Using science to identify the addicted

An evidence-based way to identify people with addiction and get them the care they need is beginning to take hold in Greater Cincinnati and Northern Kentucky medical settings, thanks to federal grants.

The method is straightforward: Quickly assess patients to find out how much alcohol or drugs they use and, if they’re at risk, talk to them about it. If they need treatment, arrange it. Then, health providers follow-up to find out whether patients got to their appointments.

The process is intended to catch people before addiction disease progresses, but during an unprecedented spike of overdoses from August through October, Mercy Health hospitals referred 47 overdose patients to treatment through the method. That compares to 73 for the eight-month period before the spike.

The method – called Screening, Brief Intervention, Referral to Treatment (SBIRT) – is in place at four Mercy Health hospitals in Greater Cincinnati. It's in the planning stages in Northern Kentucky places including St. Elizabeth emergency departments. Both Mercy and Northern Kentucky University received grants in 2015 from the federal Substance Abuse and Mental Health Services Administration to get started.

A therapist in the Mercy Health - West Hospital program is already a fan.

“I’ve witnessed patients who were engaged in problematic substance use whom, as a result of the intervention, were able to quit or decrease use,' said Eric McCallister, a therapist at Mercy West. "I’ve witnessed patients who were engaging in binge drinking that were able to cut back, decrease binge episodes or quit drinking altogether."

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The Mercy hospitals involved – West, Anderson, Clermont and Mount Orab Medical Center – received $385,000 annually for two years and are part of an enhanced linkage-to-care program, which puts a behavioral health specialist in each emergency room to screen patients..

Here's what they've been up to, from Dec. 7, 2015, through Nov. 2::

• Screenings – about 5,200 patients.
• Negative screenings – 4,314 reported they had no drug or alcohol use or were using within safe limits, and had no depression.
• Brief interventions – 603 received one on the spot in emergency departments.
• Referrals – 207 were referred to specialized treatment.

Statewide, grant recipients have screened more than 40,000 patients and referred more than 1,350 to treatment, Ohio Department of Mental Health and Substance Abuse records show. The department received a five-year, $10 million grant from Washington to hand out.

Northern Kentucky's grant, $900,000 for three years since October 2015, will get the screening and intervention program into several medical settings and to university students in health tracks, said David Wilkerson, director of the NKU project. The grant partners are St. Elizabeth Healthcare, HealthPoint Family Care, Northern Kentucky Health Department, NorthKey Community Care, Welcome House Northern Kentucky, Emergency Shelter of Northern Kentucky, and Transitions Inc. Each year, the grant will provide training and technical assistance to 100 healthcare providers. That's 300 over the life of the grant. It will also give NKU students in related health fields training in the method.

Dan Cole, St. Elizabeth director for medical specialties, said the program will get the hospitals involved in early detection of addiction.

“With the increasing overdoses, we’ve been spending so much time at the end of this problem," Cole said. "We really want to focus on the front end."

Wilkerson also stressed that SBIRT is an early intervention tool. “We’re really looking at the guy next door, the frat brother who comes to the ED and has a cut on his head after he drank too much," he said.

Father says intervention was 'magic' for addicted son

But at Mercy Hospital West, the father of a man who was in the depths of addiction called McCalliter's intervention "magic."

“This guy told my son everything he needed to know when he needed to know it,” said the father. “It really brought tears to my eyes.”

The Bracken County dad brought his 29-year-old son to the hospital on Oct. 7 after he was released from an emergency room following an overdose. McCallister quickly got the patient into a detox and treatment program in Florida. Then he was referred to intensive outpatient treatment with medication under St. Elizabeth Physicians’ care, where he remains as a patient.

The father was astonished, after seven years of inconsistent care and runarounds for his son. He would only talk to The Enquirer without being named, because of what he called the “discrimination” that goes with heroin addiction disease. He said his college-educated son is worried about how he'll be perceived at work if people know that he used heroin.

Nanette Bentley, Mercy Health spokeswoman, said its hospitals are referring 10 to 20 patients per week for drug and alcohol use and depression. Most who request treatment are addicted to heroin or opioids, she said. The most commonly used substance is alcohol.

Most local hospitals don't have the program

Most area hospital systems don't have the grant money and they don't have the program.

UC Health, Christ Hospital and TriHealth officials, who aren't training for the screening, intervention and referral method, said they're still committed to treating addiction disease.

"Hospitals in the region and across the country are using many different approaches to address this major public health challenge," said Diana Lara, spokeswoman for UC Health. "UC Health, working with the UC College of Medicine, is deeply committed to and involved in many efforts to help with prevention, identification and treatment of substance abuse."

Dr. Shawn Ryan, a certified addiction expert, said he's part of a research team at UC that's trying to identify better ways of identifying patients with addiction and getting them into treatment.

Screening, Brief Intervention and Referral to Treatment, he said, "is a good step in the right direction." But Ryan said that, in general, doctors refer patients to specialized care "through paperwork." A patient with addiction may not secure an appointment, or even if one's set, may not get there.

"What's needed is a warm hand-off," Ryan said.

He said that Greater Cincinnati generally doesn't have either a good referral system or treatment system. "The referral-to-treatment part has to have a tight linkage to care," he said. "What is happening is that patients wander around in this assessment system. They keep using heroin, and they're putting themselves at risk for dying."

Kendall Herold, a spokeswoman for Christ Hospital, said, "We refer patients to the appropriate community resources based on our assessment of their needs."

And Joe Kelley, spokesman for TriHealth, said that patients are referred to Bethesda Alcohol and Drug Treatment Program, where they get "traditional tried-and-true approaches" combined with new techniques that are incorporated into the treatment program.

Making the assessments and referrals standard

Officials in Washington, D.C., and at the American Society of Addiction Medicine want to see the program in primary care centers, hospital emergency rooms, trauma centers, and other community settings to make early intervention available to everyone.

The goal is to make the screening and intervention program the norm, said Ellen Auspurger, project director at the Ohio Department of Mental Health and Addiction Services.

“We assist doctors in having conversations about opioid abuse and use," Auspurger said. “What we’re hoping to do is standardize those conversations.”

For patients, the process can be as easy as a few questions added to the clipboard they get when they arrive at a medical facility.

Mercy Health patients get four questions about alcohol use, drug use and mood, said Brian Gray, manager of behavioral health services. Those who answer yes get another nine to 10. Next comes discussion, if needed, and possibly a referral to treatment.

Mercy and NKU plan to keep their programs after grant funding expires at the end of June, although another year of eligibility is possible. After that? "Mercy Health will continue the program, Gray said.

The NKU grant agreement states that teaching and training in the screening method will become a permanent part of the curriculum of NKU students in nursing, social work, counseling and human services-addiction work.