Could early referrals to addiction specialists slow the opioid crisis?

When Gov. Dannel P. Malloy last year signed into law a comprehensive bill targeting opioid addiction, many touted it as one of the toughest in the nation, often pointing to the seven-day cap on opioid prescriptions and new prescription monitoring requirements as reasons why.

But a lesser known aspect of the law is one that fosters a new relationship between primary care providers and licensed alcohol and drug counselors, or LADCs.

In essence, the law encourages primary care providers to keep an eye out for signs their patients may be becoming dependent on opioids. An example, according to Connecticut Association for Addiction Professionals President Susan Campion, is a patient who, not long after coming in with one injury, quickly returns with another.

If the provider suspects an addiction is developing, he or she can refer the patient to an LADC, who will follow steps outlined in Section 6 of the law by gleaning information about the person’s family and personal history of addiction and determining how likely he or she is to abuse drugs prescribed for pain.

Using a standardized consultation report, the LADC then will make a recommendation to the primary care provider, which could be anything from suggesting the patient be tapered off opioids or be sent straight into treatment. Importantly, Campion said, the LADC also could weed out people legitimately using prescriptions for long-term pain, who lately have had issues accessing their medications.

The bill, Campion pointed out, doesn’t ask loaded-down physicians to do evaluations themselves, and it leaves them with discretion over what’s best for their patients.

Still, Campion knows the conversation about possible addiction is one many physicians and patients don't want to have.

If a doctor says to a patient, “We have a new resource, which is a referral to an LADC, immediately (the patient) is going to say, ‘What? I don’t need that.’”

But Campion said most people struggling with addiction know they have a problem and ultimately will agree to see the LADC.

She cited an attorney she once had as a client as an example. He was furious, Campion said, that his doctor sent him away when his medications for high blood pressure weren’t working properly.

But after spending time with Campion, the client felt comfortable enough to admit to her he was struggling with alcohol use.

“It’s a learning curve,” Campion said of doctors referring patients to LADCs. “The doctors are going to have to find their comfort zone in having these conversations.”

Ken Ferrucci, senior vice president of government affairs with the Connecticut State Medical Society, said his group supports the LADC option because it’s another tool physicians can use to help their patients.

The medical society, Ferrucci said, hasn’t spent a lot of time promoting the tool, largely because it has been working overtime to get other aspects of the new law up and running smoothly. But he has been in contact with Campion about endeavors they could tackle in the future to help educate physicians about it.

“We are more than willing to continue to work with Susan’s group to do what we can to make sure people have access to care that’s as appropriate as possible,” he said.

Campion said the legislation also is a step toward heeding the words of U.S. Surgeon General Vivek H. Murthy. In a report released last year, he said addiction is a chronic illness and urged those in the medical field to help all citizens understand it as that.

Intervening early in someone’s addiction, Campion explained, is no different from placing someone with glucose level issues on a certain diet and referring them to an endocrinologist.

State Rep. Sean Scanlon, D-Guilford, said he’s a strong proponent of the law, parts of which he worked on.

He said an important aspect of it is that enhanced communication between addiction specialists and doctors should result in less runaround for patients.

“As a general rule in health care, it’s always more efficient for everyone to be talking,” Scanlon said. “It saves us money long term and dramatically reduces the possibility that somebody walks away from getting help because they’re frustrated.”

Campion said some doctors already have been referring patients to LADCs, but she’s hoping the new legislation brings more on board.

Blame for the growing opioid epidemic, she said, regularly is placed on doctors. Doctors, following directives handed down in the late 1990s, went above and beyond to ensure their patients weren’t in pain, even if it meant prescribing dozens of opioid pills to one patient. If they take advantage of preventative steps like LADC referrals, Campion said, doctors also can take some credit when the crisis slows in the future.

She said the Connecticut Association for Addiction Professionals will be hosting community forums in the coming months in places including Torrington and Coventry to enlighten the public about the LADC option.

Campion realizes the intent of the legislation could hit a snag when LADCs refer patients to treatment beds, but the treatment beds aren’t available. She knows, too, that Connecticut’s continuing budget issues only complicate that problem.

But the point, she said, is to get help for people before they’re so dependent they have little choice but to go on a medication-assisted treatment like methadone or Suboxone.

“It’s a smart, pragmatic and most of all humane way to do it,” Campion said.


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