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St. E partners with Betty Ford to fight heroin in NKY

Terry DeMio
tdemio@enquirer.com
Tina Roland of Burlington looks at a display of her daughter Tabatha Roland before the start of the NKYHatesHeroin.com 5K Walk/Run at Simon Kenton High School in June. Tabitha died of a heroin overdose in April 2013 when she was 24.

EDGEWOOD – Northern Kentucky soon will get the region's first outpatient clinic offering new medical interventions and counseling to victims of the raging heroin epidemic.

The creation of the clinic at St. Elizabeth Healthcare is a partnership with the world-renowned Hazelden Betty Ford Foundation and is seen as a new weapon in the fight against the addictive power of heroin.

The program combines medicine-assisted treatment – including the use of drugs to help stabilize addicts – and counseling that follows the 12-step addiction recovery method.

"I think it's a huge milestone," said Chuck Washburn, St. Elizabeth's system director of behavioral health, who has headed the hospital system's effort to create an outpatient clinic for opiate addicts. "But there are a lot of miles on the road left to travel."

St. Elizabeth and Hazelden Publishing exclusively released the news to The Enquirer, which has covered the heroin epidemic locally with a team of reporters over the past two years. Hospital officials hope to have the clinic up and running by late spring or early summer.

St. Elizabeth is among the first health organizations in the United States to partner with Hazelden, which is reaching out to address the nationwide prescription painkiller and heroin crisis.

The partnership includes training for St. Elizabeth staff in Hazelden's Comprehensive Opioid Response 12, or COR 12 program, which combines Hazelden's traditional 12-step recovery method with medicine-assisted treatment.

"What we've done is really tried to pair scientific evidence with a holistic approach," said Joe Jaksha, the publisher of Hazelden Publishing.

That approach includes community education and, for those addicted to prescription painkillers or heroin, medicine such as Suboxone and Vivitrol – drugs used to stabilize addicts – with a goal of tapering doses until the patient can live in recovery drug-free, Jaksha said.

After training is complete, Washburn said, the two organizations will maintain a one-year relationship in which Hazelden will respond to any questions from St. Elizabeth doctors and staff.

The hospital system's effort is, in part, an answer to an outcry from heroin-afflicted families in Northern Kentucky, who in an April letter asked St. Elizabeth to take the lead in attacking heroin in the region.

"They are taking the steps to ensure the wellness of our people," said Jason Merrick, chairman of Northern Kentucky People Advocating Recovery. "Every one of our requests will be met with this commitment and the governor's promise of naloxone."

Beshear on Tuesday announced the state will provide kits containing naloxone, a lifesaving drug for heroin and opioid addicts who overdose, to St. Elizabeth Healthcare and other hospitals.

"It's been a long time in coming," Merrick said. "A lot of people have died."

St. Elizabeth Healthcare and St. Elizabeth Physicians are collaborating with Hazelden Publishing, a division of the Hazelden Betty Ford Foundation, to use medicine-assisted treatment for heroin or prescription painkiller addicts combined with a 12-step recovery method of addressing addiction. The drug Suboxone is prescribed for heroin addicts to eliminate withdrawal and block the euphoric effects of opioids/opiates.

Treatment for addicts already ramping up

The plan is beginning to take shape, with training scheduled for St. Elizabeth caregivers, including physicians, behavioral health clinicians, nurses and other staff, Washburn said.

This spring, every Northern Kentucky resident will have a chance to take part in free educational webinars provided by Hazelden and St. Elizabeth.

The organizations will lead five community sessions, scheduled for April and May, to inform Northern Kentucky residents about addiction and better arm them to prevent prescription painkiller and heroin addiction.

The heroin epidemic took hold in the nation after a crackdown of the prescription of painkillers, or opioids, which have the same effect as heroin, an opiate. Kentucky rated sixth in the nation for opioid overdose deaths in 2011, according to the Centers for Disease Control and Prevention. That's part of the reason the state was so hard hit with heroin addiction – a cheaper, easily accessible substitute for painkillers.

The educational webinars include tools from Hazelden, such as a DVD to help explain opioid addiction and prevention.

"It's a great video. It does a good job of mixing the biology of addiction and interviewing people who suffer from opioid addiction," Washburn said.

The hospital system is not waiting until the end of its training with Hazelden to provide treatment.

