What we are missing in the opioid epidemic and why we are falling short in saving more lives. A lis

Erie County District Attorney John Flynn appeared on Buffalo News media last week saying the rate of deaths so far for 2017 is "unacceptable" and more must done. He is speaking my words verbatim. The current state of addiction medicine and recovery is at a turning point with new services being created, new ideas being discussed and lots of conversation, arguments, Town Hall meetings and much more. There are peer to peer services starting for the first time, new support meetings for parents, expansion of services and much positive movement that will undoubtably help to some extent. However, we have much, much more to do. Making change to addiction is just as complex as the disease is itself. We must be open to very new ways of thinking, to new ideas and to continual brainstorming and "going back to the blackboard" rather than just hoping a few simple changes will be enough.

Below are a partial list of some of what is missing and where we need to put in effort. My hope is that as we all dialog, more thoughts will evolve and more ideas will become clear. As I have been working this list the good new is.... some of the areas for improvement are being worked already on at different levels and to certain extents and we find out about them here and there. Hopefully this writing will add to the efforts to arrest this disease and if it saves just one life, just one, it will be worth it for you and me.

1. Many families are at the point of knowing their loved ones will not get the help they need unless they are forced to go. Countless parents have said to me 'Please put him/her in jail. That is the only way he/she will live." Statistics show that of all those in need of help only a very small percentage will get that help. In some states already, there is a legal option for family members to petition court and to mandate their loved ones to treatment. This would not of course mean that all persons with addiction need to be mandated, but many do. This would include those who overdose and are resuscitated or treated in ER’s and refuse help and those using substances despite life threatening consequences and refusing help.

Proposed solution: The State of Florida has the Marchman Act which allows family members concerned about their drug using family members to mandate them to get help. Michael Kearns office has undertaken my suggestion and written this law but will need our help in securing votes to get it passed.

2. The number of patients turned away from detox/inpatient due to several reasons including lack of beds, not in withdrawal, not medically cleared, etc. is incomprehensible.

Proposed solution: An addiction Emergency Room where no person is turned away. Our current ER facilities already function like this. In this new facility, patients would be triaged by nurses or other staff as appropriate such as peer mentors, family advocates, self help members, volunteers.

3. There are many treatment facilities in Western New York that have been around for decades and have helped many persons. However, success rates (measured in many ways including sobriety at different intervals after treatment discharge) are very, very low and research suggests patients will need between 5-7 episodes before long term recovery is achieved. There are multiple ways that treatment can improve and I will touch on several of them now:

a. Most agencies now have planned and implemented at least some effort at Evidenced Based Practices (EBP)'s. EBP's are types of treatments that have been scientifically demonstrated to be be more effective than "treatment as usual" or standard practice counseling. There can be multiple problems with this however including what we call "adherence" to the theory. For example, if a therapist learns a new technique, such as Motivational Interviewing, he or she will develop a certain level of skill ranging from below minimal to average to exceptional and anywhere in-between. Therefore each therapist trained may range in their skill level and this may effect delivery of that technique in both positive and negative ways. Additionally, some therapists are very motivated to use whatever new skills they have acquired while others may not be so motivated. Therapists are people, and like all people they can be very different. Some may resist change and do what is required, when it is required. Some may be fully cooperative and engaged in the technique.

At an agency level, again, all are different. Some agencies may be very compliant and willing to offer EBP's while others may advertise that they are, but may only be offering a shell of the component, while others fall in the middle.

Proposed solution: The establishment of technical assistance from appropriate Universities to provide supervision as well as assessment of the skill would be beneficial. Ideally, Universities where the EBP has been researched and taught would actively participate in an ongoing manner to assist program supervisors and therapists in delivering high quality treatment to all patients.

b. Most agencies offer some type of family treatment component but again, like 3a above, the variability is wide and ranges from low to high in quality. Many studies show that not only involving family but also offering family treatment is another form of EBP. However, many agencies still treat family members as "collaterals" meaning their concentration is on the person with addiction so collaterals will get one or two visits and not much more. Some agencies outright exclude family and become angry at families attempts to communicate and plan with the agency. It is noteworthy to say here that again, all families are different and some are too involved and may need to disconnect and learn new boundaries. But that would be the purpose of having them involved in treatment and would be much more productive then simple exclusion.

Proposed solution: Offering family therapy as EBP at all agencies with technical assistance as above for the same reasons as adherence to treatment protocol and other issues of quality of service.

Article to be continued.