’re dying and all their motivation is to never feel that way again, so they do coercive behaviors to continue to use.
Talking a little bit more, their reward system is hijacked. They continue to use substances, their environment changes. They are around other people where this behavior is acceptable and/or they’re changing their environment to just live in solitude and use and it affects their emotional states.
We talk about addiction as a disease, but unlike other diseases like diabetes for example, you could get treated for diabetes and you can address your diabetes. Sometimes if you eat well enough, you can make improvements and you don’t have to take much medication or you can reduce your medication or if you have Strep throat, for example, you go to the doctor. We do tests. We give you amoxicillin; 10 days later, you’re brand new.
Well with addiction, detox alone doesn’t work because they’ll have to continue to address their substance use for the rest of their lives. The goal of addiction treatment is really to reduce and eliminate substance use. I know you say reduce, why don’t they just stop using, but we’re really trying to meet people where they’re at and we’re trying to get them to make changes that they’re ready for because has anybody here ever tried to change anything about themselves? It’s wicked hard! I’m 5 years next week postpartum from my last child and I still haven’t made a decision to lose those last 10 pounds, right? I really want to but I just can’t stop eating the brownies.
If people could just stop, they would, but it takes a lot of motivation and if it was for all the love that their family was giving them or the concern that their friends had, or losing their job or having their children taken away, if all those things motivated them to change, they would change. But their addiction is so strong.
If you guys have questions, feel – this will be much more
Rich: No, don’t do that.
Heidi: Okay, all right. I could walk around with the mike like Doug did. You guys could ask the question. Anyways, so we’re looking to engage and retain people in treatment. Sometimes people who start in treatment think it’s a good idea and then it’s hard. You know living a life of recovery is really, really hard. In reality, it’s hard, right? Nobody in here had an easy day today, I’m sure. When you lose your coping strategy to use, we take away using, they have to relearn how to live their whole lives. We’re looking to decrease impact on the individual. We’re looking to decrease the impact on families and society. We don’t want to hear about our clients breaking into your houses. We don’t want to hear about the coercive behavior. We really want to help folks get better.
Behavioral treatment, we look to enhance motivation for behavioral change. We try to help them to anticipate triggers. They’ll know people, places, and things. We want to get them to try to take a look at that and see what they need to do. Looking to try to increase healthy coping strategies depending on when people start using. For some of our folks, they start using substances as early as 9 and 10 years old, and so imagine how you’ve grown since 9 or 10. They start smoking cigarettes and smoking weed. Before you know it, they’re 12 and 13 years old, they’re using other things. They just stop –
Sorry. Was that causing a problem?
Rich: No. You just saw me walk.
Heidi: Okay, all right [laughter]. They don’t learn how to cope like somebody else who isn’t using.
Sandra: How does a 9 -year-old get this kind of drug? When you say 9 years old – I’ sorry to interrupt – how does a 9-year-old get oxycodone or anything [unintelligible 0:10:08].
Heidi: I don't know if 9-year-olds are getting OxyContin but
Rich: Excuse me. Sorry. We will open up the questions if that’s what you want to do. So what Sandy is asking so everybody could hear it is how does a 9-year-old get a substance? How do they even get into – it might not be whatever their drug of choice is as a 9-year-old.
Heidi: From their best friend.
Sandra: From mom?
Heidi: From their parents’ medicine cabinets, from their best friend, not from a drug dealer. They’re getting it from somebody they know. [unintelligible 0:10:40] absolutely. I used to run a detox and stabilization unit for kids who are ages 13 to 18. You think who needs from 13 to 18? A whole lot of kids, right? They’re getting it from their friends. They’re getting it at school.
Rich: [unintelligible 0:10:58].
Heidi: It’s okay. I love it.
Sandra: Is some of the plans that are being put into practice to deal with this vicious situation that we have getting into the schools, to the doctors, and understanding , if I am a teacher, I have got so much else that I’m dealing with all the time. I don't notice that this 9-year-old is basically freaking out because I’ve got 30 other kids that I’m trying to deal with. What I’m just [unintelligible 0:11:34] is I really mean it sincerely is there a plan by the powers that are involved with this addiction to deal with it at the various levels such as the schools, the doctors, whoever is administering, the drug companies, the pharmacies, all these places. I mean really.
Heidi: Yeah. Why don’t I put on my cape and go to all of them? So the governor and the attorney general have rolled out a plan to address it all levels to try to increase access to treatment, increase detox expense, work with insurance companies that are refusing to pay for families’ treatment, working to try to infiltrate programs in the school. You may not know the signs. A lot of family members don't know the signs like they’re, “I’m so embarrassed. I didn’t know my kid was using for the last 3 years.” But they did notice that there was a change in their behavior, right?
