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Healthcare Solutions
Subcommittee Meeting
Minutes 9/11/15
Regrets: Ed Tessier, Baystate Franklin Pharmacy,
Ruth Jacobsen-Hardy, DPH , Eliza Lake, Hilltown
CHC
Present: Dr. Tom Higgins, BFMC CFO (co-Chair)
Dr. Ruth Potee, Valley Medical Group (co-Chair)
Pam Jobst, Athol Hospital
Rebecca Bialecki, Heywood Healthcare
Linda Singer, Probate Court
Marisa Hebble, Task Force Coordinator
Dan Sontag, CSO Crisis
Karen Sayword-Sims, BFMC MHU
Justin McNary, Recover Project,
Linda Jablonski, BFMC
Dr. Todd Mandell, CSAC
Amanda Wilson, Clean Slate,
Dawn Geller, CSO
Amy Olson, CSO.
Melissa O’Malley, Moms Together
Lynn Ferro, NWDA
Justin McNary, Recover Project
Cheryl Dukes, UMass College of Nursing
Aaron Blanchette, Walgreen’s Pharmacy
Phoebe Walker, FRCOG
Dr. Julie Thompson, Pioneer Women’s Health
Lynn Ferro, NWDA Prescription Drug Coalition
John Merrigan, Register of Probate
Dr. Stefan Topolski, Trailside Health
Amy Olson, CSO Greenfield
Melinda Williams, CSO Greenfield
Julie Payne Britton, BFMC
Erika Ross, CHD
Erin Herzig, VMG
Dr. Michael Bailin, Baystate Anesthesia
Don Wright, Recover Project
Ed Sayer, CHC FC
Janine Risser, Family NP
1. Introductions Dr. Ruth Potee and Dr. Tom Higgins, Co-Chairs, recognized the work of Aaron Blanchette,
recent winner of a community service award from Walgreens for his work with the Task Force.
2. Opioid use among pregnant mothers/neonatal abstinence syndrome update. Linda Jablonski of the BFMC
Birthplace and the Perinatal Support Coalition described the current state of Neonatal Abstinence Syndrome
in FC. Currently 7% of babies are diagnosed, higher than the state average of 5.9%. 16-25 days are the stays
for babies and moms at the hospital. They have begun meeting with moms to educate them about NAS so
they are more prepared, and can start weaning from any substances, if at all possible, and can prepare for the
boarding experience at the hospital and the involvement of DCF (which is mandatory for NAS). Seven women
have been trained as Recovery Coaches to serve as peer mentors through Moms Together. Next steps:
integration of evidence-based screening tools, SBIRT training upcoming, development of protocol for
providers.
Follow up: College of Nursing would like to be working with the Coalition more.
Perinatal Coalition would like a direct line to Clean Slate and CSAC to work on the dosage for moms as they
give birth.
3. Medication Assisted Therapies (MAT) Roundtable
What does the science say? MAT Literature Review – Jeanette Voas, Partnership For Youth Evaluation
Coordinator reviewed what scientific studies say about Methadone, Buprenorphine, and Naltrexone. After
the presentation, the group had a discussion of the bottleneck that the therapy can create to getting
treatment. Justin from the Recover Project agreed that this is a huge problem. Clean Slate is looking at
Telehealth, Dr. Potee asked about Acceptance and Commitment Therapy (ACT), which was highly rated in the
Literature Review -- where is it done? Answers: VA, CSO (some providers), Brattleboro, Service Net, PHU.
Follow up: Is more training for clinicians on this a goal? Another idea was increasing groups so that people
can get into therapy in a group to meet the requirement. Both CHD and CSO reported that they have new
BSAS money that is not tied to insurance, and expressed interest in providing more groups, especially precontemplative groups, which Marisa reports are badly needed.
