To understand of the public health dangers of one individual with an opioid addiction, look no farther than Austin, Ind.
The small community less than 40 miles north of Louisville recently experienced a spike in users who inject an opiate called Opana. One of those addicts was HIV positive.
Within a few months, more than 180 people in the town of 4,000 tested positive for HIV. Hundreds more had contracted Hepatitis C, another blood-borne disease – all because of addicts sharing used needles.
Now, the Centers for Disease Control says 220 counties across the United States are at high risk of experiencing a similar outbreak of HIV and Hepatitis C.
And 54 of those counties are in Kentucky.
Scott Hesseltine, vice president of addiction services at Seven Counties Services in Louisville, appeared on KET’s Connections to discuss the state’s drug problem and new approaches to treating those with a chemical dependency. The conversation is part of KET’s year-long initiative, Inside Opioid Addiction.
“We are in the midst of a tragic public health crisis and it’s claiming the lives of our citizens at astronomical rates,” Hesseltine says.
In 2013, Kentucky was third in nation for drug overdose deaths. Hesseltine says the numbers weren’t much better in 2014 when 1,034 Kentuckians died of an overdose.
In 2015, the state legislature responded with Senate Bill 192, which created a number of initiatives to stem opioid-based abuse and trafficking in the commonwealth. One key facet allows local communities to establish syringe-exchange programs so that intravenous drug users can trade in used needles for clean ones. Hesseltine says the programs have proven effective at limiting the spread of blood-borne diseases in the way that Austin, Ind., has experienced.
“The intent for a syringe-exchange program is to have someone use a clean needle every time they inject drugs,” says Hesseltine.
So far, four Kentucky counties have implemented needle exchange programs: Fayette, Grant, Jefferson, and Pendleton Counties. But the exchanges are not without controversy. Some lawmakers oppose the programs because they contend they facilitate addictive behaviors. Others have criticized the programs for handing out more needles than are turned in by users.
Hesseltine says a strict one-to-one exchange misses the larger public health goals of addressing the opioid epidemic. He says that drug users who participate in the exchanges are five times more likely to enter treatment for their addiction.
“Any avenue to slow the spread of disease and to help more people find the solution in recovery is a positive thing,” Hesseltine says.
Developing a New Philosophy for Treatment
Hesseltine first saw the surge in opioid addiction at his previous job with the Hazelden Betty Ford Foundation. He says not only were more people seeking treatment for an opioid-use problem, but the patients were getting younger and presenting with more health problems and greater functional impairments.
In 2012, the foundation’s chief medical officer, Dr. Marvin Seppala, tapped Hesseltine to help develop what was then a radical new approach to treating opioid abuse.
“He was proposing that we do everything possible to treat not only the psychological, social, and spiritual aspects of addiction but the biological aspects as well,” Hesseltine says.
The new strategy would blend abstinence and 12-step counseling with medicines to help patients wean themselves from their opioid addiction and combat the side effects of detoxification.
“It has to be done appropriately so we’re helping to stabilize someone from the biological symptoms of addiction so they can then engage in the recovery process,” says Hesseltine. “We’re looking at discontinuation of the medicine as the goal once someone is stabilized and established in recovery.”
That framework is what Seven Counties Services uses in its addiction treatment program. Hesseltine says they employ medications like Suboxone and Vivitrol to help clients break their addiction over a period of 12 to 18 months.
Critics argue that medically assisted treatments allow patients to substitute one drug addiction for another. But Hesseltine contends the drugs help keep clients alive and on a path to recovery. He says treatment at Seven Counties is highly structured and emphasizes client accountability. If one approach doesn’t work, Hesseltine says counselors try to intervene as soon as possible to develop a new plan for that particular patient.
Helping Mothers and Their Newborns
Seven Counties provides a range of mental health services to primarily low-income populations in Jefferson, Shelby, Henry, Oldham, Trimble, Spencer and Bullitt Counties. A new facility the nonprofit recently opened in Shelbyville will provide residential treatment and support to pregnant women who have an opioid use disorder.
The goal, according to Hesseltine, is to bring women into the 10-bed facility as soon as they know they are pregnant and work with them over a six- to 12-month period to address their addiction. He says support services will continue even after the mother and her baby return home to ensure that there’s a safe plan of care during the first months of the woman’s recovery from addiction. Finally, the program also includes guidance from neonatologists who can help treat babies born with drug dependency issues they acquired from their mothers.
As state and federal lawmakers consider new drug policies, Hesseltine says he hopes Medicaid officials will change rules that currently prevent larger facilities from being reimbursed for residential treatment services. Until then, Hesseltine says policymakers, health care providers, and treatment advocates will have to find additional ways to help the thousands of people with drug problems.
“It is a chronic disease that can be put into remission with structure, support, accountability and behavioral interventions,” Hesseltine says. “There’s always place for residential [treatment] and detox, but we need to be creative in looking at how we can provide the least restrictive, highest level of care for people where they live.”