When prescribed and used appropriately, opioids can be a real blessing to patients suffering excruciating pain caused by injury or illness. Used improperly, however, opioids can be crippling and even deadly.
For years, drugs like oxycodone, hydrocodone, and meperidine have been first-tier options for pain relief. “We’ve gone so far away from holistic measures,” said Amanda Arnold, director of quality and risk management at Health Care Collaborative (HCC) of Rural Missouri. “We seem to jump to the worst-case scenario first.” In doing so, a different, unanticipated worst-case scenario has emerged: The National Institute on Drug Abuse (NIDA) reported that, of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug.
“Opioids are almost gateway drugs,” Arnold said. “And they’re being prescribed at younger and younger ages.” She noted opioids can be as helpful as antibiotics or hypertension drugs—but only when used at the right place at the right time, with the right patient receiving the right amount.
“More than 1,100 Missourians lost their lives to opioid-related overdoses last year,” said U.S. Senator Roy Blunt (Mo.) in an August 2019 interview with KHQA-TV. “Preliminary data from the Centers for Disease Control projects that, from 2017 to 2018, our state saw around a 16 percent increase in overdose deaths. This is nothing less than a public health crisis.”
And it’s not just in Missouri. Lexington Police Chief Charlie Grom, who grew up in the state of California, noted that opioid abuse began on the coasts and gradually spread to the Midwest. He’s observed a slow uptick in Lafayette County over the past year and a half. “What I’m seeing is stuff I experienced five to eight years ago on the West Coast,” he said. “We’ve been very lucky here in Lexington to not see a lot of trafficking take place. It really hasn’t impacted our community in that regard; it’s mostly personal use and misuse of opioid products.”
That personal misuse can easily take a toll on an addict’s neighbors, however. “It’s no secret that property crimes are directly linked to drug use,” Chief Grom said. “Because drug use is an illicit activity, people don’t usually have normal, stable jobs. They’ve got to support those addictions in some way, so we find a lot of opportunistic crimes. Being a rural community, people aren’t as focused on home security. That’s an issue we have been diligently working on, showing people how to protect themselves from the randomness of theft.”
Funding the Fight
In 2017, as the crisis continued to rage across America, the U.S. Department of Health and Human Services (HHS) established a Five-Point Opioid Strategy requiring:
- Better addiction prevention, treatment, and recovery services
- Better data
- Better pain management
- Better targeting of overdose reversing drugs
- Better research
The first year, HHS issued more than $800 million in grants to support opioid addiction treatment, prevention, and recovery programs. This year, HHS awarded nearly $400 million nationally to support Health Resources and Services Administration (HRSA)-funded community health centers, rural organizations, and academic institutions in their fight against Opioid Use Disorder (OUD).
HCC was awarded just under $2 million, benefiting patients served by its Live Well Clinics in Buckner, Carrollton, Concordia, and Waverly:
- $200,000 – Rural Communities Opioid Response Program (RCORP) Planning Grant
- $1 million – RCORP Implementation Grant
- $600,000 – Federal Office of Rural Health Policy (FORHP) Small Provider Quality Improvement Grant
- $167,000 – Integrated Behavioral Health Services (IBHS) Grant
Services to be provided include primary care, behavioral health, counseling and therapy, preventative health and wellness services, detoxification, and more in both inpatient and outpatient settings. “Grant monies were used last year to have Live Well providers certified in Medication Assisted Treatment (MAT),” Arnold said. MAT uses a combination of therapy and well-documented drugs like methadone, naltrexone, and buprenorphine to gradually wean addicts off opioids. Existing HCC patients already receiving primary, dental, or behavioral health/mental health care can be referred to these MAT-certified providers for help in overcoming addiction.
It takes teamwork to combat opioid abuse. Live Well representatives and several key community stakeholders meet monthly to discuss, plan, and implement practical approaches to tackling the problem. Stakeholders include:
- HCC and its Live Well Centers
- Compass Health Network
- Lafayette County Mental Health Board
- Lexington, Mo. Police Department
- Lafayette County Sheriff’s Department
- Lafayette County Probation and Parole Department
- Lafayette Regional Health Center
“Pettis County has implemented a program similar to the one we’re trying to implement in Lafayette County and surrounding areas,” Arnold said. “They’ve been our mentor through all of this, as they currently have their program up and running, also funded by grants.
Their next step is to look at sustainability, how they’re going to continue the program after the grant funds run out. That’s been a critical piece for us, looking at sustainability upfront, along with cost savings to the hospital, the state, the jail, our health centers, Medicaid, etc.”
Strategizing the Fight
“More and more people have been talking about opioid abuse and sharing statistics, bringing the misuse to light,” Arnold said. An early effort by Live Well to curb opioid abuse had patients sign a pain contract agreeing to use medications as prescribed. “If they violated the pain contract, we would terminate the patient. But they just moved on to the next provider down the road or in the next community. There were no consequences.” In 2019, HCC stopped prescribing narcotics. “We posted signs in all our clinics that we will give you a referral to a pain management specialist, but we will no longer be providing those medications.”
