Revolutionizing Opioid Addiction Management with Medication-Assisted Treatment

Sarah S. Kawasaki, MDBy Sarah S. Kawasaki, M.D.
Pennsylvania Psychiatric Institute

PPI is helping to revolutionize management and treatment for patients who have opioid use disorders through its new Advancement in Recovery (AIR) Program / Opioid Treatment Program. The program recognizes medication-assisted treatment as the gold standard of care and provides a way to fast-track people who have an opioid use disorder into treatment. In addition, PPI is one of four Pennsylvania providers that has received a $1 million PA State grant to establish an innovative “hub-and-spoke” model of care to improve access to treatment for patients who have opioid use disorders and for providers who provide services to these patients.

Together these steps are helping PPI lead Pennsylvania’s charge to stem the opioid epidemic and to prevent deaths from overdose. In Pennsylvania this public health crisis affects people of all ages and incomes in cities as well as rural communities. In 2016, there were 4,642 deaths, approximately 13 people per day, due to drug-related overdose in the Commonwealth: A 37 percent increase from the previous year.

PPI’s AIR program opened in November 2017, and more than 270 patients are receiving treatment at the clinic. Many other patients have been directed to the most appropriate resources for their care. Dr. Sarah Kawasaki, an internist and addiction medicine specialist at Penn State Health Milton S. Hershey Medical Center and PPI, leads the team of medical doctors and clinicians assisting patients dealing with opioid use disorders.

Through the clinic, caregivers support patients as they transition to buprenorphine, methadone, and Vivitrol (naltrexone for extended-release injectable suspension) using a step-wise treatment approach similar to what is used for chronic illnesses like diabetes and cancer. The patients and their caregivers work together to develop treatment and intervention plans based on the severity of the patient’s opioid use disorder.
Through the PA State grant, a progressive model of care is being developed to make it simpler and faster for anyone from any health care setting or socioeconomic background to access high-quality treatment, stay in treatment, and stay alive.

In the model, PPI is a resource for primary care practices and community clinics from its seven county service area. Dr. Kawasaki provides guidance and support to primary care physicians so they can render direct patient care including prescriptions for medication-assisted treatment. Through this comprehensive approach patients are also connected to drug and alcohol counseling in their communities and have access to resources for case management and legal services through PPI.

By connecting primary care practices and clinics with PPI services we are providing more patients with lifesaving treatments and ongoing support to restore their dignity and help them become productive members of society.

As Pennsylvania declares the heroin and opioid epidemic a “statewide disaster emergency,” PPI is proud to be leading a change in the way opioid use disorders are treated in the region and to be a conduit that makes treatment accessible when and where it is needed. You can find more about PPI’s AIR Program click here.

First 100 Days: Leading the Region with Excellent Behavioral Healthcare

Elisabeth Kunkel, MD, Chief Medical OfficerBy Elisabeth Kunkel, MD
Chief Medical Officer
Pennsylvania Psychiatric Institute

At the end of March 2017, I became Chief Medical Officer for the Pennsylvania Psychiatric Institute (PPI). After spending 28 years at Thomas Jefferson University in Philadelphia, where I served as Vice Chair for Clinical Affairs 2002-2017, I saw an opportunity to help PPI grow in its clinical services and partnerships to improve access to care and meet the behavioral health care needs of Central Pennsylvania with evidence-based, targeted programming.

PPI is a unique behavioral health provider because of its connection with a nationally recognized academic medical center. Through Penn State University and the Milton S Hershey Medical Center our clinicians are attuned to emerging research which advances our understanding of how and why psychiatric illnesses develop and can best be treated. As a result, PPI’s programs and services are always based on research and evidence-based models of care.

We are equipped to serve patients of all ages, from four years and up, and at all stages of their diagnosis and treatment. Patients can be seen in outpatient settings, and if they require higher levels of care, can be moved to treatment in inpatient or partial hospitalization programs. A new inpatient unit specifically created for children was opened in the spring, 2017. Planning for an outpatient opioid treatment program (OTP) was well underway when I arrived, and a ribbon-cutting ceremony to open the OTP is planned for November 17, 2017. Under the leadership of Dr. Sarah Kawasaki, PPI and Penn State Health received a $1 million state grant to do coordinated medication assisted treatment for opioid patients. We were delighted to host Governor Tom Wolf and other colleagues from the PA state legislature including Jennifer Smith, Teresa Miller, Dr. Rachel Levine, Dr Erika Saunders, Dr. Craig Hillemeier, and Dr. T. Wolpaw on October 17 to celebrate this award.