There are programs that are trying to try to give education to families, to schools, to guidance counselors, to coaches, things like that. but it’s from all levels. I think that we have more access now than ever. It’s easier for kids to use marijuana than it is for them to steal their parents’ [unintelligible 0:12:55], right? You know what I mean? Kids are pretty creative. They abuse everything from cough syrup to inhalants to you name it. They’ll take Benadryl.
Rich: You’re giving some people in the room ideas.
Heidi: Okay, all right. Do not do that at home. Anyways, it’s a huge problem.
Audience: [unintelligible 0:13:18]
Heidi: We’re working at all levels. Spectrum is actually a national organization. We have we’re opening our 13th outpatient department site in Mulberry at the end of the year. We have Department of Correction programs all over the country. We have inpatient programs that Amy is going to talk about, but we work with people at all ages. There is also medication-assisted treatment, which I work in, so we work with folks who have been addicted to opiates and now they’re on methadone or Suboxone. Medication-assisted treatment can get a bad rap because 10 percent of every treatment doesn’t do well. It takes a lot to change, but what we’re looking to do is stabilize imbalances and we’re looking to facilitate a healthier lifestyle and help them, stabilize them from craving the opiates while we give them medication-assisted treatment.
We look to improve engagement and retention in other addiction treatment modalities, and any treatment alone doesn’t work, so detox alone doesn’t work. Residential alone doesn’t work. We all have to follow up and we need to work with each other.
Spectrum has a wide array like a continuum of care, so ideally somebody coming out of detox needs a lot of support, so detox will help them get off their substance. But then, they need to follow up in outpatient or maybe they need a residential level of care that Amy will talk about. They need the support of their family. Their families need treatment. Addiction is a family disease and it affects everybody in the family, and so everybody will need the help ultimately.
And so, Amy is going to talk a little bit about our continuum of care. Yeah?
Female Audience 2: This is just a quick question. I stopped Percocet [unintelligible 0:15:21]. Is that the same thing as [unintelligible 0:15:35]?
Rich: Percocet is the same as OxyContin.
Heidi: They’re not the same, but they’re both opiates. They’re not the same drug but they’re both opiates.
Female Audience 2: We flushed it down the toilet.
Heidi: Yeah. There are safe drop-off centers that people may not know about but you could go to the police department. You could go to the Department of Public Health website, and they will let you know of safe drop-in areas where you can bring in medication, and that’s the other thing. Prescribers prescribe much more fluidly, so when I had my wisdom teeth out, I think I got Motrin, right? Now when kids get their wisdom teeth out, they’re getting Vicodin and so maybe families don’t need all that leftover medication, but really being responsible in getting the leftover medication out of your homes is helpful because it could get into the hands of the wrong person, so.
Rich: They gave me Percocet when I had my wisdom teeth taken out. I didn’t take them but the guy at work asked me. He says, “What did they give you?”
I said, “They gave me this box of Percocet. I don’t really know what it is.”
He’s like, “How many of them are there?”
I said, “Thirty. Why?”
“I’ll give you $10 for it.”
“Forget it.” I held out for more money. No, I’m just kidding. I’m just kidding. We’re very right behind schedule. I just want to know, are you ladies going to be able to hang around for questions afterwards?
Rich: You will. We’re going to go for a couple of minutes. If it’s okay, we have a question now.
Female Audience 3: I just want to say that you can call your local police department. They will tell you where to drop your medication off. If the police department doesn’t have a safe drop box, they’ll know where does have one in your town.
Heidi: Also afterwards, I have overdose prevention information that people need as well, so.
Rich: She said don’t flush it down the toilet.
Heidi: Yeah, don’t.
Rich: We don’t want to get the fish high.
Heidi: That’s right [laughter].
Rich: It gets in the drinking water.
Amy: Hi, everyone! I’m Amy George. I’m in business development at Spectrum Health Systems. My job is going out and meeting with various providers in the area, hospitals, police departments, family members and sort of spreading the word that there are resources out there, that there are programs that can help your loved ones and that there are programs that can help your children.
Like we said there’s a number of locations that Spectrum has. Our biggest component actually happens to be the corrections division across the nation. We work a lot with inmates, assisting them in the process of getting rehabilitated and getting back into the community. But around here in Massachusetts, we have a number of outpatient sites. Out of our outpatient sites – and there are like we said 12 locations we have two in Worcester, we have in Leominster, Framingham, Milford, Pittsfield. We’re sort of all over the place. I mean out f those facilities we are able to provide medication-assisted treatment as well as counseling.