Repeat offenders tend to become known in provider circles. “We’re seeing the same individuals abusing opioids in the ER, in our clinics, and getting picked up by the police department,” Arnold said. If they’re on probation or parole, there’s a good chance they’re returning to the same place where drugs were readily available before. Unless something is done, the person will fall back into addiction. “It’s a vicious cycle,” she said.
So, if you want to help an addict, where do you intervene?
“We identified two places: the medical and behavioral health/mental health side, and the law enforcement side,” Arnold said. “We believe the hospital is a key stakeholder in this grant, since that’s where an addict often goes in an emergency situation. If we’re able to set them up for a follow-up appointment using case managers or community health care workers to get them into a primary care setting to receive mental health, dental care, and everything else, they’re less likely to go back to the ER.”
After being arrested or incarcerated, an addict may be released with no follow-up plan—including how to deal with their addiction. “They’re expected to check in with their probation or parole officer, but with transportation, housing, and medication all being issues, a lot of times those clients don’t have the wherewithal to sort all that out. They’re living crisis to crisis,” Arnold said. “If we’re able to meet those clients where they’re at—and that’s in jail, at the probation office, or at the time they’re picked up by law enforcement—we’re going to have much better success in getting these individuals that follow-up care.”
Chief Grom concurs. He believes having street, probation, and parole officers play a role in recovery leads to better outcomes all around. “Then law enforcement isn’t seen as the adversary in people’s lives, but more of an advocate for getting them off this stuff.”
Working Shoulder to Shoulder
Along with acting as police chief, Grom also serves on advisory boards for both HCC and Lafayette County Mental Health. “It’s important for us to have a spot at the table when we talk about community health, both from a medical standpoint and a mental health standpoint,” he said.
Cross-agency communication revealed that a high percentage of patients dealing with opioid abuse also have mental health issues. “When we talk about drug abuse and mental health issues, it’s difficult to determine which came first,” Chief Grom said. “To address one without acknowledging the other is missing the boat. Often, drug abuse is a result of mental health issues and people trying to self-medicate. Or you may find people who’ve been involved with drug abuse for so long that their mental health is starting to decline. We need to view this as a whole and not separate issues, as most places have in the past.”
He agrees with Arnold about the importance of a community safety net for addicts. “When they get out of a hospital or criminal institution, they need that support system to make sure they’re not just left to their own devices. Because there’s a window of time there where, if we don’t get them connected to proper services, they may not be able to do that themselves.
“That’s what this whole grant program is focused on: making sure we tighten up those loopholes so that people are helped from one place to another and that we’re all communicating about the same people about the same issues.” Working together also educates key stakeholders about what each group does, building empathy as they serve the community both as standalone agencies and as a team.
Grant funding allowed HCC/Live Well Centers to hire a consultant to help the community formulate a three- to five-year strategic plan. “It’s a brand-new program and process, and we’ll know more as we get into it,” Arnold said. “Our target population is the uninsured and underinsured – those who want to get into a program, but don’t have insurance or medication to do that. Opioid addiction treatment is very expensive. But with this grant, there is some medication money written into it.”
Citizens Taking Responsibility
“Drug use and abuse is not something to be viewed as an isolated incident,” Chief Grom said, “either for the person who’s suffering from the addiction or the family members who have to experience the fallout from a drug-addicted relative or friend. It really is a community-based problem. We may not think that crime or drug abuse affect us because, most of the time, we don’t get directly touched by it. But indirectly, we do.”
He encouraged residents to join in the fight against opioid addiction by volunteering or actively supporting those who are participating in community service programs. “Doctors do their part; law enforcement does its part. It’s important for the community to do its part,” he said. “I’ve met a lot of good people out there working their tails off, trying to make a difference. I’ve seen communities able to make that turn and start going in a different direction. It’s an absolutely wonderful thing to watch a neighborhood begin to revitalize and come back. But it takes everybody’s positive input and cooperation for that to happen.”
HCC, its Live Well Centers and the other community stakeholders are passionate about serving the rural population. “We are here for you,” Arnold said. “If someone picks up their phone and calls my number, I will personally guarantee that we’ll be able to help them with some resource. We may not be able to fix all their problems, but we’re going to stick with them and help them through it. That’s the reason I came to work with HCC; I truly wanted to help people. And that’s exactly what HCC is doing. They’re doing their best to not let any patient fall through the cracks.”
Contact Amanda Arnold at 816-807-5795 (cell), 816-249-1521 (Live Well Community Health Center, Buckner), or by emailing firstname.lastname@example.org.
HCC is headquartered at 825 S. Business Highway 13 in Lexington, Mo. 64067. For more information, call 660-259-2440.