Outreach vans and emergency responders trained in new treatments are part of the new anti-addiction toolkit that providers are using to expand access to opioid treatment in New Jersey, but experts say more must be done to increase treatment capacity and connect with patients on their own terms.
The need to beef up treatment capacity and better connect with patients were among several challenges outlined by experts who discussed how to make addiction treatment more mainstream; they were participating at the Progressive Response to the Opioid Epidemic symposium hosted Tuesday by Integrity House, one of the largest nonprofit treatment facilities in New Jersey, along with Rutgers New Jersey Medical School and Seton Hall School of Law. John Jacobi, a professor of health and law at Seton Hall, moderated the discussion.
Physicians on the panel highlighted how they are training more of their colleagues to provide medication-assisted treatment, or MAT, a process that includes controlled doses of opiates to curb cravings and addictive behavior and is considered the gold-standard in opioid treatment; they are also forming partnerships to help patients with addictions address multiple health issues. In addition, they are seeking to engage medical students in this work early on.
But the speakers agreed this may not be enough to reach some of the most desperate patients. “Systems like this are tough to maneuver through for people who are not addicts,” said Robin Shorter, senior director of outpatient services with Integrity House. The process is even more challenging for someone with a full-blown addiction, who may also be homeless, returning from jail or lack identification, transportation and community support.
That’s where the Integrity’s Hope IV van comes in. It is one of a fleet of vehicles the nonprofit dispatches to Newark’s parks, shopping centers and the Penn Station area, where they serve as a mobile service hub offering mental health counseling, HIV tests and other services, including immediate rides to detox or treatment programs. The program has assisted 1,200 people in the past year, she said, and through it 172 people were referred to treatment in that time.
“We go to the locations others really don’t want to go,” Shorter said. “And we’re able to bring treatment directly to people, right then.”
As awareness of opioid addiction has grown, new — and far more effective — treatments have emerged, including new forms of medication-assisted treatment. But experts agree that access to these medications remains limited; only a small fraction of doctors are licensed to prescribe these drugs and far fewer are treating as many patients as they are allowed under federal law. (The MAT waiver allows them to treat 30 patients the first year and 100 in following years.)
To address this gap, the state Department of Human Services, which oversees most addiction programs, invested $2 million to create two centers of excellence — one in Camden, one in Newark — in partnership with local medical schools. The programs have trained hundreds of clinicians in the MAT protocol, are encouraging those with waivers to prescribe to the full extent of their license despite the stigma surrounding the disease or concerns about the highly regulated prescription process. They have also launched a hotline to provide assistance to practices that already offer MAT.
“I think we all know we have a huge access program here in New Jersey,” said Dr. Erin Zerbo, an assistant professor of psychiatry at Rutgers New Jersey Medical School, in Newark, and leader of the center of excellence there. Arming doctors with more information on the science and process makes them more comfortable with MAT, she said, and should in turn increase prescribing capacity.
Treatment not available for everyone
More than 2,700 people have died of overdose-related deaths so far this year in New Jersey, on top of more than 3,000 who lost their lives in 2018, and the state’s death rate outpaces the national average by at least 60%, according to one speaker. More than 70,000 residents sought treatment annually in recent years and tens of thousands more were unable, or not ready, to get assistance.
To reach more people with substance use disorders, Cooper University Health Care in Camden — the site of the South Jersey center of excellence — has employed a “low threshold” to treatment approach. That means offering MAT and other services to emergency room patients who suffered an opioid overdose. Earlier this year, the state Department of Health became the first in the nation to permit certain emergency responders to offer this treatment to individuals who have been revived from an overdose on the street.
While this approach has helped — especially for extremely vulnerable citizens, like those who are homeless — engaging primary care doctors has also been a critical part of Cooper’s strategy, the speakers said. But, in order to effectively meet the region’s needs, more of these family medicine providers must be part of the response.
“The only way we could have done this effectively is by partnering with our primary care providers,” explained Dr. Matthew Salzman, an assistant professor of emergency medicine with Cooper University’s medical education program. “They’re already seeing patients struggling with substance use disorders and they need to incorporate (MAT) into their routine care.”
Dr. Jill Williams, an addiction psychiatry professor at NJMS, in Newark, said she uses social media to try and convince other psychiatrists to obtain their MAT waiver. She is also encouraging her students to consider this MAT approach; they are a group she said is eager to get involved.
But MAT alone is not sufficient care for these patients, Williams stressed, especially when it comes to mental health needs. “Chronic pain and depression seem to go hand in hand,” she said, noting that depression has probably been under-diagnosed for years. “There’s a huge need to treat the whole person and intervene effectively.”