Friday, October 20, 2017

Community Gathers to Discuss Fauquier’s Opioid Crisis

FauquierHealth and the Mental Health Association of Fauquier County teamed up on October 11 for an all-day conference on “Addressing the Opioid Crisis: Treatment that Works.” The morning’s focus was on the particular vulnerability of women to opioid addiction – and the downstream effects on their babies, born addicted. The afternoon introduced best practices for treatment and recovery and shared the resources that are available in our region.
   The major themes addressed were:

  • Addiction is a complex neurobiological disorder, not a moral failing, and is best treated as a chronic health condition.
  • Medication Assisted Treatment (MAT) works and people do recover, though only about 10% of those addicted to opioids receive MAT.
  • This community has come together to address the crisis on multiple fronts, including the Youth and Family Initiative to create awareness and offer prevention programs, law enforcement’s reduction of overdose deaths with the use of Narcan, and expansion of local treatment resources.

   Mishka Terplan, MD, MPH, FACOG, FASAM, professor of the departments of Obstetrics and 
Dr. Mishka Terplan
Gynecology and Psychiatry at Virginia Commonwealth University; and Addiction Medicine Consultant for Virginia Medicaid,
opened the discussion by making the case for an emphasis on opioid abuse in women. He explained that between 2004 and 2010, opioid overdose deaths increased 237 percent for men – an eye-catching statistic. Unfortunately, the number jumped 400 percent for women. And when women are affected, so are their babies. Dr. Terplan described the maternal fetal unit by quoting D.W. Winnicott, saying, “There is no such thing as a baby … If you set out to describe a baby, you will find you are describing a baby and someone. A baby cannot exist alone, but is essentially part of a relationship.”

   Dr. Terplan said that pregnant women are motivated to stop using opioids for the sake of their babies. When they can’t, it is defined as addiction: a brain-centered disease whose symptoms are behaviors. He explained, “The salient feature of addiction is continued use in spite of adverse consequences.”
   Although pregnant women are a population most in need of treatment, fewer than 20 percent receive it, according to Dr. Terplan. Screening is the first step, but most are never screened for opioid use disorder (OUD). Patients avoid screening because of a fear of discrimination or judgment; a previous bad experience with health care provider; a fear of Child Protective Services; or they don’t consider their use problematic. Some physicians can be resistant too, citing a lack of time or payment and lack of knowledge about what to do if a patient screens positive.
   Addressing the audience next was Alta DeRoo, MD, FACOG, FASAM, associate professor, OB/GYN, at the University of Virginia. She is the director of OB/GYN at UVA Health System, at Culpeper Medical Center, and is an addiction medicine consultant. She spoke on the screening and treatment of opioid use disorders in pregnancy.
   Dr. DeRoo began by quoting another sobering statistic: “The Virginia Department of Health reports 16 percent of pregnant members had substance use disorder.” She then gave specifics on treatment options, including the effectiveness of administering buprenorphine or methadone in combination with counseling to help pregnant women cope with opioid addiction.
   Elsie Mainali, MD, PhD, neonatologist with Fauquier Health’s Family Birthing Center then
Dr. Elsie Mainali
addressed the need for a community effort to improve the outcome of neonatal abstinence syndrome (NAS). Dr. Mainali brought the opioid crisis down to the local level by sharing that 11 people died in 2016 from opioid overdoses, four in the town of Warrenton. In 2016, 741 Virginia babies were hospitalized for NAS.
   She drew a picture of what NAS babies endure after then are born. When an addicted baby is admitted to Fauquier’s NICU, the hospital’s neonatal team works to reduce the amount of stimuli the baby experiences. A baby born addicted must be:

  • Placed in a quiet room with dim lighting and low activity.
  • Moved away from telephone or high traffic areas
  • Handled with slow movements and caregivers should avoid talking at the bedside
  • Disturbed as little as possible
  • Experience one stimulus at a time (rocking, voice, soft music, etc.)

   In addition, caregivers can provide the following supportive therapies:
         Wrap or swaddle infant; use short-haired sheepskin with a soft cotton sheet
         Hold the infant firmly and close to the body
         Promote skin to skin contact and use of infant sling
         Massage infant or try relaxation baths
         Rock gently, talk, sing or hum softly
         Play heartbeat audiotapes
         Decrease stimulation at first signs of distress
         Feed on demand – give frequent small feeds with rests between sucking
         Change diaper frequently, use triple paste cream to prevent skin damage
         Use gentle suction if nasal secretions cause obstruction to ensure adequate respiratory function
         Weigh baby and assess hydration daily
   Dr. Mainali joined the panel discussion that followed, which also included Dr. Terplan, Dr. DeRoo and Fauquier Health Emergency Department chairman Michael Jenks, MD. Panelists answered questions from the audience, which focused on MAT and related issues.
   Nick Szubiak, MSW, LCSW, director of Clinical Excellence in Addictions and Integrated Health
Nick Szubiak
Consultant for the National Council for Behavioral Health, offered advice to addiction counselors. He explained the best ways to gain the trust and cooperation of clients and spoke of stigma and discrimination as barriers to change. He quoted Dr. Michael Miller, ASAM: “At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas…  Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.” 
   Szubiak detailed how addiction develops, and also emphasized the important role of primary care physicians in screening, brief interventions and referral for treatment of substance use issues.
   Ashley Clark, PhD, QMHP, program manager of Outpatient Mental Health and Substance Use
Services for Rappahannock Rapidan Community Services, was the final guest speaker. She ended the conference on a hopeful note by enumerating all of the services available in the area, from residential options to local supplemental services like:
      Infant Toddler Connection
      Fauquier Link
      Crisis Services
      Child Mobile Crisis
      Parent Café
   New services coming online through Rappahannock Rapidan Community Services include
Ashley Clark, PhD
expansion of MAT, new intensive outpatient groups, and a treatment program to address substance use issues in young adults.
Sallie Morgan
   Sallie Morgan, of the Mental Health Association of Fauquier, was enthusiastic about the forum. “We’ve heard a lot about the scope of the opioid crisis and its impact on this region, and now it is time to focus on solutions. The Surgeon General has defined the need to address opioid addiction and other substance use issues as a moral test of each community, and Fauquier is really rising to meet that test. Medical professionals and community members coming together to learn more about effective treatment is part of a larger, community–wide effort to offer prevention programs, treatment options, and support for individuals in recovery.”

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