In the third installment of his “Ideas” series addressing the state’s opioid crisis, Ohio Attorney General Mike DeWine focused on the medical and treatment community.
About 700 medical professionals gathered at 18 satellite locations throughout the state on Sept. 25 to take part in the live “Ideas in Practice: A Closer Look at the Continuum of Addiction Treatment” event hosted at the 4-H Center at Ohio State University. During four sessions, panelists discussed evidence-based practices for helping opioid-addicted patients.
“We are tragically well into this opiate epidemic,” DeWine said. “The bad news is pretty obvious: 12 to 15 people die every day. We have babies born every day who are addicted. Our children’s services are overflowing with kids. Half of the kids in foster care are there because one or both of their parents are drug addicts. Our jails are detox centers. I don’t have to tell you about the impact on the medical community.”
“But what I find is that in community after community, people are doing amazing work,” he said. “What we have tried to do at the Attorney General’s Office is to figure out where we could be value-added in dealing with this problem.”
The Attorney General’s Office operates three state crime labs to which 90 percent of Ohio’s police departments submit drug evidence. The office also takes part in multijurisdictional task forces involving the Drug Enforcement Administration, the FBI, and local law enforcement, among others.
“We know what is happening,” DeWine said. “We’ve seen a move from the pain meds to the heroin, then into fentanyl and carfentanil. As we moved into this crisis, we wanted to do more.”
The Attorney General’s Office formed a Heroin Unit and tasked members to work with local communities on grass-roots efforts.
The group was recently invited to speak to OhioHealth nurses and doctors about the state of the opioid crisis in Ohio as the hospital system was preparing to start a pilot project at four hospitals to do more for patients with substance use disorder. When high-risk patients seek medical treatment, they and their families are offered naloxone, training on how to use it, and a resource packet with links to treatment.
“The solution to this epidemic is going to take all of us,” DeWine said.
Dr. Shawn Ryan, president and chief medical officer at BrightView, an outpatient addiction medicine practice with four locations in Ohio, echoed the need for teamwork in the addiction fight.
“Treatment must be medical, psychological, and social,” he said. “Medication-assisted treatment works. Psychological interventions are necessary. And social supports are needed.”
Also necessary, said Ryan, who is also president of the Ohio Society of Addiction Medicine, is a cultural shift away from seeing addiction as a moral failing when, in fact, it fits the definition of a chronic disease.
He cited a 2016 report by Surgeon General Dr. Vivek Murthy, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” as an important guide to those treating addiction. In the report, Murthy makes clear that substance use disorder is a chronic, relapsing disease with significant economic, personal, and public health consequences.
“This is probably the most impactful disease to our socio-economic status as a country that exists today,” Ryan said.
Treatment is worthwhile and worth the cost, he said.
“The return on investment is as high as $18 for every dollar spent on treatment. That is the full return on investment, including reduced number of people in jails, improved mental health, reduced drug utilization, reduced hospitalization.”
Ryan is a firm believer in medication-assisted treatment.
“The evidence is not subtle,” he said. “We should always work with the patient to decide upon the best medication-assisted treatment for them. …This is not an emotional decision for a physician.”
Quite often, mental illness also plays a role in addiction.
Dr. Dan Bielecki, director of clinical services at BrightView, said about 50 percent of addicts have a dual diagnosis.
“Starting mental health treatment while someone is starting the medication-assisted treatment is going to address the underlying problem,” he said. “We can also help them develop healthy coping skills, help them realize that cycle of use in order to start breaking that cycle with different strategies, and increase their awareness of triggers that factor into addiction.”
For families with parental addiction, Attorney General DeWine unveiled the Ohio START (Sobriety, Treatment, and Reducing Trauma) pilot program in March to provide specialized victim services to children.
When a child is removed from the home because of parental addiction, this program moves in with resources to try to heal the parent and reunite the family, he said.
The program first delivers intensive mental health services to the children, then drug treatment services to parents, and, finally, brings representatives from drug treatment, the child welfare system, and the courts together to provide wraparound services to the families.
To view the materials and videos presented at the meeting, visit
www.OhioAttorneyGeneral.gov.