My initial assessment of PPI revealed many strengths. We have a strong leadership team, skilled clinical providers and a diverse mix of clinical programs. We also have excellent potential to continue development of both education and research programs. My role in these first 100 days has been to enact changes that will assure continued excellence and growth to meet the region’s behavioral health needs by bolstering administration, clinical and quality standards as well as programming for education and research. Here is a sampling of steps we have taken:

Administration

  • Standardizing clinical and quality operations
  • Strengthened the recruitment and retention practices

Clinical operations

  • Revamped provider performance evaluations
  • Appointed service line medical directors for the child and adult service lines
  • Instituted additional training for care providers
  • Revised and standardized policies for medications and appointment scheduling
  • Implemented procedures for suicide assessment and risk-based interventions
  • Improved IT interfaces between Pinnacle, PSU HMC and PPI to improve access to the patient’s past medical history

Education

  • Completed a needs assessment of faculty interest in various teaching opportunities
  • Established a Public and Community Psychiatry Fellowship Program Director and began the planning for the Fellowship

Research

  • Applied for grants to support clinical trials of medication safety
  • Reactivated research committee at PPI

These are just a few of the highlights. We’ve taken great strides in these first few months with overwhelming support from our providers, staff, and community partners. PPI is a great foundation that allows us to expand upon, improving access and provision of excellent behavioral health care to our communities, while positioning PPI as an academic flagship for HMC’s Department of Psychiatry and the region’s behavioral health providers. In future columns, I’ll delve more deeply into some of the above initiatives and expand on other future plans that are already in motion.

Substance Use and a Pandemic

From WITF:

Amid the COVID-19 pandemic, Americans are also facing a substance use crisis. According to the Centers for Disease Control, the pandemic has prompted more people to start or increase use of a substance as a way of coping with the stress. Overdose deaths have also spiked since the start of the pandemic.

See the video on WITF’s website: https://video.witf.org/video/substance-use-and-a-pandemic-3mabnk/

Women who Achieve: NASA Trailblazers Katherine Johnson, Dorothy Vaughan and Mary Jackson

This year for Women’s History Month, we are highlighting different women each week who, although you may have not heard of previously, have contributed greatly to society.

This week we are shining light on Katherine Johnson, Dorothy Vaughan and Mary Jackson, three women who played a vital role in advancing NASA’s missions. These African American women computers played a vital role in 1962, when they helped send the first American astronaut into orbit, John Glenn. You may have heard about their story from the 2016 film Hidden Figures.

Katherine Johnson. Credit: NASA

Katherine Johnson was born on Aug. 26, 1918 in White Sulphur Springs, WV. Her brilliance with numbers shone early on and vaulted her ahead several grades in school, and by 13, she was attending high school. At 18, she enrolled in the historically black West Virginia State College, where she graduated with highest honors in 1937 and took a job teaching at a black public school in Virginia. She left her teaching job and enrolled in the graduate math program in 1939. Katherine was one of the three black students handpicked to integrate West Virginia’s graduate schools. At the end of the first session, however, she decided to leave school to start a family with her first husband, James Goble.

It wasn’t until 1952 that she heard about open positions at the all-black West Area Computing section at the National Advisory Committee for Aeronautics’ (NACA’s) Langley laboratory, headed by fellow West Virginian Dorothy Vaughan. Katherine and her husband moved to Virginia to pursue the opportunity, where Katherine spent the next four years analyzing data from flight tests until her husband died of cancer in December 1956.

