According to the Illinois Department of Public Health, in 2020, opioid overdose deaths among Illinois residents increased 32.7% from 2,219 deaths in 2019 to 2,944 deaths in 2020. And some of the communities we serve are among those most affected. Based on 2019 data, Vermilion County had the highest overdose rate in the state and Iroquois County reported one of the highest fatality rates from overdose in the state.
Rural areas have been particularly affected by this epidemic, and yet those areas often lack sufficient infrastructure and resources to provide addiction treatment services. This is unfortunate, because medications to treat opioid addiction work well to help patients stay in remission. Access to treatment dramatically reduces the risk of death from overdose.
While the situation may look bleak, Carle is going to great lengths to improve these statistics and ensure people throughout central and southern Illinois are able to receive the care and support they need.
Through the State Opioid Response II Grant, Carle has dedicated resources to be a leader in addiction treatment and education. Carle is using its expertise to promote and develop resources while facilitating partnerships with and between community stakeholders. Such efforts include working with Community Health Initiatives to expand mobile addiction treatment services and forming a team of community outreach workers to engage local stakeholders throughout the Carle service area.
As part of this work, Carle recently launched its newest initiative – the Carle Opioid Use Disorder Treatment Fellowship ECHO Program, which welcomed 27 providers from various health systems across the state as its inaugural class. This program, which is also the focus of a multisite research study, trains rural providers in counties hardest hit by the overdose epidemic to treat patients addicted to opioids.
In this nine-month program, each provider – physician, physician’s assistant or nurse practitioner – attends an online intensive weekend training and then participates in a series of weekly webinars along with virtual learning sessions. During the series, fellows review patients they care for in their practice and receive feedback on best management strategies from a team of addiction experts.
According to James Besante, MD, Addiction Recovery, who is leading this fellowship program, this delivers much needed training to providers.
“The majority of healthcare providers currently in practice received little to no formal training in addiction medicine. Only recently has addiction curriculum become a requirement of medical training programs and what does exist is limited in scope,” Dr. Besante said.
This fellowship is helping address that gap by weaving together a network of providers, clinics and hospitals to better serve affected communities. The aim is to create a community of practice where providers can learn from each other.
“The overarching philosophy of Project ECHO is to democratize knowledge. Our ECHO Program was built using an existing model for collaborative medical education and care management known as Project ECHO (Extension for Community Healthcare Outcomes),” Dr. Besante said.
Like many providers, Connie Catron, APRN, FNP, hadn’t received any addiction medicine training during her formal education to become a nurse practitioner. Nor had she treated patients for opioid use or addiction. But she recognized a need in her community and wanted to be able to serve that population.
“Illinois has many ‘desert’ areas, meaning there is nowhere for the patient to receive treatment. I work in Iroquois County and also have patients from the Vermilion County area and both are considered ‘desert’ regions,” Catron said. “Transportation is a huge issue in the rural area, but more so for these patients because they often lose their licenses; I wanted to have this service available for our community since traveling to appointments is not ideal for many.”
At Dr. Besante’s urging, Catron participated in the ECHO program through Rush, which served as a model for Carle’s own fellowship. Being new to the addiction medicine realm, she welcomed the opportunity to learn alongside her peers.
“The program was amazing. It’s a learning environment allowing providers to become more comfortable prescribing buprenorphine as well as giving a network of resources: evidence-based prescribing practices, templates, handouts, and people whom you can access to name a few,” Catron said.
While going through the ECHO program, Catron was able to consult with another provider upon encountering a patient whose symptoms might have been due to either heroin withdrawal or a chronic health problem.
“I was able to contact my senior fellow to ask what I needed to do since I didn’t know which to treat. It is wonderful to have someone who responds to your questions in a short amount of time – especially when you’re unsure of yourself because you’ve not been prescribing very long.”
Now a senior fellow for Carle’s fellowship program, Catron is applying what she’s learned and mentoring other rural providers on addiction medicine.
“The mentality for addiction medicine is ‘harm reduction.’ If a patient has a setback with a relapse, we talk about what happened, ways to improve the situation and what could be done differently in the future,” Catron said.
Carle Addiction Recovery Center Community Outreach Manager David King, MSW, notes that the focus of harm reduction in addiction treatment is a crucial aspect to addressing a major challenge posed by the opioid epidemic: stigma.
“Stigma affects everything – access to treatment, funding of treatment, availability of medical services, and acceptance of other treatment approaches, such as harm reduction.” King said. “People can recover from this. A lot do, but because of the stigma, it limits access. Traditional resources narrow the path for recovery. We recognize there are multiple paths to recovery. People can live a full life not shackled by addiction. We’re training providers in how to be more open to the fact that this isn’t a moral issue; it isn’t a moral failing.”
For Catron, the stigma associated with opioid addiction is what inspired her to care for these patients.
“My philosophy is ‘An addiction, is an addiction, is an addiction. Some will simply kill you quicker than others.’ There are a lot of addictions out there – food, sex, gambling, drugs, alcohol to name a few, but I don’t know any that have a higher biased and negative connotation than opioid addiction,” Catron said.
King recognizes that recovery is possible, but removing the stigma is key to getting patients the help they need.
“Embrace and engage people who use drugs with compassion and dignity. Meet them where they are. Use person-centered language rather than stigmatizing language – for example, ‘person who uses drugs’ rather than ‘addict.’ Promote hope and healing rather than stigma and isolation,” King said.
Categories: Redefining Healthcare