Earlier this month, health care leaders from across New England joined together to explore solutions to the difficult challenge of combating substance abuse in our rural areas. Presentations and discussions spanned a variety of related topics related to the New England Governors' plan for preventing and treating opiate addictions in the region as well as substance abuse interventions in health care settings and rural communities. Special populations were discussed including: adults, Veterans and youth.
- Learned about evidence based practices and models that are working in the region
- Networked with regional and Federal peers who are also working to combat substance abuse
- Shared their experiences with others to help strengthen our regional capacity
"The Hungry Heart" Documentary
A highlight of the recent New England Rural Health Conference was the screening of Bess O'Brien's documentary, "The Hungry Heart," which focuses on a VT pediatrician who treats young substance abusers. Many communities are showing the film and if you are interested in bringing it to your town, you may contact O'Brien here.
Three-in-One Rural Health Conference Tackles Substance Abuse
For the first time in its 17 year history, the RoundTable melded its Annual Symposium, "Federal Day" and Oral Health Conference into a seamless whole, unified by the theme of combating substance abuse in rural New England.
Keynote speaker Dr. Harry Chen, Secretary, Agency of Human Services, VT, attributed Gov. Peter Shumlin's 2014 State of the State address, devoted wholly to substance abuse, as the catalyst for action among all six states. Massachusetts' Gov. Deval Patrick declared a public health emergency in his state and in June, a New England governors' conference triggered a regional approach to the problem of opioid use and overdose. Dr. Chen said that in 2013 opiates overtook alcohol as a public health disease. "If it can happen here (Vermont), it can happen anywhere."
Conference attendees heard encouraging news from A. Kathryn Power, Regional Administrator, Substance Abuse and Mental Health Services Administration (SAMHSA) about efforts of the Federal government to coordinate substance abuse and health promotion activities.
Dr. Hugh Silk, Clinical Associate Professor of Family Medicine & Community Health, University of Massachusetts Medical School, always a favorite speaker at the Oral Health Conference, has for years advocated for the "medical-dental connection." Doctors, he asserts, still know too little about oral health and how it fits into overall health. Substance abusers can suffer a variety of oral health problems, which Dr. Silk sees in his current work in prisons.
Recovery IS Possible, Say State Officials Dealing with Substance Abuse
Although the extent of opioid and prescription drug abuse in our region seems an almost overwhelming challenge, there ARE success stories to report. In the "breakout" sessions, speakers from Maine, Vermont, Connecticut, Rhode Island, New Hampshire and Massachusetts offered a range of ideas for prevention, treatment, and recovery.
Vermont's Care Alliance (familiarly known as the Hub and Spoke model) integrates opiate addiction treatment into primary care. The Vermont "model" is becoming a standard for other states to follow. Barbara Cimalglio, Deputy Commissioner for Alcohol & Drug Abuse Programs, VT Department of Health, spoke about office based opioid treatment, with extra training offered for those providers certified to prescribe buprenorphinen and other medications to addicts. "Medication assisted treatment is effective," she said. The Care Alliance for opiate addiction aims for patients to have a medical home, a pharmaceutical home, and a single prescriber. Cimalglio (and a number of other speakers) emphasized that medical schools are not giving students enough training in addiction.
Despite the depressing statistics on opioid and heroin addiction, many presenters made the case that recovery is possible. Working together as partners, rural communities can fight the scourge of addiction but "it takes a community," with law enforcement, hospitals, pharmacists, youth services, physicians, educators and others sharing an integrated approach. Emergency responders now have effective ways of preventing deaths from overdoses (Narcan); physicians are being encouraged to send patients home with fewer opioids for pain relief after surgery (medical and dental); families are being educated to clear their medicine chests of pain killers that their teens may easily access.
Massachusetts, for 20 years, has had an effective Prescription Drug Monitoring System, which many at the Conference believed to be a key factor in preventing patients from obtaining opiates from multiple providers. (The familiar "doctor shopping" strategy.)
Dr. Leslie Ochs, Assistant Professor and Vice Chair, University of New England College of Pharmacy, hammered the theme of responsible opioid prescribing in her session. More prescriptions are being written today, and in larger quantities, than ever before, reflecting a change in physicians' more relaxed attitude toward mitigating pain. Pharmacists need to do more, she said, but patients also need to take responsibility. Which post-surgical patient is most likely to become addicted? This is a challenge to physicians.
In a breakout session on dental care for substance abusers, Dr. Jeff Roscow, Dental Director, Connecticut Valley Hospital, dedicated his talk to long-time RoundTable Board member Margaret Ann (Peggy) Smith, DMD. Dr. Roscow and Peggy were classmates and he commended her for her many years of effort in bringing oral health needs to the forefront. Peggy was the champion and founder of the RoundTable's Oral Health Conference, now in its ninth year. She retired recently as Dental Director, Generations Family Health Center in Willimantic, CT.
Dr. Roscow's psychiatric population has special needs, which require extra sensitivity in dealing with patients who may have both substance abuse and mental health challenges. With his warm, engaging personality and sly sense of humor, Dr. Roscow epitomizes a practitioner who can relate to "difficult" individuals. He treats the patient, not the disease.
In a few paragraphs, it's not possible to cover all the valuable information coming from the three-day meeting. Executive Director Kim Mohan promises that the speakers' power point slides will soon be available on the NERHRT web site. And - surprise - a new web site is due to be unveiled within days! Watch for it!