The 1957 launch of the Soviet satellite Sputnik changed history—and her life. She worked on and published several papers with engineers that formed the core of the Space Task Group, the NACA’s (later becoming NASA in 1958) first official foray into space travel.
In 1962, as NASA prepared for the orbital mission of John Glenn, Katherine was called upon to do the work that she would become most known for. As a part of the preflight checklist, Glenn asked engineers to “get the girl”—Katherine Johnson—to run the same numbers through the same equations that had been programmed into the computer, but by hand. “If she says they’re good,’” Katherine remembers the astronaut saying, “then I’m ready to go.” The flight was a success and marked a turning point in the competition between the United States and the Soviet Union in space.
Katherine retired in 1986, after 33 years at Langley. “I loved going to work every single day,” she said. In 2015, at age 97, President Barack Obama awarded her the Presidential Medal of Freedom, America’s highest civilian honor. She died on Feb. 24, 2020, at 101 years old – an American hero who’s pioneering legacy will never be forgotten.

Dorothy Vaughan. Courtesy Vaughan Family

Born Sept.20, 1910, in Kansas City, MO. those who speak of NASA’s pionefers rarely mention the name Dorothy Vaughan, but as the head of the National Advisory Committee for Aeronautics’ (NACA’s) segregated West Area Computing Unit from 1949 until 1958, Vaughan was both a respected mathematician and NASA’s first African American manager.

Dorothy Vaughan came to the Langley Memorial Aeronautical Laboratory in 1943, during the height of World War II, leaving her position as the math teacher at Robert Russa Moton High School in Farmville, VA to take what she believed would be a temporary war job. Two years after President Roosevelt signed Executive Order 8802 into law, prohibiting racial, religious and ethnic discrimination in the country’s defense industry, the Laboratory began hiring black women to meet the skyrocketing demand for processing aeronautical research data.

Dorothy Vaughan was assigned to the segregated “West Area Computing” unit, an all-black group of female mathematicians. Over time, both individually and as a group, the West Computers distinguished themselves with contributions to virtually every area of research at Langley.

Dorothy Vaughan helmed West Computing for nearly a decade. In 1958, when the NACA made the transition to NASA, segregated facilities, including the West Computing office, were abolished. Dorothy Vaughan and many of the former West Computers joined the new Analysis and Computation Division, a racially and gender-integrated group on the frontier of electronic computing.

Retiring from NASA in 1971, her legacy lives on in the successful careers of notable West Computing alumni, including Mary Jackson, Katherine Johnson, Eunice Smith and Kathryn Peddrew, and the achievements of second-generation mathematicians and engineers such as Dr. Christine Darden.

Mary Jackson. Credit: NASA

Last, but certainly not least, is Mary Jackson. Born April 9, 1921, Mary grew up in Hampton, VA. After graduating with highest honors from high school, she then continued her education at Hampton Institute, earning her Bachelor of Science Degrees in Mathematics and Physical Science.

Mary’s path to an engineering career at NASA took several turns. After graduating she was a math teacher at a black school in Maryland. After a year of teaching, Mary returned home, finding a position as the receptionist at the USO Club, as a bookkeeper in Hampton Institute’s Health Department, a stint at home following the birth of her son, Levi, and a job as an Army secretary—before Mary landed at the Langley Memorial Aeronautical Laboratory’s segregated West Area Computing section in 1951, reporting to the group’s supervisor Dorothy Vaughan.

After two years in the computing pool, Mary received an offer to work for engineer Kazimierz Czarnecki in the 4-foot by 4-foot Supersonic Pressure Tunnel. Czarnecki offered Mary hands-on experience with experiments in the facility, and eventually suggested that she enter a training program that would allow her to earn a promotion from mathematician to engineer. Mary completed the courses, earned the promotion, and in 1958 became NASA’s first black female engineer.

Mary began her engineering career in an era in which female engineers of any background were a rarity, and may have been the only black female aeronautical engineer in the field. In 1979, seeing that the glass ceiling was the rule rather than the exception for the center’s female professionals, she made a final, dramatic career change, leaving engineering and taking a demotion to fill the open position of Langley’s Federal Women’s Program Manager. There, she worked hard to impact the hiring and promotion of the next generation of all of NASA’s female mathematicians, engineers and scientists.

Mary retired from the NASA Langley Research Center in 1985 as an Aeronautical Engineer after 34 years. Among her many honors were an Apollo Group Achievement Award and being named Langley’s Volunteer of the Year in 1976. A 1976 Langley Researcher profile might have done the best job capturing Mary’s spirit and character, calling her a “gentlelady, wife and mother, humanitarian and scientist.” For Mary Jackson, science and service went hand in hand.

