SCE: It’s time to advance new ideas in addiction treatment

The addiction treatment community came together on Wednesday in Chicago at the Summit For Clinical Excellence, The Opioid Crisis: Strategies for Treatment and Recovery, and engaged in a lively discussion of new ideas while challenging some of the old ones. Expert speakers offered encouragement as well as practical solutions that can be incorporated into any treatment program.

Nirav Shah, MD, JD, director of the Illinois Department of Public Health, offered stats specific to the state but also pointed out that the entire Midwest continues to see a rise in overdoses related to fentanyl. In fact, he noted that the mortality data probably doesn’t account for the full scope of the problem.

“We have talked a lot about fentanyl-laced heroin, but what we are increasingly seeing is heroin-laced fentanyl,” Shah said.

His message to the community was one of hope, however. He reminded the addiction professionals that recovery is “within reach.”

Ali Abbasi, who assists Shah at the department, cautioned that the opioid crisis is comprised of many geographic and demographic variations and that the public health response must take those nuances into account. For example, urban areas are more likely to see fentanyl overdoses, while rural areas tend to see more heroin overdoses.

“Understand that the epidemic described to the press is true, but there are many epidemics happening,” Abbasi said. “And the narrative is different for each.”

Amanda Kim, who heads the Illinois health department’s strategic initiatives, described the state’s opioid action plan. Its goal is to reduce overdose deaths by one-third in three years’ time. For example, there’s a new 24-hour hotline that has received 1,400 calls since December 2017. A standing order in the state allows pharmacies to dispense naloxone without a prescription, and more than 150 pharmacies are participating. Increasing access by increasing the number of waivered physicians is also part of the initiative.

“Treatment for opioid use disorder, particularly with buprenorphine, methadone and naltrexone, is effective,” Kim said. “We know these treatments are effective but availability is limited.”

Chief medical officer of the Las Vegas Recovery Center, Mel Pohl, presented a detailed look at pain. Because pain is so subjective, it’s difficult to assess and treat in today’s reality of increasing opioid-related deaths. Pohl recommended that clinicians examine the emotional aspects of pain and reconsider the use of opioids for chronic pain.

“If we don’t pay attention to the patient’s affect and their experience of chronic pain, we miss the boat,” Pohl said.

He also recommended that for those with chronic pain who have developed a tolerance and increased pain related to the effects of long-term opioid use, more clinical trials should be conducted to evaluate best practices for ending opioids.

Camille Cisneroz, clinical director of University Park Behavioral Health, discussed the importance of considering the whole person and arriving at a solid diagnosis. She has seen many cases in which a patient was misdiagnosed for years. For example, not everyone who has had a traumatic experience will have post-traumatic stress disorder, nor will they necessarily respond to EMDR treatment.

“When diagnosing, we look at a ‘menu’ of treatments,” she said. “We need to look at the whole person, their history, their personality traits, their character and their diagnosis.”

Author Mark Sanders, a licensed clinical social worker who treats young adults and adolescents, outlined the many ways that clients fall through the cracks—that is, they don’t engage in treatment then possibly end up relapsing or overdosing. Sanders discussed trauma, unemployment, grief and untreated psychiatric disorders as underlying issues that fuel addiction.

New strategies on his laundry list include creating a more welcoming environment that speaks to the client and offering incentives—even small gifts or raffle prizes—for attendance at group sessions. In fact, he has seen participation in group activities of 95% when clients have a chance to earn something as simple as a round of applause. And a chance to win some pro sports merchandise doesn’t hurt either.

“The incentives are important in the first 90 days,” he said. “Then the gratitude takes over.”

Sanders also recommends that clinicians give clients the ability to be less-than-perfect because perfection is often seen as unobtainable.