Increased use of medication-assisted treatment and broader cooperation among stakeholders will expand Delawareans’ access to the most effective addiction care, Kara Odom Walker, M.D., MPH, MSHS, secretary of the Delaware Department of Health and Social Services, said Jan. 18 at the inaugural Leslie and Edward Goldenberg, M.D., Disease Prevention and Health Promotion Lectureship.

Speaking at Christiana Hospital’s John H. Ammon Medical Education Center, Dr. Walker said medication-assisted treatment, or MAT, is “the best evidence-based therapy to prevent overdoses” but nonetheless remains underused. The medication blunts cravings and give its users the chance to break the cycle of withdrawal and relapse. It is most effective when paired with counseling.

Tapping its potential to treat the thousands of state residents who lack access to care will require seeing addiction as a chronic mental illness, she said. Because it is mediated by biology, sociology and psychology, addiction should be met with a correspondingly broad response; “all points lead to treatment.”

Lectureship emphasizes prevention

Seeing a wider role for health care providers is at the core of the medical philosophy of Dr. Goldenberg, FACC, Christiana Care’s director of preventive cardiology.

“I want doctors to realize that our role goes beyond taking care of the sick,” Dr. Goldenberg said.

Dr. Goldenberg said the lectureship is a way to educate providers and lead them to embrace a wider notion of prevention, health promotion and the importance of social determinants of health. Prevention is at once central to health and one of its most neglected tenets, he said.

Throughout his career in cardiology, Dr. Goldenberg has championed prevention in the hospital, classrooms and the halls of government, said Chief People Officer Neil Jasani, M.D., MBA, FACEP.

“Dr. Goldenberg has been a leader among change agents, a career-long champion of the prevention of illness,” Dr. Jasani said. “He embodies our core values and behaviors and anticipates the needs of others.”

Dr. Goldenberg has made outreach and education his keystones, Dr. Jasani said. His efforts include:

  • Head Start for a Healthy Heart: An effort to educate teachers on how to teach their students about heart health.
  • Use of LDL apheresis: A dialysis-like procedure in which blood is removed from the body and filtered to remove bad cholesterol.
  • Smoking cessation: Christiana Care’s campuses became smoke-free in 2005 after a campaign led by Dr. Goldenberg.

Affordable, effective, patient-friendly care

Dr. Walker said an estimated 11,000 Delawareans have substance use disorder, but only about 5,000 receive treatment.

Effective alternatives to hospital beds already exist to help the remaining 6,000 people, she said.

For example, if Delaware added 45 prescribers of medication-assisted therapy, an increase of 50 percent, it could serve 1,350 more patients.

Moreover, health providers could tap their full capacity if they communicated among each other and other stakeholders in a more systematic way. For example, if first responders were better educated about how overdose victims could begin treatment, they could direct these victims to services more consistently.

At present, Dr. Walker said, to call it a “system” is more an aspiration than a description.

“I’m not sure I would use the word ‘system’ right now, but we’re getting there,” she said.

Dr. Walker also described how office-based opioid treatment that incorporates MAT and group counseling could be a cost-effective way to increase access to treatment. Furthermore, its collaborative, team-based approach could support providers while enhancing the patient experience.

In other words: Patients and providers love it, it’s been shown to be effective, and it’s financially sustainable.

During the question-and-answer session, Anand Panwalker, M.D., associate vice president for medical affairs at Christiana Care, suggested that courage is needed to adopt harm-reduction strategies such as needle-exchange programs. It’s a value that Dr. Goldenberg demonstrated in 2005, when he campaigned for Christiana Care to go smoke-free.

“He single-handedly changed the culture and made this campus smoke-free,” Dr. Panwalker said.