“One of the most stigmatizing groups is the medical profession,” said Dr. Brian O'Connor, founder of Middlesex Recovery, a treatment center located about 9 miles north of Boston.
An OB-GYN by training, O'Connor began working in addiction recovery when he discovered in 2005 his son was using heroin. O'Connor got certified to prescribe the medication-assisted treatments methadone and buprenorphine after a number of his obstetrics patients began having addiction issues. “Because it's so pervasive, and it touches so many peoples' lives, I think they see it from a different perspective rather than thinking it is somebody else's problem.”
O'Connor estimated up to 99% of the 1,000 patients who visit his treatment center are white, middle class, and from the Boston suburbs. He said providers in these areas have gotten more accustomed to dealing with issues related to addiction as the number of patients presenting such problems increased.
“It's not new in suburban areas—it's been present here, but it truly popped up in the urban areas first and then made its way here,” said Laura Balsamini, director of pharmacy services for Summit Medical Group, a large physician-owned practice in suburban New Jersey. “Now we're on a level playing ground, only they may have paved the way with some of the strategies on how to combat it prior to us, and now we're catching up.”
Suburban providers have some advantages in treating substance abusers. Their patients are generally better educated and more aware of the dangers posed by addiction to prescription opioids. As a result, addicted suburbanites are more likely to recover than those in more impoverished areas where resources for treatment are scarcer and adherence to program treatment harder to achieve.
“Suburban people on average have more resources to respond to the problem than rural people,” said Dr. Keith Humphreys, professor of psychiatry at Stanford University's School of Medicine and a former senior policy adviser to the White House Office of National Drug Control Policy. “They tend to be more educated, have better jobs and live closer to more healthcare professionals than rural people. This extra capital makes them more likely to recover from their addiction.”
But the stigma associated with addiction may still cause suburbanites to believe that drug abuse is something that happens somewhere else. “If they believe that addiction 'can't happen here', they will neglect to screen their patients for substance use as they should and respond appropriately to addiction when they detect it,” Humphreys said.
For a suburban provider, such a belief could cause them to fail to establish system measures that would improve prevention and treatment efforts. “A lot of hospitals could be doing a lot more and they're not,” said Aaron Weiner, director of addiction services at Linden Oaks Behavioral Health, the mental health and substance abuse treatment arm of the Edwards-Elmhurst Health system in Naperville, which, like Advocate Good Samaritan, is in DuPage County just west of Chicago.
Linden Oaks is developing drug prevention and treatment standards for the system. Last year, Linden Oaks launched an opioid task force that focused on changing prescribing habits, increasing education on addiction, reorganizing a pain clinic and expanding addiction treatment resources.
The task force recommended physicians use the state's prescription-drug-monitoring program. Linden Oaks incorporated an alert system in a patient's electronic medical record to let prescribers know if a patient has a history of seeking drugs. It also included a prescription for naloxone, an overdose-reversal drug, with every opioid prescription doctors wrote. “Treating the afflicted is one part of the epidemic, but the other part is containing the outbreak,” Weiner said.
Only 15% of the patients who come to the detox unit at Good Samaritan each month go on to get addiction treatment, a statistic that is both frustrating and gives hope, Fergle said. The unit works closely with local rehabilitation centers and 12-step programs, whose members volunteer their time with visits to the hospital at least once a week.
Patients who refuse to go directly into treatment from the detox unit are given the option of working with a community liaison specialist, who follows up with phone calls and one-on-one visits after discharge. The idea behind the program, according to Royal Mayer, one of those specialists, is to try to establish a relationship of trust with the patient that will hopefully help persuade them to seek treatment down the road.
“For me, it's just like baby steps,” Mayer said. “This population is so difficult that you just have to be patient and keep giving them chances.”
The program's successes prompted the hospital to increase the unit's inpatient beds to 14 by October. The model has even caught the attention of two other Advocate hospitals, who are considering developing similar units at their facilities.
“It's exciting when you can get those success stories,” Fergle said. “That's lifesaving, getting people into treatment.”