Mishka Terplan, M.D. and Cathy Wilson talk inside the MOTIVATE Clinic.

Tuesday, July 11, 2017

Opioids: An American health crisis

Overdose deaths in the United States involving prescription opioids have quadrupled since 1999, according to the Centers for Disease Control and Prevention. Ninety-one Americans die daily from an opioid overdose and more than 1,000 are treated daily in emergency departments for not using prescription opioids as directed. In 2016, Gov. Terry McAuliffe and Virginia Health Commissioner Marissa Levine declared the opioid addiction crisis a public health emergency in Virginia.

At VCU and VCU Health, efforts are underway to combat this public health crisis — through addiction treatment, pain management, health care policy, education and research. This multipart series provides a snapshot of those efforts.

Cathy Wilson greets the diverse group of patients she sees every week with the same line: “If it were easy, I’d tell you to go home and stop using. But it’s not that easy and that’s why we’re here to help you.”

Wilson delivers that message sternly, yet lovingly. She is a registered nurse at the VCU Health Multidisciplinary Outpatient Intensive Addiction Treatment Clinic, designed to treat people struggling with addiction. Since opening in Richmond’s Jackson Ward neighborhood April 3, the MOTIVATE Clinic has treated between 60 and 80 patients. Most of them are referred from Virginia Commonwealth University Medical Center after receiving some sort of treatment for drug addiction or even an overdose. As an established presence minutes from the hospital, the MOTIVATE Clinic provides medical staff with a specific place to send substance abusers after they’re treated emergently at the hospital.

At the tipping point of a national opioid epidemic, a facility like the MOTIVATE Clinic is a jewel in the rough spot where the nation’s problem hits home. In November 2016, Virginia Gov. Terry McAuliffe and State Health Commissioner Marissa J. Levine, M.D., declared the opioid addiction crisis a public health emergency in Virginia. And, according to a policy brief that same year by VCU School of Medicine researchers, close to 80 percent of the nearly 1,000 fatal drug overdoses in Virginia in 2014 involved opioids in the form of prescription opioids or heroin.

However, as information and statistics about opioids mounts, VCU Health addiction experts say it’s not more research but actual resources, like the MOTIVATE Clinic, that will make change going forward.

“The public health issue is less about what to do, but more about providing access to treatments that work,” said Mishka Terplan, M.D., the clinic’s director.

‘Meet the patient where they are’

The MOTIVATE Clinic currently operates with a social worker, a front desk administrator, one full-time physician and one-and-a-half nurses. It is open Monday through Friday, from 8 a.m. to 4 p.m., by appointment only, at 501 N. 2nd St. As part of treatment, patients’ progress is monitored weekly and behavioral counseling sessions are available in individual and group settings. Patients also are treated with buprenorphine, a drug used to relieve hankerings for heroin and other opiates.

The combination of services is designed to complement a population that is as complex as it is diverse.

“Our responsibility is to meet the patient where they are,” Terplan said.

Part of that responsibility means that every aspect of the medical field must be prepared for the possibility of identifying and treating addiction, he added.

“Addiction draws across the spectrum of medical trainings,” Terplan said. “No matter what [medical] field you go into you’re going to come into contact with someone with an addiction.”

National coverage of the opioid epidemic has offered no geographical or socioeconomic bounds, with rural and urban communities, and middle- and high-income communities succumbing to its ill effects. Physicians say treating substance abuse should involve medical approaches that mimic treatment methods for any long-standing disease.

“The goals of addiction treatment are similar to the goals of other chronic medical disorders, such as diabetes and hypertension, which are to use multimodal treatments to maintain health and reduce lapses to unhealthy behaviors,” said F. Gerard Moeller, M.D., chair of the Division of Addiction Psychiatry in the VCU School of Medicine.

Multimodal treatments are a combined medication and counseling approach to addiction that, Moeller said, “will reduce opioid misuse and overdose” and help offset other addictions.

Compassionate treatment

Despite a national spotlight on the opioid epidemic and national attempts at eliminating its prominence as a public health issue, some statistics show that substance abusers, overall, aren’t seeking treatment. A 2016 Surgeon General report found that only one in 10 people receive any specialized treatment to manage their addiction and 40 percent of people addicted to substances neglect treatment.

Still, Moeller, who has worked in the addiction field for 20 years, said a shift has happened that should help erase the stigma related to addiction and embrace multidisciplinary treatment models.

“I think the two biggest changes I have seen are a greater acceptance of addictions as a medical disorder rather than a moral failure, and a greater interest in medication treatment for addictions,” he said.

Using the MOTIVATE Clinic as a bridge to walk patients from immediate treatment to continued treatment is an improvement from what providers could previously offer. Before the clinic, VCU Medical Center providers sent substance abuse patients to already bombarded, outside agencies for follow-up care. Now, patients get a proper sendoff.

“Some patients are very cautious. They’ve been made to feel less than and made to feel they don’t deserve a lot,” Wilson said. “For substance abusers who’re already confused and threatened, to have someone say, ‘Here, go here and they will help you,’ makes a difference.”

For more information about the Motivate Clinic call (804) 628-6752.