SCE: Be open to evidence-based treatment

Experts speaking Thursday in Chicago at the Summit For Clinical Excellence, The Opioid Crisis: Strategies for Treatment and Recovery covered a number of treatment modalities that clinicians might not be embracing just yet. Some strategies are proven with fairly recent science, but others are a bit far afield with promise for the future.

Elizabeth Salisbury-Afshar, MD, the medical director of behavioral health for the Chicago Department of Public Health, discussed medication assisted treatment (MAT) and the evidence supporting it. MAT helps those with opioid use disorder to reduce their rollercoaster patterns of highs and lows and move forward on what she calls a “smooth road.”

While many people might ultimately recover without treatment, Salisbury-Afshar noted that a practical goal of treatment is to shorten the time it takes someone to get into recovery. In that regard, MAT can be an asset and save lives, in spite of the ongoing resistance from various stakeholders who don’t advocate for its use.

“Just as some people might need to be on blood pressure medication for life, some need to be on medication assisted treatment for the rest of their lives, especially people who have used opioids for a long time. Some have used for 20 or 30 years,” she said.

There’s a great need for more long-term studies that compare MAT drugs head-to-head, including longer term studies on naltrexone, Salisbury-Afshar said.

She underlined the fact that insurance coverage and affordability remain key issues in ensuring access. The audience was comprised of behavioral health professionals from 13 states and one Canadian province, yet only two individuals indicated by show of hands that they work in a facility that offers all three FDA-approved MAT drugs.

Lloyd Sederer, MD, chief medical officer for the New York State Office of Mental Health, talked about the war on drugs and historic approaches to the opioid crisis. He advocated for keeping an open mind for treatment options for the future.

For example, controlled studies are examining psilocybin to combat anxiety for people with late stage cancer, he said, although psilocybin is a Schedule I substance that currently has no accepted medical use.

“This is promising,” Sederer said. “It is a serotonin-inducing drug, and there was not one adverse reaction in 500 administrations. Of course, that has something to do with the settings, which are highly controlled.”

Audience members cautioned that psilocybin—“magic mushrooms”—obtained on the street can lead to psychosis, and individuals who use the illegal substance can be very hard to treat.

Chelsea Laliberte, executive director of the Live4Lali advocacy group and co-developer of Illinois’ Lake County Opioid Initiative, presented a model for increasing awareness and rallying communities to address addiction. State’s Attorney Michael Nerheim discussed the evolution of the initiative that has brought the county stakeholders together.

Although the project was created out of mutual passion among several people who wanted to impact the opioid crisis in the community, a more methodical approach was necessary. The initial foundation was built from SAMHSA resources, Laliberte said.

“If you think that you don’t need a model to work from, understand that you do,” she said.

Laliberte, who lost her brother to overdose, also recommended that communities focus on data initiatives to discover what’s working for families and those with substance use disorders so resources can be optimized.

One early effort in the county drove extensive use of naloxone by first responders. Nerheim said law enforcement officers weren’t coaxed into using the rescue drug, rather, they quickly welcomed the opportunity to save lives. Previously, they might have responded to an emergency call but then would have to sit idle as they waited for medical personnel to arrive to use the naloxone and help an individual in respiratory distress. Now they can administer naloxone themselves.

“The police don’t get enough credit for what they’re doing,” Nerheim said.  “Forty-three police departments in our community literally were trained and started saving lives overnight.”

Naloxone is certainly not a complete answer, he said, but it has helped save hundreds of lives.

The county’s A Way Out program has grown to include a texting channel for crisis intervention, prevention, education, training for K-9 officers and policy changes designed by the cooperative, collaborative local stakeholders.

John Briere, associate professor of psychiatry and psychology at the University of Southern California, discussed compassion fatigue, noting that the clinician’s job is difficult. Many want to avoid hearing yet another trauma story. He recommended self-care including vacations, exercise and social action that helps stop community issues upstream.

He also advocated for being authentic.

“Trying to fix things messes you up, but you have to allow yourself to be part of the same population with your own issues and their own issues,” he said.