'Changing the picture of addiction'
The young woman had already overdosed three times the week Sandy Brekke met her and heard her story. She had experienced abuse, family addiction, homelessness and abandonment. And after hip surgery in her 20s, she found relief with opioids, drugs that eased her physical pain, along with the emotional pain she had been carrying.
When her prescription stopped, she turned to the street for drugs. She tried unsuccessfully to quit using on her own. She desperately did not want to be addicted.
"Nobody grows up and says, 'I want to be an addict.' When she was hurting, opioids were the thing that took the pain away," Sandy remembers.
While this woman continues to struggle with addiction, Sandy, a senior consultant with the Gundersen Health System Office of Population Health, and more than 100 community members in the Alliance to HEAL (Halting the Effects of Addiction Locally) are working to cut the supply of drugs in the area and show people that life is better without drugs.
Health systems, small non-profits, private businesses, law enforcement, school districts, local elected officials and many more are part of the Alliance to HEAL. The Alliance is focused on four goals: 1) decreasing the supply of opioids; 2) increasing the number of people in treatment; 3) decreasing the fatal overdose rate; and 4) decreasing the non-fatal overdose rate.
Early success is encouraging:
- La Crosse County reported two fatal overdose deaths in 2018, down from 19 in 2016.
- The Alliance has a goal to cut the time it takes to get someone into a treatment program from 30 days or more to 24 hours
"This issue affects all of us on some level," Sandy says. "Changing the picture of addiction is the call for the community to raise awareness and help people struggling with addiction."
Progress at Gundersen
"As clinicians and as a system, we feel a sense of responsibility because, for better or worse, we contributed to this opioid epidemic by virtue of things that happened in the 1990s," says Marilu Bintz, MD, MBA, Chief Population Health Officer, Gundersen Health System. "Pain was classified as a vital sign and, frankly, patients were being judged or evaluated based on how well they were relieved of pain. That really contributed to the opioid epidemic."
This epidemic impacts patients of all ages and from all walks of life. Gundersen clinicians and frontline clinical staff are staying updated on internal and external pain management guidelines and best practices. Their efforts are making an impact. The number of opioids prescribed system wide at Gundersen dropped 31 percent in 2018; pills per prescription decreased 26 percent.
"The data that we've created is not just for folks on the Gundersen La Crosse Campus. It's data for the prescribers across our entire system," Dr. Bintz says. "Our regional clinics are taking up the banner of decreasing their opioid prescribing habits as well. We're helping prescribers understand how their prescribing habits compare to a partner's prescribing habits and whether there is there an opportunity for education where alternatives to opioids might be used to diminish the likelihood of substance use disorder in patients. This is a system wide effort."
Alliance to HEAL in Action
During conversations, huge gaps in treatment were identified by Alliance to HEAL members. 100 people who had gone through treatment locally were surveyed, and it was found the average length of time to get into treatment was 30 days.
"Research shows you have to have someone in treatment within 24 hours for it to be effective," Brekke says. "There is a group within the Alliance to HEAL that is working on how to get people into treatment more rapidly, and how standardized patient assessments across all community stakeholders can help reach the goal."
Other work in The Alliance is examining the distance some patients have to travel to receive treatment.
"We're currently sending some people two hours away to get treatment," Brekke says. "Alliance to HEAL members are creating a business plan for a local treatment facility that will address initial treatment through follow up treatment five to 10 years in the future. In the meantime, how do we fill the gaps? Who can treat patients? This is what the Alliance to HEAL is trying to figure out."
The Alliance to HEAL is also implementing innovative practices created from community stakeholder conversations and connections.
"We have nine work groups working to change how everything is done in the community," Brekke says. "One of our work groups is now having police officers and social workers go along on mobile meals rounds to collect unused prescription drugs. There have been massive amounts of medications collected from these homes, and this work is now being replicated across Wisconsin. This happened because we had everyone at the table talking about solutions."
Watch the WXOW "Hooked to Heal" half-hour special.