Dr. Jeffrey Brenner and Camden Coalition Staff

Helping Camden practices overcome barriers to providing opioid addiction treatment

illustration-of-suboxone

Opioid addiction rates are escalating across the country, and low-income communities like Camden have been hit especially hard. As overdose deaths continue to rise, health care providers in Camden are finding themselves on the front lines of the crisis.

While health care providers and lawmakers across New Jersey have made strides in curbing the epidemic and continue to search for long-term solutions, our Medicaid Accountable Care Organization (ACO) is looking at ways to save lives and ensure that Camden patients with opioid addiction are getting the quality care they need. One approach is by helping primary care practices that make up our ACO overcome barriers to prescribing Suboxone, which has been shown to be effective for many patients dependent on opioids, such as prescription pain medications and heroin.

A combination of buprenorphine and naloxone, Suboxone is a relatively new evidence-based treatment option that can provide relief from opioid cravings and ease withdrawal symptoms without producing a “high.” But despite the acute need for medication-assisted treatment (MAT), most primary care providers in Camden are not licensed to prescribe Suboxone. With the partnership of our ACO’s participating providers, we are hoping to change that.

“What we are trying to do at a citywide level is help each practice independently overcome barriers to prescribe Suboxone and other MAT,” said Carter Wilson, associate director for the Coalition’s Clinical Redesign Initiatives. “For practices that are unsure about getting licensed to prescribe the drug, we can provide trainings and reimburse them for certification and initial costs. We can also connect them to local clinics and experts for technical assistance and encouragement. And for practices that are already actively prescribing Suboxone, we can help free up their bandwidth so that they can support other practices in their activation.”

To reduce stigma and help raise awareness that addiction is a chronic, treatable condition, the Coalition has been holding trainings for participating providers in our ACO, as well as our staff and community partners. Last March, we hosted a series of “Addiction 101” trainings, focusing on the science of addiction and trauma, how medication-assisted treatment helps patients with addiction recover, and the importance of trauma-informed care. Three hundred staff members from 20 organizations attended. Since then, the Coalition has continued to train agencies in Camden to raise awareness of addiction as a chronic, treatable condition, with the hope that it will encourage more practices in the city to become licensed to prescribe Suboxone and other evidence-based treatments.

 

“It requires a vigilance”
One participating practice in our ACO, Project H.O.P.E., has long been a champion in treating people with substance use disorders with Suboxone and other evidence-based treatments for the past four years. At Project H.O.P.E., which provides medical care and social services to the homeless population of Camden, family nurse practitioner Susanne Johnson has treated countless patients with substance abuse disorders, both at the clinic and in her previous position as a nurse at Penn Medicine. Trained through the American Society of Addiction Medicine, she recently became licensed to prescribe Suboxone at her clinic and currently sees about a dozen patients with opioid addiction on a weekly basis. For Susanne, prescribing Suboxone has been a mostly positive experience, but because people often relapse, she maintains a watchful eye on them.

“I’m writing their prescription, I’m looking at their urine drug screens, I’m looking at how they’re doing in group therapy. It requires a vigilance,” she said. “You are monitoring for safety because there are other opiates that might show up in their urine screenings. It does add extra weight to your plate because there is significant monitoring involved.”

Still, she has seen many of her patients on Suboxone engage less in risky or illegal behavior and begin to reclaim their lives. One young female patient at Project H.O.P.E. who struggled with a five-year heroin addiction has reconnected with her young daughter after a long absence. Thanks to reflective writing exercises assigned by her Project H.O.P.E. counselor, she has found writing as a powerful outlet to work through her history of trauma. And she is regaining her self-worth.

“A big thing that has come up with her is she has a lot of missing teeth, which has taken a toll on her self confidence, so she is having dentures created,” said Susanne. “She feels that’s going to be a big piece, in terms of how she views herself and how the world views her, and that it will help her get a job. She feels stable enough with Suboxone to pursue these other goals in life.

“If people are interested in prescribing Suboxone, I would recommend that they speak with other providers, do some shadowing, and to really consider how they’re going to provide for the essential wellness of those patients,” she added. “Partner with a local psychologist or psychiatrist, and have resources on hand. Don’t just start giving it out.”

When asked what she would tell providers who are undecided about pursuing certification to prescribe Suboxone, Susanne replied, “I know the argument: ‘Well, you’re just substituting one addiction for another.’ That’s inaccurate because the term ‘addiction’ also has a psychological component. It’s important for providers to recognize that you can’t just prescribe the medications and not provide any psychosocial support… We require it as part of our program. You can’t say, ‘Here’s this medication,’ but not address people’s history of trauma, abuse, violence, neglect, or depression.

“Suboxone does significantly reduce harm for some people. It doesn’t work for everybody, and it’s not a panacea, but is it worth trying for someone if the other option is that they lose their life? I think so.”

Posted: September 14, 2017