ANA Maine Journal - August 2018

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Page 10 ANA Maine Journal August, September, October 2018 Opioid Misuse in Maine – Partnerships in Action Juliana L’Heureux, BS, RN, MHSA BANGOR, ME – Drug overdoses are a leading cause of injury caused deaths in the United States. Understanding the differences in illicit drug use disorders, and overdose deaths in metropolitan and nonmetropolitan (rural) areas are important for informing public health programs, interventions, and policies. Addiction treatments in rural communities are often not providing equal access to care. A crucial need for the prevention, treatment, and recovery to curb the opioid, and substance use disorders in rural communities were the subjects of a panel discussion held on July 9, at Husson University’s Gracie Hall. Drug overdose deaths in rural areas are rising. Reported by the Center for Disease Control and prevention (CDC), the causes for the rising rates of deaths from all causes in rural America are related to the misuse of addictive substances. A discussion panel was led by Anne C. Hazelett from the United States Department of Agriculture (USDA). She convened members from Maine’s community leaders, providers, clinicians, and advocates who are knowledgeable in the prevention and care for people who are victims of opioid misuse. Panelists also included Maine Senator Angus King and Second District Congressman Bruce Poliquin. A total of 15 people were moderated by Hazelett, the Assistant to the Secretary for Rural Development with the United States Department of Agriculture. Access to treatment and recovery in rural communities was the focus of the discussions. Compelling testimony about the importance of providing access to recovery care was presented by Courtney Allen, who is the co-founder of James’ Place, providing recovery care in Augusta, ME, for men and women. Hazlett described how the USDA intends to be a rural partner with leaders in local communities to help prevent, treat and provide recovery support for victims of opioid misuse. Other panelists were Christine Theriault, LMSW, CPS, program Manager, Maine Center for Disease Control. Also, Lenard Kay, Director of the University of Maine Center on Aging; John Gale, Senior Research Associate, Maine Rural Health Research Center, Muskie School of Public Service; Ric Tyler, “The Voice of Maine” radio host and Damien Pickel, the Town Manager of Milo, Maine. Community treatment was discussed by Trip Gardner, M.D., from Penobscot Community Health Care. Law enforcement was represented by Penobscot County Sherriff Troy Morton. Stephanie Nichols, PharmD, BCPS, BCPP, Associate Professor at Husson University School of Pharmacy, spoke about the pharmacists’ response to the opioid addiction crises and the passage of LD 1594 “An Act Regarding the Dispensing of Naloxone Hydrochloride by Pharmacists.” Other panelists were public health clinician Captain Chrisopher Bersani, Deputy Regional Administrator, Health Resources Service Administration (HRSA) and Sheldon Wheeler, Director, Office of Substance Abuse and Mental Health Services, Maine Department of Health and Human Services. OMNE/ANA-Maine Annual Meeting “Cultivating the Future of Nursing in Turbulent Times: Resilience, Civility, Empowerment” September 27 – 28, 2018 The Hilton Garden Inn, Freeport, ME Featuring Keynote Speaker A. Lynne Wagner, EdD, MSN, RN, FACCE, CHMT, Facility Associate, Watson Caring Science Institute speaking on “Renewing the Heart of Nursing for Self and Others: Sustaining Resiliency Through Caring Practices” Register online at www.omne.org OMNE Nursing Leaders of Maine PMB 342126, Western Avenue, Augusta, ME 04330 Leading the judiciary response was Leigh Saufley, Chief Justice, Maine Supreme Judicial Court. Clinicians on the panel were Bruce Campbell, Clinical Director, Wellspring/BARN and Barbara Ford, Director, Shepherd’s Godparent Home Husson University President Robert Clark welcomed the panel and the audience who met in the Gracie Auditorium. Clark described how Hussen University is concerned about how to provide quality services in response to the need for educational and support services for students who live in an increasingly stressful environment. Senator Angus King welcomed the expert panel and Anne Hazlett to Maine. He acknowledged the urgency of the opioid addiction crises. At least one person dies every day from the misuse of addictive substances. The disease of addiction is impacting rural communities and impacting all sectors of the community, from law enforcement to families. Cost of treatment is not only measured in the coverage for treatment, but also impacting economics by not having enough young people in the workforce. For every person who is not treated for addiction, means is there is one less person who would otherwise be a support to Maine’s local and the state economy. Senator King called for funding addiction prevention, treatment and recovery. “Treating addition without funding is like sending a fire truck to the scene of a fire without water,” said Senator King. Support for mental health care is also essential, because addiction and mental illnesses are often co-dependent. Congressman Bruce Poliquin recognized the importance for responding to the opioid and addiction crises. Poliquin acknowledged his brother’s death as a result of substance abuse. “I’m involved in this, in part, because my brother is no longer with us,” he said. “He was a great guy with a big heart, who died too young because of his drug addiction.” Poliquin called for support for H.R.5109: “Federal Opioid Response Fairness Act of 2018.” Access to prevention and treatment can be negatively impacted in rural areas because people are more likely to hide their need to seek help caused by fear of stigma due to their familiarity with others in the community. On the other hand, urban areas may provide more anonymity for people who need access to care. Rural hospitals are often the least well equipped to treat opioid addiction. Veterans must also have access to care, where it must be made available close to home. Access to broad band internet will help to provide access to people in rural communities. USDA is involved in prevention, treatment and recovery, includes Broadband access in rural communities. Investment is focused on equipping local leaders with tools where local leaders can access information about other agencies or nonprofit agencies. An interactive map is now available to spread information between community programs currently in operation. USDA Resources are focused on leveraging available resources for prevention, treatment and recovery. Courtney Allen is an advocate for recovery. She grew up in a family with challenges and eventually she was in a situation where she needed recovery care. She recognized the power she had to change her life. An opportunity for recovery came from the family treatment court. In a court room she