Page 7 - FOCUS December 2017

COVER STORY
“If you address a patient’s withdrawal,
then you can talk about the deeper psychological issues that have contributed to the addiction.
“There’s a lot of trauma among my patients.”
Jolomi Ikomi, M.D.
OUTPATIENT PROGRAM REDUCES BARRIERS TO TREATMENT
Christiana Care started an outpatient substance use program about two years ago due to demand for a multidisciplinary, integrated program that combines therapy with medications.
“We started out slow, and it grew quickly because the need is so substantial,” said Lisa Gonzalez, MS, LCDP, program coordinator.
The program’s niche is meeting the complex needs of patients suffering from addiction, including removing barriers to treatment such as transportation, access to health care and a variety of other stumbling blocks. It’s built for people for whom other options haven’t worked.
“Our program is about acknowledging that people often need extra help to succeed in treatment,” she said.
The program accepts referrals from within the Christiana Care network, including Project Engage, behavioral health and primary care. The team, which includes a dedicated social worker and counselor, is actively treating about 75 patients.
Gonzalez said alcohol remains the single most abused chemical, though most patients with addiction use multiple drugs.
Mental health therapy is the clinic’s baseline treatment; about half of its patients also take medication.
Jolomi Ikomi, M.D., joined the clinic as medical director in August after serving in the same role at a treatment clinic associated with the Yale School of Medicine. He said medication is sometimes appropriate to reduce cravings, which will ultimately make it easier to identify and treat underlying
mental illness.
“If you address a patient’s withdrawal, then you can talk about the deeper psychological issues that have contributed to the addiction,” said Dr. Ikomi, a double board certified addiction psychiatrist. “There’s a lot of trauma among my patients.”
He said patients who take these drugs are able to begin to take steps to conquer their addiction in the long term.
“The majority of my patients feel gratitude and ask themselves why they did not get the medication earlier,” he said.
A minority of patients struggle with guilt.
“There’s a stigma of being on a medication, as people wonder if they are really in recovery if they are taking a drug,” he said.
He often tells patients the medication is not the cure.
“Really, what’s going to bring about change is counseling and psychotherapy,” he said.
Overall, Dr. Ikomi said the combination of medication and therapy has been shown to be effective.
Making progress on addiction, then, is largely about overcoming the barriers to this treatment, whether they’re financial, related to stigma or caused by provider hesitance.
REDUCING OPIOID PRESCRIPTIONS
While prescriptions for opioids have been declining since 2010, the Centers for Disease Control reports that opioids are still overprescribed.
Two years ago, Christiana Care initiated a project to ensure
all clinicians were adhering to opioid prescription regulations. Each primary care doctor in The Medical Group of Christiana Care was provided with a list of their patients receiving opioids for more than 90 days, and doctors reviewed their peers’ charts.
“We saw a reduction in the utilization of narcotics,” said Julie Silverstein, M.D., FACP, physician leader of Primary Care
& Community Medicine. “The underlying goal is to make prescribing habits more thoughtful, to make sure that patients are aware of the risks and benefits of prescribing opioids.”
In April, Delaware passed requirements for opioid prescription that set new rules around written consent, urine drug screens, analyses of prescribing patterns and substantially limiting the quantities of medication that can be prescribed. Christiana Care collaborated in crafting this legislation. By November, Delaware reported a 12 percent drop in prescription rates statewide since the rules went into effect, as well as an 8 percent drop in the number of patients being treated with opioids. | CONTINUED
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