By Thomas Goldsmith
In April, when Hickory was ranked fifth in the nation in the rate of opioid abuse, the designation sent shock waves through this foothills city of about 40,000.
At a recent conference there, citizens and professionals looked for solutions to Hickory’s headline-generating prescription drug abuse problems, offering lists of existing resources.
But it was the lack of coordination among professionals treating people with both mental illness and substance abuse problems, known as “dual diagnosis” clients, that emerged as a possible key factor behind the problem during the daylong event.
“Clinicians in the world want to do mental health or they want to do substance abuse and they do not intermingle,” said Heather Lail, substance abuse clinical director at Clay, Wilson and Associates in Hickory. “This is where the huge gaps exist.”
Lail led one of nine sessions on Oct. 14, when more than 350 people gathered for a Partners Health summit on opioid addiction at the Hickory Metro Convention Center.
“Hickory is No. 5 in the United States of America. That’s huge,” she said.
Patients, providers too far apart
Partners is the regional management agency handling services for eligible people with mental illness, substance abuse problems and intellectual and developmental disabilities in Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry and Yadkin counties.
The eight counties’ populations total about 900,000, less than Mecklenburg or Wake, and the region has large rural areas. In Morganton, Burke Integrated Health Services offers medical, mental and substance abuse health care at one site. But elsewhere in the region, clients with dual diagnoses often have to find their way — or be transported — to multiple locations for treatment.
“The biggest issue with any of our clients obtaining services is transportation,” Lail said. “These clients need longer care over a long period of time than we can nine-times-out-of-ten offer. That comes back to funding issues.”
Deanna Cosby, a licensed professional counselor at the conference, said behavioral health training tends to offer too little emphasis and time spent on substance abuse problems. She once treated a client who had been an addict for longer than she had been alive.
“He said, ‘I’ve been an addict for 36 years,’” Cosby said between sessions. “I said, ‘I’m scared of you and I’m scared of your addiction. I need you to help me.’”
Attendee Cornell Thomas, 61, has established a Gastonia facility, Samantha’s House, in honor of his wife, who was killed by a reckless driver last year. A self-described addict from 1968 to 2009, Thomas was at the conference to urge a broader range of treatment for addiction.
“Doctors are part of the problem,” Thomas said. “Most of the stuff they do is from an intellectual bias.”
Thomas and other attendees noted that getting an addict sober provides only limited help if, for example, the “dual diagnosis” client continues to deal with bipolar disorder or other mental health problems. During his years of addiction, Thomas said, using methadone or other medical treatments didn’t resolve his habit. Instead, he said methadone enabled his use and the illegal path he followed to support it.
“When you really look at it, it just helped me maintain my criminal activities,” he said.
Reimbursement standards need revision
Dr. Michael Clark, Partners’ associate medical director, said the current system of payment to professionals tends to limit what could be helpful communication between professionals.
Therapists are only paid for the clients they see, Clark pointed out during a break in the conference. Better communication among all the patient’s providers could help reconcile a patient’s physical, mental, emotional and practical needs, he said. But health care reimbursement rarely provides an incentive for the extra effort needed to share information.
“In the ideal world there would be a coordination piece that we could be reimbursed for,” Clark said. “There could be a shared computer system that people could get on and see what’s going on.”
Patients also need education about the interaction of mental illness and substance abuse, Lail said.
“They always say, ‘Well I can’t sleep, so I smoked a joint,’ or ‘I can’t sleep so I drank a glass of wine.’” she said. “Not being able to sleep can be the result of a mental health disorder.”
From pain pills to heroin
Keynote speaker Dr. Mel Pohl, chief medical officer of the Las Vegas Recovery Center, offered information on alternative means of dealing with chronic pain and opioid addiction.
Pohl said 80 percent of today’s heroin users started their drug habit by stealing painkillers from their parents’ medicine cabinets.
State Rep. John Torbett, a Republican representing much of Gaston County, offered support at the event, but noted that he has not delved into the problems of addiction.
“Standing before you is someone who knows very little about this issue,” Torbett said.
Torbett asked that symposium attendees join him in finding some kind of significant new approach that could eradicate the opioid problem within a few years.
Attendees, many of whom have spent decades in the field, returned only tepid applause, giving little response to Torbett’s request.
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