November 14, 2019 — A who’s who of Mendocino County substance abuse treatment providers gathered at the Ukiah City Conference Center this week for a two-day training about effective treatments for opioid addiction. With money coming in from the state and federal government and settlements with drug companies, some experts are optimistic that addiction medicine has a chance at getting the infrastructure, expertise, and compensation that’s found in systems of care for other types of medical conditions.
This week’s training, led by nationally renowned addiction specialist Dr. Cory Waller, was funded by a state opioid response grant, which includes a year of free training for participants to either start providing medication-assisted treatment or increase their capacity to provide the treatment to more patients. Waller reported that these medications, particularly Buprenorphine (the active ingredient in Suboxone) and Methadone, can reduce the overdose death rate by 60% in the general population, and as much as 74% in patients who have just been released from jail or prison.
Ben Anderson, a licensed clinical social worker who is the behavioral health director of the Mendocino Community Health Clinics, says the local opioid addiction problem is pretty severe. Out of 58 counties in the state, Mendocino is in the top five, per capita, for opioid overdose deaths, all drug-related deaths, and opioid-related visits to the emergency room. He’s hopeful that the training will lead to local people entering the field of addiction medicine and continuing to practice locally, where there is a severe workforce shortage at all levels. He says that, “in general, we just have a lack of resources...we don’t have a medical detox in this county.” And, while patients have access to Suboxone nearby, the closest Methadone clinic is in Santa Rosa, which presents an additional hardship for patients who often struggle financially.
Waller contends that the entire field of addiction medicine needs to be more attractive and more systematic in its approach. Waller is a principal with Health Management Associates, a consulting firm that’s focused on systems of care provided by government-funded insurance. During his presentation, he spoke about the treatment cardiology patients can expect: algorighmically-informed tests, procedures, and followup appointments with specialists whose focus is sometimes narrowed down to left or right ventricular failure. But addiction, which is more pervasive than ever, with patients now aging into MediCare, is still what he dubbed a “martyr-based system of care.” When Waller switched from being an emergency room doctor to practicing the far more complex addiction medicine, he says he took a 30% pay cut.
The good news now, Waller belives, is that money and data are now available to start working toward creating an effective system. But, “the biggest gap,” he adds, “is not necessarily the technical aspects or the business aspects. It’s the hearts and mind piece where people are letting belief get in front of the science...This doesn’t happen unless the community is on board.”