was told, “I was a person.” Until then, she said, “I had no idea that recovery was possible. My life dramatically changed.” Moreover the moral of Allen’s personal story was that everyone must have the benefit of receiving treatment at the time when it’s needed. Let’s build our communities to be “recovery ready.” Today, she is dedicated to recovery advocacy. “People can and do recover,” she said. Moderator Hazlett asked Allen what would have made a difference in her journey toward recovery. “Was there a place where prevention would have helped,” she asked? Indeed, childhood trauma prevention or “trauma treatment” for children would have helped to prevent her need to access recovery, said Allen. Prevention and root causes of addiction were discussed by panelist Theriault. Youth and young adults must be educated before they are exposed to addictive substances. Most youth do not begin their addictions with heroin or opioids. Instead, they begin with alcohol, prescription drugs and marijuana. Individuals, families, communities and schools must be included in prevention activities targeted to their particular areas where intervention can be effective. For example, targeted education is provided to prescribers of opioids who receive information about where to obtain safe needle exchanges. Lenard Kay spoke about the risk to older adults who are the most vulnerable to receive prescriptions with opioids. Barriers to prevention and treatment for older adults are miscommunications about prescription use. Often, older adults do not follow the prescription regimens and they do not discuss this with their providers. Effects of long term care opioid use are complicated by lack of “episodic foresight,” the term used to describe the inability to address the potential outcomes of long term effects of addictive substances. Troy Morton spoke about the impact of addiction on law enforcement. Medicaid coverage stops when a victim of substance abuse enters the criminal justice system and goes to jail. Damien Pickel is the Milo Town Manager. He spoke about the rural impact of addiction. He is concerned about how to maintain the well-being of children and to prevent food insecurity stay in touch with children who have lost their parent to substance abuse. Some older people are selling their prescriptions as a way to pay for expenses like fuel or food. Prevention is hampered by the low number of law enforcement presence, compared to urban areas. Public Health officer Dr. Christopher Bersani discussed trauma informed care at a younger age and at school based clinics. He agreed with Senator King about the need to include mental health care in addiction treatment and called attention to AIMHS: Actively Increases Mental Health Services. Dr. Trip Gardner spoke about addiction treatment at Penobscot Community Health Center: He described how addiction causes people to change behaviors.
August, September, October 2018 ANA Maine Journal Page 11 They pursue their drive to satisfy the need for drugs with the same drive as the desire to drinking water for hydration. Addiction is a real disease like high blood pressure or diabetes. Stephanie Nichols discussed pharmacy prevention in rural communities. She explained LD 1594, An Act Regarding the Dispensing of Naloxone Hydrochloride by Pharmacists whereby a pharmacist who is trained may prescribe and dispense naloxone. Leigh Saufley is the Chief Justice of Maine Supreme Court. She acknowledged how important it is for towns to reach out and help small communities to prevent addiction. In fact, the goal is to reduce the number of people who are in jail because of addiction. Nevertheless, the only place where many addicts feel “safe” while trying to get sober is in the county jails. A return to family connections is essential to maintain recovery. Immediate access to safe housing for those in recovery must eventually accommodate families. Dental care is needed to prevent access to opioids to treat pain related to caries. People in recovery must be kept in a safe place away from those who influence their addiction. A strong recovery program requires knowledge about how to access treatment at every level of the community. Sheldon Wheeler said that Washington County has the highest affliction rate in Maine for substance misuse and addiction. Bangor was the fifth program in the nation where the USDA has convened a panel to learn how to address addiction and substance misuse in rural communities. Contact Anne C. Hazlett for more information at Anne.Hazlett@oscc.usda.gov Membership An Act Regarding the Dispensing of Naloxone Hydrochloride by Pharmacists Juliana L’Heureux, BS, RN, MHSA Passage of LD 1594, the Maine Board of Pharmacy, by rule making, has established procedures and standards for authorizing pharmacists to prescribe and dispense naloxone hydrochloride in accordance with Title 22, section 2353. The rules must establish adequate training requirements and protocols for prescribing and dispensing naloxone hydrochloride, when there is no prescription drug order, or standing order or a collaborative practice agreement authorizing naloxone hydrochloride to be dispensed to the intended recipient. A pharmacist authorized by the board may prescribe and dispense naloxone hydrochloride in accordance with Title 22, section 2353. Moreover, the law authorizes a trained pharmacist to prescribe and dispense naloxone hydrochloride to an individual at risk of experiencing an opioid-related drug overdose. Additionally, a pharmacist may prescribe and dispense naloxone hydrochloride to a member of an individual's immediate family or a friend of the individual or to another person in a position to assist the individual if the individual is at risk of experiencing an opioidrelated drug overdose. In the event there is no trained pharmacist who is immediately available to prescribe and dispense the naloxone per the rule, a referral can be made to another who is trained to do so. An Act Regarding the Dispensing of Naloxone Hydrochloride by Pharmacists was sponsored by Representative Karen R. Vachon of Scarborough. 9th Annual Patient Safety Academy Monday, September 17, 2018 9 am – 3:30 pm University of Southern Maine Portland campus Registration: $30/$20 students | Includes lunch FMI and to register: usm.maine.edu/muskie/patient-safety-academy-2018 Open to anyone interested or engaged in patient safety activities. Includes skill-building workshops and best practice presentations! Medical Professionals Health Program MPHP is a program available to all nurses who live or work in the state of Maine. Our staff are trained and experienced in providing clinical assessments, coordination, monitoring, and advocacy services for anyone who may be struggling with addiction, behavioral and mental health issues. If you or someone you know is in need of assistance, please contact us at: mphp@mainemed.com 207- 623-9266 www.mainemphp.org
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