​ With so much discussion across the country over what to do about the opioid crisis, Jowanna Lunsford, senior clinical liaison and business development for Ohio-based Atlas Healthcare Solutions, says having a strategy to care for those with drug addictions involves a lot more than treating the addiction; it encompasses business and clinical factors.
Juwanna LunsfordShe recognizes that while her provider is active in partnering for the care of patients with opioid and other substance addictions, others are not equipped to deal with the challenges involved. But, even as Atlas works in the addiction space, changes to regulations and improved reimbursement for treating patients with an opioid addiction could help. Lunsford says the main roadblock on the regulatory front is that nursing facility licensures and federal regulations are written to deal with an elderly population.

“With this need coming on the scene we’ve found it makes it very difficult within the confines of the current licensure and regulations. The treatment setting for these patients becomes an issue,” she says. “We have yet to see the regulations flexible enough to care for the increased demand caused by the opioid epidemic.”

Staffing, Services Must Be Specialized

When talking about what happens inside a facility caring for people with addictions, Lunsford says nursing staff must be educated, trained, and competent to deal with this “new wave” in health care. Addiction programs, combined with medical care, are a must in order to treat the “whole” person, as Atlas is trying out with its CMAT pilot, which stands for Collaborative Medical and Addiction Treatment.

The list of services for those residents with an opioid addiction can involve individual or group counseling, medication management, case management, potential psychiatric treatment, therapies, medical assessment, medical detox, and community resource connection, which “are all important components to empowering patients to start or continue a recovery journey,” she says. “Our job is to treat both their medical needs and their addiction in order to stop this cycle.”

The Certification Element

There must be specially trained doctors and staff to handle the opioid-addicted population, which Atlas does under CMAT and its collaboration with Quinton Moss, MD, and Modern Psychiatry & Wellness.

“That is why it is important to partner with a physician who is sensitive to these needs and who can prescribe to those needs,” Lunsford says. “Dr. Moss has a level of certification that allows him to prescribe the meds the patients may need. If we are dealing with methadone for instance. If delivered for pain, then the nursing facility can deliver, but for addiction they cannot, they have to go offsite.”

With these regulations in place, there are certain needs that accompany them. “We have to provide transportation to get to the nearest center that can deliver that medication, which may be 50 minutes away. And, it prevents us from being able to provide that care,” she says.

PICC Lines Are a Challenge

The opioid epidemic has brought a different level of service requirement, because most times those that come to the skilled setting do so with PICC lines inserted from the hospital, which demands a different level of care and has inherent risks, Lunsford says.

PICC refers to Peripherally Inserted Central Catheter, a thin, soft plastic tube akin to an intravenous (IV) line that allows an individual to receive medicines and fluids.

“Because intravenous use is for some of them one of their downfalls, we have to protect them, we have to keep them safe. And, we have to be willing to get services to keep them safe, and without a CMAT program it becomes more difficult,” she says.

And, there is always the threat of failure. “If [opioid] cravings pop up and the resident decides to leave against medical advice, we have to be able to pull that PICC line,” Lunsford says.

But, with CMAT and the total treatment plan there is hope to not only keep patients with addictions safely in the facility but to have them improve and be returned to the community to continue their recovery.

“With Dr. Moss and the fact our onsite licensed addiction expert is in the day they are admitted, or within 24 hours of being admitted, we are immediately addressing the addiction need, which is 50 percent of what is going on,” she says.

Where facilities fail is when the whole person is not addressed. “Yes, this is a different population than nursing homes are used to dealing with,” Lunsford says. “As caregivers we have to meet a patient’s need and meet treatment demands. We must be part of the solution to overcome the epidemic.”