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On track for 570 opiate deaths in 2016, Erie County steps up response

Fatal heroin and opiate overdoses are on pace to double from last year, and if the pattern holds, as many as 570 people in Erie County will die in the epidemic this year.

Eleven people are dying from suspected opiate overdoses each week so far in 2016, county experts say.

The death toll is prompting health care and Erie County officials to take steps to offer assistance to the addicted. Their goals are to build up the treatment infrastructure that is overwhelmed and to find more addiction doctors and counselors. Too much delay is occurring in treatment services, according to County Executive Mark C. Poloncarz and key members of his administration.

Atop of their list is a telephone hotline to connect addicts with treatment services and to increase Health Department staffing for programs addressing the epidemic.

Other steps are aimed at doctors also are in the works:

• Training more local doctors in how to provide medications to treat addicts.

• Teaching physicians on how to screen individuals, particularly young people, who may be at risk of becoming addicted to prescription opioid painkillers.

• Forging relationships between primary care providers and addiction treatment specialists.

The need for more physicians and other specialists trained to deal with addictions is acute, according to Dr. Richard D. Blondell, a professor of family medicine at the University at Buffalo and vice chairman for addiction medicine.

There are 15 board-certified addiction specialists in the area, Blondell said, but “two times that number is needed.”

“You need a workforce of experts to take care of patients, train medical students and help educate community physicians,” he said.

Experts in the treatment community say the county’s efforts cannot come fast enough.

“I just sent a father with his addicted 18-year-old son to Terrace House for detox and they said, ‘You can’t come here without a referral.’ So they went to Erie County Medical Center for detox and sat for hours,” said Karleen Bordonaro, a certified drug counselor who serves at Drug Court in Amherst.

“At that point, the son, who is a heroin user, started to become very sick from the withdrawal and talked his dad into leaving. The son said, ‘I’ll only use a little so that I won’t be sick.’ ”

Delays in receiving treatment could be avoided with a hotline whose counselors would be able to quickly connect those individuals and their family members with treatment facilities, county Mental Health Commissioner Michael R. Ranney said.

“The hotline would be a hub, a feeder to providers. People suffering from addiction, their loved ones, law enforcement, hospital emergency room departments and residents would be using it,” Ranney said.

Focus on hotline, training

Ranney and county Health Commissioner Gale R. Burstein are scheduled to meet Thursday morning with members of the County Legislature’s Health and Human Services Committee to discuss funding the hotline at a cost of $301,467.

If the full Legislature approves, a contract with Crisis Services would be expanded. That organization already has a contract to operates the county’s suicide-prevention hotline.

“The beauty of the drug hotline is that it will be available 24/7. There will be follow-up when a referral is made to a treatment facility by Crisis Services. It won’t just be anyone calling the treatment provider,” Burstein said of the five full-time staff members who would operate the hotline under the guidance of a supervisor.

Hotline counselors would also connect people seeking help to “angels,” volunteers who work with local police departments, she said. Those volunteers, when available, will be sent to make the initial contact with addicts and their loved ones to help guide them into treatment.

“Now, if you go to an emergency room department, you may or may not get information and treatment, and these individuals may not have the self efficacy to navigate the system. But a call to the hotline will facilitate treatment,” Burstein said.

Those who are saved by Narcan, the opiate antidote, and released from emergency rooms often have a false sense of security and return to the streets in search of more drugs as they experience withdrawal symptoms, Bordonaro said. Linking them quickly to treatment by way of the hotline could prove a lifesaver, she said.

Of the concern that Terrace House is turning away individuals, Anne D. Constantino, executive director of Horizons, which operates the downtown facility, recommended that addicts and their loved ones call ahead “so that they can be better advised and informed on the next step.”

The proposed hotline would go a long way toward addressing that situation, she said.

“It is essential to get a phone number in our community that families can call, a local resource, that understands our local system of care and links for immediate resources,” Constantino said. “We’ve been waiting and wanting this.”

More doctors are needed for treatment to help bring the opiate epidemic under control, Burstein said.

“The demand for medication-assisted treatment is far greater than our county’s capacity. We need more methadone clinics, doctors who are certified to prescribe buprenorphine to treat addiction and education on other medications such as a monthly injection of naltrexone that stops opiate cravings and causes sickness if opiates are taken,” Burstein said.

Certification for physicians

To that end, the health commissioner said, a free, 8-hour certification course for physicians to prescribe buprenorphine, also known as Suboxone, is scheduled for Sept. 10 at the Catholic Health System’s offices, 144 Genesee St. Registration information can be obtained by calling 858-6976.

Sessions to explain how naltrexone and other medications work and how to spot signs of addiction among pain medication patients, including adolescents, and instruction on acute pain management are also being planned for the coming months.

While these are viewed as positive steps, one local addiction specialist cited several hurdles to ensuring that enough physicians are available to treat addiction.

“They want to get family doctors to do addiction work on the side. I say to take care of addiction, you need more than an 8-hour course. Anyone familiar with alcohol and addiction problems knows that it is complicated,” Blondell said.

Alcohol and drug addiction affects 1 in 12 adults, according to a study by the National Council on Alcoholism and Drug Dependence. That figure could be applied to this area with reasonable certainty, experts said.

With a shortage of primary care physicians who are already overworked, Blondell said, it might be difficult to attract those doctors to take the certification course.

A rigorous response similar to when the AIDS epidemic struck is needed, Blondell said, including a financial commitment for research and to train more doctors in addiction medicine.

But with addiction medicine at the low end of pay among medical specialties and its patient population known for presenting “difficult problems,” it can be challenging to attract doctors into that specialty, Blondell said.

“You have to accept failure as part of the job. But every once in a while you make a hit. Their lives do a 180-degree turnaround and it is very gratifying,” Blondell said of the work.

The training planned for primary care doctors includes linking them up with addiction specialists “who will serve as mentors and start the patients on Suboxone while weaning them off opiates, the most challenging part of the treatment,” Burstein said.

Striving for coordination

Health insurers also need to do their part in making access to treatment less cumbersome, Ranney and Burstein said.

“Work needs to be done with insurers to make sure different treatment options are covered,” Ranney said.

“And,” Burstein said, “that it is not such an onerous process for health care providers to grant approvals.”

This includes providing long-term treatment for addicts at extended-care facilities where they can reside for months at a time as they learn ways to live without drugs, Ranney said.

Burstein added that inpatient care is not always the answer, explaining that a combination of medication and outpatient treatment can reap successful outcomes given that these people seeking recovery need to learn to live in the communities where they reside. In addition, Burstein said, she is working with health insurance companies “so that we can all be on the same page” when it comes to addiction prevention.

Besides a hotline, there is also an “urgent need” to hire a public health educator and an account clerk at a cost of $74,128, Poloncarz said.

“Currently, a single medical care administrator in the Erie County Health Department is coordinating a preponderance of opioid epidemic activities,” he said.

The Health and Human Services Committee will address staffing and hotline requests at 9:45 a.m. Thursday.