Sources:

  • Katherine Johnson Biography | NASA
  • Dorothy Vaughan Biography | NASA
  • Mary Jackson Biography | NASA

Compliance and Ethics Week

PPI is grateful for our staff participating in Corporate Compliance & Ethics Week. This annually held company-wide compliance and ethics education gives additional opportunity to shine a spotlight on the importance of compliance and ethics and boost compliance culture. Our staff following the highest standards means providing our patients with the best care!

Part of Corporate Compliance & Ethics Week is educating our staff on the seven elements of an effective Compliance & Ethics Program. Read more about these elements on the blog: Compliance & Ethics Week

Corporate Compliance & Ethics Week is an extension of PPI’s ongoing compliance and ethics program. Company-wide compliance and ethics education, held annually, allows our organization to roll-out new and updated compliance and ethics program policies and reinforce with employees their compliance and ethics obligations. Participation in Corporate Compliance & Ethics Week gives additional opportunity to shine a spotlight on the importance of compliance and ethics and boost compliance culture.

Nurse Practitioner Week

This week is National Nurse Practitioner Week. Although held annually, PPI recognizes and celebrates our exceptional health care providers for the work they do every day. Thank you for going the extra mile daily for our patients and making a positive influence on your colleagues!

Women Who Achieve: Lucy Stone and Mary Church

This year for Women’s History Month, we are highlighting different women each week who, although you may have not heard of previously, have contributed greatly to society.

Second to be highlighted is Lucy Stone, a leading suffragist, abolitionist, and vocal advocate promoting women’s rights. She studied school at Oberlin College and was the first Massachusetts woman to earn a bachelor’s degree in 1847.

Lucy Stone. Source: Thoughtco

At her wedding ceremony in 1855, she read a ‘marriage protest,’ signed by her and her husband, Harry Blackwell. The protest denounced the legal portions of a marriage in which a woman became subservient to and property of her husband. She was the first American women to keep her last name when she was married.

In the1869 anniversary celebration of the Equal Rights Association, Stone quoted, “I believe that the influence of women will save the country before every other power.”

When Equal Rights Association refused to give women voting rights, the National American Woman Suffrage Association (NAWSA) was formed by two rival women’s suffrage organizations in1890. The NAWSA represented millions of women to protest at state level, believing that state-by-state support would force the federal government to pass the amendment.

While she stood for women’s rights, she was also an abolitionist in support of the 15th Amendment, earning African American men the right to vote.

In 1893, Stone passed away before the ratification of the 19th Amendment, granting women the right to vote. Her endless efforts paved the way for her daughter and future generations of women to earn the rights they willingly deserve. On her last day, she said, “I am glad I was born, and that at a time when the world needed the service I could give.”

Another noteworthy figure of the time, Mary Church Terrell, was a women’s suffragist and civil rights activist.

Terrell was one of the first African American women to earn a degree at Oberlin College in Ohio. She continued her education to earn a master’s degree in 1888. After college, she became a teacher in Washington D.C. and the first African American woman appointed to the school board of a major city.

In 1896, she became the president of the National Association of Colored Women. Her work focused on the notion of racial uplift, a belief that blacks would end racial discrimination by advancing themselves and other members of the race through education, work, and community activism. Her words, “Lifting as we climb” became the organization’s motto.

Terrell fought for civil rights and women’s suffrage because she belonged to “the only group in this country that has two such huge obstacles to surmount… sex and race.”

She was a charter member for the National Association for the Advancement of Colored People (NAACP) – the largest American civil rights organization established in 1909.

After the 19th Amendment was passed and women were granted the right to vote, Terrell focused on a broader spectrum of civil rights. In 1940, she published her autobiography, A Colored Woman in a White World, highlighting her experiences with discrimination.

In 1948, she became the first black member of the African Association of University Women after winning an anti-discrimination lawsuit. In 1950, she challenged segregation in public places by protesting a restaurant in D.C. In 1953, The United States Supreme Court ruled segregated eating facilities as unconstitutional and she claimed her victory. This rule was groundbreaking in the civil rights movement.

Terrell fought tirelessly to bring racial justice and equality for all African Americans up until her death in 1954.