"We are already, in a small way, starting to roll out some of this," Washburn said. "You can see the momentum."

St. Elizabeth is recruiting physicians who will get required training for a waiver that allows them to prescribe Suboxone. Some are in various stages of the process of getting licensed.

Physicians already have started administering Vivitrol within its behavioral health clinic in Edgewood and at the St. Elizabeth Alcohol and Drug Treatment Center in Falmouth

St. Elizabeth physician Dr. Jeremy Engel, a public health activist at the forefront of the heroin battle, is prescribing Suboxone in a St. Elizabeth pilot program.

"You don't have to wait to go to the addiction clinic," he said.

The short-term goal, after St. Elizabeth is trained in the Hazelden program, will be to treat most patients in an outpatient clinic at the Edgewood hospital and at the St. Elizabeth Alcohol and Drug Treatment Center in Falmouth, Washburn said.

"The long-term goal is to be able to integrate it into primary care," Washburn said.

Northern Kentucky People Advocating Recovery has been training the public on how to use nasal naloxone to pull people from heroin overdose. This demonstration took place at a clinic where nalxone kits were being handed out at the Kenton County Administration Building on May 31.

New approach combines medicine, counseling

In 2012 Hazelden, known since its inception in 1949 for its abstinence-based approach to recovery, altered its approach after research showed that medicine-assisted treatment results in better recovery rates for opioid or heroin addicts.

"We must move past stigma and let evidence-based science and compassion guide our response to this crisis," said Dr. Marvin D. Seppala, chief medical officer of the Hazelden Betty Ford Foundation, based in Minnesota.

To address the problem of poor outcomes for opioid addicts, the foundation embarked on its Comprehensive Opioid Response 12, or COR 12, program, combining medicine treatment and the 12-step recovery model.

Dr. Adam Bisaga, professor of psychiatry at Columbia University Medical Center's Department of Psychiatry Division on Substance Abuse, said the shift toward medicine-assisted treatment is essential in addressing opioid addiction.

"In the last two years, with the overwhelmingly ineffective and even dangerous outcomes of 12-step treatment for opioid dependence, programs like Hazelden started developing the new approach that integrates 12-step with medicine-assisted treatment," Bisaga said.

"I think this program promises to be a major advance in the field and will be available to many patients who are involved in 12-step recovery."

Engel said the integrated approach to treatment allows the large contingent of advocates of abstinence in Northern Kentucky and those who support medicine for heroin addicts to agree to move ahead on treatment.

"It's a broad tool we can all agree on that includes the necessary tools to carry out the mission of treating heroin addiction," he said.

The St. Elizabeth's commitment also ensures that heroin patients will be counted, for the first time, and outcomes of treatment will be measured, Engel said.

The treatment approach could continue to evolve as outcomes are reviewed, Washburn and Engel said.

Washburn said St. Elizabeth leadership felt the best way to move ahead on opioid addiction treatment was to do so with best practices espoused by Hazelden.

"We reached out to them," Washburn said. "We thought, if this is what Hazelden is doing, then it made all the sense in the world."

Suboxone: A synthetic opiate that partially fills the brain's mu-opioid receptors. It reduces cravings and prevents withdrawal symptoms. It also blocks euphoric effects of opiates such as heroin and opioids such as prescription painkillers. Generally used for individuals who've had shorter-term heroin or opioid addiction. It is prescribed by physicians and can be taken in a pill or dissolving film form.

Vivitrol: A nonnarcotic pharmaceutical that blocks mu-opioid receptors so that opiates such as heroin or opioids will not provide any effect. Generally prescribed for patients who have had shorter-term heroin or opioid addiction. It is given by injection monthly.

Naloxone/Narcan: Naloxone is the generic form of Narcan, a drug that is injected or sprayed into the nostrils to revive people who have overdosed on heroin or opioids. It causes almost immediate withdrawal and restores normal breathing in the patient, reviving him or her.

•Methadone: A synthetic opiate that completely fills the mu-opioid receptors in the brain. It reduces cravings and prevents withdrawal symptoms. It is regulated in the body to stabilize the patient so he or she functions well without euphoric effects. Generally used for individuals who've had long-term heroin or opioid addiction. It is provided in a highly structured and federally regulated clinic setting in a liquid form.