MidMichigan healthcare workers and community leaders band together for opioid crisis

When Kathryn Tate started hearing stories from community members who had lost loved ones to the opioid epidemic, she knew this was a tragic problem that couldn’t be fixed fast enough.

In particular, the death of an 18-year-old shook her.

“When we realized were losing kids right out of high school, we knew someone needed to step in and get things moving in the right direction,” said Tate, president and CEO of the Legacy Center for Community Success. The Legacy Center helps nonprofit organizations improve outcomes and evaluations and they also provide literacy services and youth development to the community.

Kathryn Tate, president and CEO of the Legacy Center for Community Success.

In 2018, they secured a grant and partnered with MidMichigan Health to develop a training and education program for their employees. With the help of the grant funds, the Legacy Center created a coalition that paired MidMichigan Health with other local organizations throughout the community working to address the opioid epidemic. The partnership has helped formalize resources for primary care providers, engaged community education initiatives and created a consolidated effort to move toward one goal — decreasing opioid use.

“They’ve been absolutely great to work with,” says Tate of the partnership with MidMichigan Health. Tate says that they’ve been responsive to community input. “A few years ago, physicians didn’t know how to wrap their heads around it, and now other health systems are looking at what MidMichigan Health is doing.”

Tate believes the center of her work is to drive connections and forge partnerships that weren’t there before. She sees the Legacy Center as a place that can bring people together, so that those who are currently working on this issue can find new partners and understand what gaps still need to be addressed.

Dr. Madhura Mansabdar, chief clinical integration medical officer at MidMichigan Health.

Madhura Mansabdar is the chief clinical integration medical officer at MidMichigan Health, and one of those partners. Mansabdar says that at MidMichigan Health, they are well aware of the opioid crisis, both nationally and throughout the state of Michigan. According to the National Institute on Drug Abuse, there were 2,033 overdose deaths involving opioids in Michigan in 2017. This translates to a rate of 21.2 deaths per 100,000 people, which is higher than the national average.

“It’s important to make providers aware of the opioid epidemic, and equip them with resources to help patients as they transition off opioid use,” says Mansabdar, who has been with the health system for more than twenty years. In her current role, she coordinates efforts between health care providers and community partners. She, with her team, help primary care physicians understand what resources are available to them while treating patients. Before this role, she practiced as an internal medicine physician for many years.

One of the initiatives Mansabdar has worked on includes creating an educational program for primary care providers, which can help them recognize inappropriate opioid use, as well as become trained on how to use naloxone to help protect patients who might be struggling with addiction. Naloxone is a medicine used to counter the effects of opioids, especially when someone is in an emergency overdose situation.

According to the National Institute on Drug Abuse, there were 2,033 overdose deaths involving opioids in Michigan in 2017.

Some of the resources her team provides to physicians include a checklist for prescribing opioids and a pocket guide to tapering, or slowly weaning someone off opioid treatment. There are also guidelines around when to use opioid therapy for chronic pain, which remind clinicians that they should talk through the risks and benefits of opioid therapy with their patients.

“The health system has a huge role in this effort,” says Shannon Martin, a physician who oversees primary care practices at MidMichigan Health. Martin’s capstone project in graduate school was centered on education around opioid prescribing, so it is an effort she has been invested in for some time. “A lot of it is about offering resources to our patients and identifying where there’s a gap.”

In her role at the health system, Martin travels to different physician practices to get staff up to speed on the resources available and help them navigate concerns. She rotates throughout the year, visiting almost all of the MidMichigan Health locations throughout the region including Midland, Mt. Pleasant, Gratiot, Alpena, West Branch, Clare, Gladwin, Bay City, Freeland and Sanford.

According to the National Institute on Drug Abuse, there were 2,033 overdose deaths involving opioids in Michigan in 2017.

“These are open and honest conversations,” says Martin who reiterates that these discussions offer a space for providers to talk through the difficulties they are facing as a group. She says that she receives a lot of questions about tapering. “They want to know how to communicate in a way that the patient understands it is in their best interest.”

Physicians see things the patients may not see, including the side effects that are a result of opioid use and the risks of addiction. Mansabdar echoes that one of the barriers is psychological acceptance of issues related to addition in the patients, and getting them access to counseling that can help manage pain in a productive way.

“Sometimes there are very few alternatives for patients,” says Mansabdar when it comes to how to treat chronic pain. But she says that through these educational programs they are making sure physicians know what the other options are and are able to go through a detailed assessment process to know what will best suit their patients.

Kathy Dollard, director of the behavioral health service line at MidMichigan Health

Kathy Dollard, director of the behavioral health service line at MidMichigan Health, also chairs the substance use disorder and community outreach committee at MidMichigan Health. Part of the initiatives she overseas is making sure there is a good process for identifying people who have substance use disorder. Often this involves screenings at multiple touch points with the health system, including the Emergency Department, primary care physicians, and specialty care.

Another area Dollard helps educate physicians on is medication-assisted treatment. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), medication-assisted treatment is when medications along with counseling and behavioral therapy is used as the treatment approach for individuals struggling with addiction.

“We’re working on how to give providers the support they need so they feel more comfortable in providing that type of treatment,” says Dollard.

In the emergency room itself, Dr. Jeffrey Newman talks about future plans to start offering Narcan, or naloxone nasal spray, to patients who might be suffering from addiction or overdose when they come in. He serves on the MidMichigan Opioid Task Force, which was started in the spring of 2017. Dr. Newman says that the main focus of the task force is education — for physicians, nursing staff, and mid-level practitioners like physicians’ assistants.

Michigan's rate of 21.2 deaths per 100,000 people, is higher than the national average.

“It has really made a difference,” says Newman of the education he has seen around opioid use in recent years, whether through the health system or on the radio. He is the vice chair of the Emergency Department at MidMichigan Health. “In the community, people don’t want to be prescribed opioids anymore.”

Finally, Dollard references the Project ASSERT program with Ten16 Recovery Network, a partnership to help people with addiction access support and services in the Emergency Department.

Dollard hopes people both within the health care field and outside of it continue to become more aware of addiction, noting that it can impact someone from any socioeconomic group.

“It’s not discerning of one type of person,” says Dollard who has noticed that sometimes people only learn about this when a loved one is affected. “People from all types of families can have addiction happen. It’s better when you can learn about it while not currently dealing with a crisis.”