One thing at Spectrum that I think is really important really critical is that it's important to us that we treat the whole individual and that people that are engaged in any type of medication-assisted treatment are also receiving therapeutic services as well. It’s not like we’re having people come into our system, get a medication, and then see you later. Have a good day. No! We’re providing services consistently to that person.
Out of Worcester especially we do have an intensive outpatient treatment program. That would be for individuals that need maybe a little bit more support than just going to therapy every day. There are groups that are set up throughout the day. We have them during the day and in the evening, so they can accommodate people’s work schedules. Then we have a number of inpatient facilities.
I don't know if people are familiar with our biggest campus, which is in Westborough. It’s right kind of parallel to Route 9 behind all that. But over there, we have our detoxification services. We have a young adult program, which is inpatient. We have the Faris Center, which is brand new. It’s a state-of-the-art residential facility. It has 104 beds. It serves both men and women. The average length of stay is about 3 months there. While an individual is there, they’re getting a lot of help in the way of recovery. They’re learning a lot about what brought on their addiction. They’re working one-on-one with the clinician, and they’re in a pretty restricted environment. The focus is on recovery. Our goal is to always set people up with a plan for when they’re not in our care anymore, when they’re out and they’re back with their families and their home and those triggers are around them.
Again once someone comes into our system, our goal is to always look at what the next step is for them and how they’re going to develop their recovery when they’re out in the community again.
We also in our Westborough campus have a new program called The New England Recovery Center. That’s our first private facility. Now Spectrum is a nonprofit agency, and we are, which I think is so amazing, we’re able to serve everyone. We can serve the individuals that have been homeless, that have no insurance, all the way to individuals that have Harvard Pilgrim, Blue Cross Blue Shield.
Our newest facility, New England Recovery Center, is our private facility for substance use disorders. It has 8 detox beds, 36 beds in total. We serve women and men, with both mental health issues and substance abuse issues, and it’s a 30-day program. That would be for individuals that maybe have like your Blue Cross Blue Shield or whatnot, they could come into that facility, but I think again talking about the continuum of care, it’s really fantastic that I feel like we are able to provide services to pretty much anyone.
I know you got to wrap up a little, so I just want you to know what we are accessible. Please reach out to us if you have any questions or if there are people that you think maybe a match for our services or you just want to inquire.
You can feel free to call us directly. You can call me directly anytime at my office. Again, it’s Amy George. I work out of the home office in Worcester. Because it’s very overwhelming, I think this whole process for people can be really tough, trying to figure out where to get services, trying to figure out what to do next, and we can help guide you in the right direction.
Rich: I just have one last question.
Rich: Can you talk a little bit about Narcan?
Amy: Yeah, yes we can.
Heidi: We’ll get it. Just real quick.
Rich: I’m going to guess that most of us hopefully don't know what it is.
Heidi: So naloxone here, I was going to talk about it. I get really excited about this. I’m sorry. So anybody who uses opiates are at risk for overdose. Most overdoses are accidental, and I’ll just go through real quick. I was going to talk about overdose. I get all excited about it. Anyways, Narcan, I’ll refer to as naloxone, is a way to reverse opiate overdose. If you know that somebody is overdosing, you can use naloxone to reverse the opiate overdose. You have access to this if you go to AIDS Project Worcester, you can get a free kit. You can also use your insurance, and you could go to CVS and you could just get one. Anybody can get it at CVS, or Walgreens, or AllCare Pharmacy. There is a standing order to be able to get naloxone.
If you know of people who use opiates, it’s good to have a kit at home. It looks like this and one kit has two vials in it, but if it gets into the wrong hands – I’m sorry. I have them and I meant to bring one today to show you. I could use it. I haven’t used opiates, so nothing will happen. If somebody is blue and they’re overdosing, you can use this. It’s just a nasal spray and it reverses the effects of an opiate overdose for 30 to 90 minutes.
It still means that they should go to the hospital. You should always call 911. You don’t have to say that you know that somebody has overdosed. All you have to say is the person is unresponsive and not breathing.
Sandra: You can go to CVS? I can go tonight to CVS.
Sandra: And go and purchase this?
Sandra: How much is it?
Heidi: You could get it through your insurance company. It’s great. This is a way. If you know people who are using, this is a way that you could save somebody’s life.
Rich: Unbelievable! Let’s hear it for the folks in Spectrum [applause].
Amy: I just want to say one more thing [applause]. I know. I put this sheet over there. This is like golden. This has all the information about all the resources that we have available at Spectrum Health Systems, okay?
To download these slides you must be a paid and active member.