Sources:

  • Top 10 Women’s Suffrage Activists (thoughtco.com)
  • Marriage Protest:Lucy Stone and Henry Blackwell, 1855 (thoughtco.com)
  • Lucy Stone | anna brones
  • The National American Woman Suffrage Association (brynmawr.edu)
  • 5 Essential Black Figures In The Women’s Suffrage Movement (wgbh.org)
  • Mary Church Terrell | National Women’s History Museum (womenshistory.org)
  • NAACP – HISTORY

September is National Recovery Month


September is National Recovery Month. Recovery Month is a national observance held every September to increase awareness and understanding of mental and substance use disorders and celebrate the people who recover. Each September, we aim to educate our community about substance use disorders and promote our services to help those with substance use disorders live healthy and rewarding lives.

At PPI, the hard work that goes into a successful treatment plan often goes unnoticed. We are proud of our staff members who help to facilitate the recovery process, but we are the proudest of our patients who have put in the work and have been successful in their recovery. Effective treatment and successful recoveries only benefit the members of our community.

Opioid use disorder is on the rise, and the COVID-19 disease has a large part to play in this upturn. According to the Centers for Disease Control and Prevention (CDC), as of June 2020, 13% of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19. Overdoses have also spiked since the onset of the pandemic. In early months substance use increased 18% nationwide in overdoses compared with those same months in 2019. The trend has continued throughout 2020, according to the American Medical Association, which reported in December that more than 40 U.S. states have seen increases in opioid-related mortality along with ongoing concerns for those with substance use disorders. (source CDC)  

The epidemic is overwhelming, but it is important to remember that people do recover. It is possible to overcome addiction. You are not alone. It’s just a matter of reaching out for help, and then getting connected with effective, evidence based, comprehensive treatment.
 
PPI is providing that help with their innovative Advancement In Recovery (AIR) Program. Through a combination of Medication-Assisted Treatment (MAT) and intensive counseling, people with opioid use disorder are getting a second chance to live a fulfilling life.

If you would like to speak to someone about better managing your stress and anxiety, or to make an appointment, please call (717) 782-6493  for more information.

September is Suicide Prevention Awareness Month

September is Suicide Awareness Month

Suicidal thoughts, much like mental health conditions, can affect anyone regardless of age, gender, or background. In fact, suicide is often the result of an untreated mental health condition. Suicidal thoughts, although common, should not be considered normal and often indicate more serious issues.

September is Suicide Prevention Awareness Month. This is a time to raise awareness on this stigmatized, and often taboo, topic.

Individual Impact:

• 78% of all people who die by suicide are male.

• Although more women than men attempt suicide, men are nearly 4x more likely to die by suicide.

• Suicide is the 2nd leading cause of death among people aged 10–34 and the 10th leading cause of death overall in the U.S.

• The overall suicide rate in the U.S. has increased by 35% since 1999.

• 46% of people who die by suicide had a diagnosed mental health condition.

• While nearly half of individuals who die by suicide have a diagnosed mental health condition, research shows that 90% experienced symptoms.

Community Impact:

• Annual prevalence of serious thoughts of suicide, by U.S. demographic group:

◦ 4.8% of all adults
◦ 11.8% of young adults aged 18-25
◦ 18.8% of high school students
◦ 46.8% of lesbian, gay and bisexual high school students

• Some of the highest rates of suicide in the U.S. are among American Indian/Alaska Native and non-Hispanic white communities.

• Lesbian, gay, and bisexual youth are 4x more likely to attempt suicide than straight youth.

• Transgender adults are nearly 12x more likely to attempt suicide than the general population.

• Suicide is the leading cause of death for people held in local jails.

Crisis Resources

• If you or someone you know is in an emergency, call 911 immediately.

• If you are in crisis or are experiencing difficult or suicidal thoughts, call the National Suicide Hotline at 1-800-273 TALK (8255)

• If you are employed or have insurance, you can call the behavioral health phone number on the back of your health insurance card or see if your employer offers an Employee Assistance Program (EAP).

• If you’re uncomfortable talking on the phone, you can also text NAMI to 741-741 to be connected to a free, trained crisis counselor on the Crisis Text Line.

GET HELP TODAY

#Suicideisnottheanswer
#Gethelp

Source: CDC, NIMH, NAMI

If you would like to speak to someone about better managing your stress and anxiety, or to make an appointment, please call (717) 782-6493  for more information.