Clinic-based Suboxone data – Amanda Wilson of Clean Slate described their program and protocols. They
opened their first center in Greenfield six years ago, and have taken care of 20,000 in MA. Now open in PA,
and in conversations in IN, OR. Will soon be doing clinical trials with NIDA. They categorize patients into four
categories: Green/ doing well, negative screens, 6 months in program: (22%), Yellow (57%), Orange/new
(32%), Red (11%) – need to be moved to Methadone or residential program. Retention at Clean Slate at one
year is 62% (national average 19%), at two years 50%. In their experience, Vivitrol is not a good first
treatment, but works for those already successful with an agonist or coming out of incarceration. Questions
from providers – private provider line can be gotten from Michelle L’Italien
([email protected]). They have spaces in Greenfield, but not North Quabbin --problem with a
lack of Athol area providers.
Methadone Clinic data – Todd Mandell, Community Substance Abuse Center. They are being crushed with
requests for new visits. Lots of concern for Fentanyl overdose (white or whiter heroin is a sign). Some people
are knowingly using it. New problem: Feds have forbidden NPs from adjusting doses. Deaths from diversion
from methadone is generally from pain mgmt. clinics, not their clinic. Most CSAC patients take the methadone
on site, but some can be cleared for home. No one can get it if they have a medical marijuana certificate.
Todd is concerned that aproviders are not educating people about driving when they prescribe sedatives. In
their 18 programs in four states they have 500 additional new people since the beginning of the year. They
screen for all risk factors, including anyone who has had an overdose, since it puts you at risk for another.
Todd will get some data on polypharmacy -- many have Adderal, Xanax and more. Todd recommends we all
work together to communicate any “change in patient status.” Question about whether the ED communicates
with CSAC, do the ED docs know to check the interaction.
Discussion of benzodiazepines – Melissa asked about why so many pregnant women are on Klonipin. Dr.
Mandell answered that Benzos are not intended for long term use, but culturally we expect chemical solutions
to our problems. All of these sedative medications make the patient at risk for major problems while on
methadone. Fixing the correct methadone dose is very hard, so the person may keep using because the
cravings may not be managed.
Justin asked about connection between MAT providers with behavioral health specialists, since he sees so
many failures and so many people with acute mental health problems.
Family Practice Suboxone data – Ruth Potee, Valley Medical Group and co-Chair. Her patients like being seen
as part of a family practice. Their practice has about a 80% success rate, but that is possibly because these
patients have to be more organized to start with than those seen at other MAT clinics. Ruth reported on the
progress with getting more primary care providers to get their X licenses. VMG has four sites with 65,000
patients. After years of developing thinking on this subject, they have committed to having at least two
suboxone providers per site – a great step forward. There is however, still room for more primary care
providers to get their waivers and become suboxone providers – not many have done it. Rebecca Bialecki
reported that currently three Athol Hospital physicians have integrated it into their primary practices.
In her Medical Director role at the House of Corrections, Ruth reported that inmates there get superb
treatment by ServiceNet. The HOC does re-entry planning for relapse for tobacco and other substance abuse
and works with each person to get them whatever they need to prevent relapse from as many things as
possible. Fast track into Clean Slate, Methadone when the spots are available. They use Vivitrol – works great
for alcohol – 50% in the jail are OUIs.
4. Updates:
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Dr. Higgins gave a CHART grant update – BFMC will be able to get up to $1.8 million (three focus
areas: SBIRT, expanded access to Partial Hospitalization Unit, and a special team to closely work
with the 150 highest utilizers of the emergency department).
Newspaper Advertisement for the Safe Prescriber Pledge – coming out tomorrow, 9/12 in Recorder
and Athol Daily News
Safe Prescriber Conference on 9/25
10/5 Visit from Office of National Drug Control Policy
Alternative Pain Treatment Resource List will be available at the next meeting.
5. Set Next Meeting Date: October 16 10-12:00, Olver Transit Center
Priorities for next mtg:
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Hepatitis C issue – each costs $80-$120,000 in medication alone.
Clean Slate reports that: 25% of IV drug users get Hep C in first year. MAT can drop that to 4.5%.
Needle Exchange/Active User Engagement
Policy suggestions from ICER
Convening a meeting for local pharmacists – ideas:
o Resources available to them, handouts they could give out.
o Direct communication avenues with Clean Slate, CSAC
o Aaron thinks they would be interested in clean slate’s information on color coding of patients
o Jeanette’s data would be interesting to pharmacists, esp. the focus on the cost of the
medication, not the avoided social costs.
o Who should they call when they see a red flag with a patient?