Some addiction treatment facilities treating opioid addiction, sometimes complicated by concurrent severe pain, are finding that service quality can be improved in small-group treatment settings with a narrower focus on the opioid patient alone.
Addiction Professional this month interviewed leaders with two centers that have found it necessary to focus more sharply on the individualized needs of the patient dependent on heroin or prescription pain medication.
Site conducive to MAT
At the close of the year, Rosecrance Health Network in Illinois was transitioning to an “opioid-specific program” in which it hopes “to get more buy-in into the idea of recovery,” says Raymond Garcia, MD, medical director for adult services.
Rosecrance believes that by isolating opioid-dependent individuals from the rest of its patient population, it can work to reduce the duration of detox and do a better job of educating patients on the diverse treatment options available to them—including medication-assisted treatment (MAT). Rosecrance uses both buprenorphine and injectable naltrexone (Vivitrol) as part of treatment, in detox and for maintenance therapy in some cases.
“Patients are more open to the idea [of medication treatments] when they see other people trying these treatments and doing well,” says Garcia.
The new program has a ceiling of 15 patients, with coed group sessions and other programming offered. Garcia says Rosecrance seeks to reduce time in detox from a traditional three to seven days to about two to three days. The program is physically located close to the residential unit to which patients transition after detox.
Garcia says the program is seeing a good number of individuals in their mid-20s, and a growing percentage of women. It is treating a combination of individuals in earlier stages of addiction (using primarily prescription medications) and those in a later stage (who have transitioned to heroin).
Having individuals on MAT in this separate program also reduces the potential for diversion of medication to other patients, says Garcia. He adds that Rosecrance still uses Suboxone to a greater degree than other medication therapies because “that is what insurance mostly covers for.”
Changing response to pain
At Silver Hill Hospital in Connecticut, administrators are reporting what they consider surprisingly strong outcomes from a Chronic Pain & Recovery Center program launched in 2012 to target patients with substance dependence and severe pain. Silver Hill president and medical director Sigurd Ackerman, MD, says the facility has deliberately limited the patient capacity for this program to 8. “This is a difficult group of patients—they require a lot of individual attention,” says Ackerman. “They are fed up, they are angry, and many have family problems.”
The program relies heavily on reconditioning and cognitive-behavioral therapies. “We teach people to experience less pain and to be more willing and able to lead functional lives,” Ackerman says.
At the time they were designing the program, leaders at Silver Hill had been finding that admitted patients who had opioid abuse problems were rating their pain on average at a 7 on a 10-point scale. The program seeks to get patients off opioids early on, which actually often helps with their pain, but it does not take the approach that every patient must be 100% opioid-free upon leaving the program. “Some would not get there,” Ackerman explains.
A typical day for patients in treatment at the Chronic Pain & Recovery Center program involves two hours of morning physical therapy and three hours of afternoon groups. A critical element of the self-pay program offers a full year of continuing care post-treatment, consisting of occasional daylong visits to the clinic and ongoing telephone contact between bachelor's-level clinical staff and patients/family members.
Some of the recent data from a group of nearly 100 patients show significant improvement following treatment and continuing care. A total of 80% of patients were found to be either off opioids or receiving agonist therapy at that point, while there was a 24% mean reduction in reported pain and more than a 50% decline in pain interference with activities and enjoyment of life.
“I'm surprised at how good these data are, given the complexity and duration of the problems these patients have had,” says Ackerman.
More information about opioid dependence and pain management will be shared at an Addiction Professional conference on the opioid crisis, to be held Feb. 2-4 in Anaheim, Calif. For more information, click here.