By Layne Turner, Lehigh County Drug & Alcohol Administrator
When considering the interplay between Substance Use Disorder (SUD) and Opioid Use Disorder (OUD), we are trying to solve an eco-system problem, in which everything is interconnected and requires a complete picture of the situation. While prescription opioids may have been at the onset of the OUD epidemic, their scarcity, whether through expense or more stringent prescription writing practices, shifted the focus to heroin, fentanyl and other street drugs creating an imbalance. The target fixated funding and attention on OUD has created limited ability to identify and treat all SUD. These are perfect examples of ecological disruption of how a disturbance in one part of the system has far reaching effects in other parts of the system. The information presented below will demonstrate the impacts of an imbalanced system.
Lehigh County SCA received Opioid State Targeted Response (STR) funding for OUD in Pregnant and Postpartum women. This funding was initiated on September 4, 2018 and through a partnership with Lehigh Valley Hospital (LVH) the Connection Clinic was created. Over 45 OUD pregnant women are receiving physical health and behavioral (OUD) integrated treatment (which consists of CRS, Case Management, specialized residential inpatient, specialized OP and MAT). However, the LVH Connections Clinic Medical Director has identified an additional 12 pregnant women who suffer from poly-substance abuse (non-cannabis) without opioids. Due to their non-opioid status, these 12 women are excluded from the specialized care management provided by the Connection Clinic. Consider the impact:
L. is a 41 year old women who was in her early 3rd trimester of pregnancy. She’s had 11 pregnancies and 6 births. Her drugs of choice were cocaine and meth. Due to her substance use, her unborn child was growth restricted and L. was experiencing other health complications. Once she was medically cleared she was unable to access the specialized inpatient treatment needed (because the treatment track developed and associated funding is targeted at OUD). Attempts were made to maintain and support L. in the community were unsuccessful as her environment supported continued drug use. L. was not able to access the treatment level of care clinically necessary until after she delivered.
The Lehigh SCA was able to leverage specialized OUD funding to create a Warm Handoff (WHO) program with Lehigh County’s six (6) hospitals. The Hospital Opioid Support Team (HOST) was created in 2015 and provided an avenue for physicians to refer patients to access treatment. In 2015 and 2016, the combined annual referral rates were less than 40. The low referral rate was concerning. As a result of multiple meetings with the hospital stakeholders it was determined that the program (and funding to support it) was not meaningful to the hospital: focused solely on OUD, based solely in the EDs and allowed patients to slip through the cracks. In January 2017 the HOST program was modified (and additional funding provided by the SCA) based on the needs of the hospitals.
For 2017-2018 the WHO program has received over 2,800 referrals (significant increase from 80 referrals from 2015-2016). The table below represents the data the Lehigh SCA was able to access. The SCA’s office is in the process of converting to a new data collection tool and the information below is missing 7 of the 23 months of data. Also, the data provided is based on the top 4 drugs of choice. For 2018, the WHO averages 185 referrals per month. More than 50% of those referred are for Alcohol.
As illustrated, Alcohol Use Disorder (AUD) continues to generate the highest number of referrals. Also striking is the increase in referrals for meth. As the SCA, we are identifying patients in real time who are in need of SUD treatment; however, priority and increase in funding is only provided for OUD.
By way of comparison, the chart below illustrates the disparity between individuals with OUD vs those with SUD relative to HealthChoices treatment claims (1st & 2nd Quarter 2018) – Lehigh County only.
|HealthChoices Treatment Claims Data
Jan 1 – March 30, 2018
|HealthChoices Treatment Claims Data
April 1 – June 30, 2018
This chart supports the premise that increased support for the individual with OUD does positively impact their treatment retention. However, treatment access and retention for all other SUD falls dramatically – largely due to those individuals inability to access the specially designed treatment opportunities that are available only to OUD.
For the FY 17/18 and 18/19, the SCA has completed slightly under 1,000 assessments in Lehigh County Jail and/or Community Corrections. Based on the referral, the DOC is:
- Opioids: 56%
- Alcohol: 38%
- Cocaine: 23%
- Meth: 20%
Lehigh County SCA does not use or apply OUD funding for any criminal justice related program. As a result, over the last 23 months, the SCA has been able to successfully place 464 individuals directly into residential inpatient treatment from jail. Creating all-inclusive programs does yield significant, clinically appropriate outcomes.
This brief narrative brings to life the need to re-balance our eco-system. If we continue to focus and restrict funding to just one area of our environment, the impact will not heal the environment but will create further dysfunction.