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Commentary: Ohio’s biggest Medicaid provider facing the opioid epidemic fearlessly

Cathy Ponitz is vice president of the CareSource Foundation and community relations. Gregg Pieples is CareSource’s enterprise substance use disorder lead.

In the battle against the opioid epidemic, CareSource has been all in. As a nonprofit health insurance organization, we are wholly and uniquely committed to the well-being of our members. It is our mission, our purpose and the reason we continue to fight in the grip of addiction throughout the communities we serve.

CareSource is collaborating with our members, our health providers and the broader community with a comprehensive, integrated approached to substance use disorders. We are making progress on a number of fronts: improving access and outcomes, ensuring quality, reducing potential harm and engaging members in their own care.

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As a result, we have a clear picture of what we’ve seen that works. And what is not. Ultimately, our efforts towards eradicating opioid addition leads us to understanding those key levers that are critical to ensuring a bright, hopeful future. For everyone.

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What does a recovered community look like and how do we get there? What does that perfect world look like? We see the answers falling into two big buckets:

A HEALTHY COMMUNITY

• All health practitioners — doctors, nurses, social workers, school counselors, teachers, first responders – should be trained on the basics of substance abuse disorder and treatment. Knowing how to identify and treat addictions is imperative.

• All medical professionals are fully educated on Prescribing Guidelines for opioids. The Center for Disease Control (CDC) provides strong, well-researched guidelines to prescribe opioids for pain.

• Doctors have comprehensive training in Medication Assisted Therapy (MAT). Ohio has one of the highest rates of opioid deaths, yet is currently one of the lowest in clinical personnel available to treat those in need. In a perfect world, all medical professionals have the clinical and humanistic background to identify and address MAT to accommodate anyone with addiction issues.

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• First responders have the resources, education and support to deal with the current crisis including readily available Naloxone (Narcan) for all police, fire, EMT and social workers — a lifesaving drug for someone who has overdosed.

• Pain Management alternatives are explored and available as readily as opioids. We’re learning that many opportunities exist as alternatives to opioids and perhaps should be the first choice in dealing with pain – acupuncture, relaxation techniques, occupational therapy, massage, physical therapy.

• The flow of drugs is greatly diminished. Strategies to curtail drugs into a community isn’t easy, but many are identifying significant methods to cutting off the supply and they are working. Dayton is one of them.

COMMUNITY COLLABORATION

• Substance use prevention is a common topic throughout K-12. Research shows that the earlier you talk about smart choices in life, the less kids tend to move towards drugs.

• Coordinated community efforts in place to deal with public health concerns around substance use disorder. This is a systemic issue — no one organization has responsibility for the solution. In Dayton, the Community Opioid Action Team, Court-based programs and Quick Response teams are outstanding examples of regional partners planning and implementing high-impact solutions.

Continuum of services to treat substance use disorder available across the region. All services – from residential, detox, outpatient services, intensive outpatient, aftercare, Alcoholics Anonymous/Narcotics Anonymous, church, peer services — coordinate individual care, outcomes and plans.

No wait lists and no barriers for treatment. When a person is in crisis, immediate action is imperative. The response to, “I’m desperate and I need help now” is often met with, “Why don’t we schedule an appointment next week when we have an opening.” Capacity combined with compassion is the key.

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• Technology and system collaboration developed to seamlessly make referrals from one known portal. What happens when we need treatment space? An open bed? Immediate counseling? A way out of social isolation? Technology is important to accomplish this – apps, online, mobile, web based.

• Coordinated care that follows individuals seamlessly without having to do repeated referrals and assessments. Detox, residential to outpatient treatment—each one has a unique assessment with 50-plus questions that can take well over an hour. People get frustrated when they have to repeat their stories to multiple groups. It can be painful and often demotivating. In a recovered community we are giving them a warm hand-off to the next step where their information has been fully reviewed and shared prior to arrival.

• Substance use disorder approach replicates a chronic disease model approach. If you go into a detox center (which is not treatment, but a way to get to treatment) for five days, leave and go back to using, the chances of overdose skyrocket. Therefore, treatment following detox is vital. Using a care model that focuses on systemic protocol vs. episodic treatment has the highest potential for success.

• Social systems working collaboratively and without barriers including criminal justice, treatment, prevention, housing, employment. As we address addiction, we also need to address the social determinants of health. What are those issues that complicate or encourage a full recovery? We need to give people the entire tool kit, not just the hammer.

• Sustainable funding for a full continuum of care. It is critical for community, health and legislative leaders to help create thoughtful funding streams.

• Aligned privacy requirements that allow for improved care coordination and data sharing. It can be cumbersome to communicate with other vital service providers due to health privacy regulations. Allowing for greater management and coordination between providers and care centers helps accelerate the path to good health.

• Perhaps most important: those in recovery are thriving, not just surviving. Bias is real. Especially for a former addict. The stigma of their past can be haunting. Helping the network of those who have overcome addiction requires a community that allows them to move forward. As with many diseases, ask a person in recovery what they want to be known as, and they will answer: I want an identity that isn’t defined by my past. Not of my illness. I’m an engineer. I’m a teacher. I’m an artist. I’m a pilot. I’m a business owner. I’m a good parent. I am a person of value.

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