encouraging, equipping, and engaging Christians to live out the gospel through health care among the poor
THE EPIDEMIC IN OUR BACKYARD I was surprised to find Frank sitting on my front porch when I got home from work. I used to be Frank’s pastor in a life prior to CCHF, but I had not seen him in over 5 years. Frank is a good man, a generous servant, and a brother who genuinely loves Jesus. So I was even more surprised when he said, “I am ashamed of myself, Steve. I am addicted to heroin and I don’t know what to do.”
Frank is a self-employed roofing installer. Like most of your patients, he lives hand to mouth. For as long as I have known him he has been uninsured. A year ago he fell off a ladder and broke his ankle. At the ER they patched him up, gave him painkillers, recommended surgery and discharged him. He called a few orthopedic practices, but no one would see him without insurance. So he lived with the pain until it became unbearable. Eventually he went to see a primary care provider referred by the hospital, who
refilled the prescription the ER doc had given him. Frank hated taking painkillers, and only took them when he had to work. But his ankle did not get better, the pain got worse, and he eventually asked his PCP for more refills. Six to 8 months later, the PCP told Frank that he would not give him any more refills. He tried Tylenol, but the pain was unbearable, and he was unable to work most days. A friend at his apartments told him he could get him the same stuff, and he began to self-medicate so he could go back to work. But the pills soon became hard to get, and his friend switched him to heroin. Frank’s story is not unfamiliar to those of us who serve under-resourced populations. We are aware of the growing heroin and opioid addiction crisis in America – more than 28,000 deaths reported 2014 according to the CDC. While chronic pain patients need compassionate care, the tide of addiction and subsequent mortality makes this a complex issue.
Clinics at a Glance 2
Refuge Clinic Lexington, Kentucky
Opioid Epidemic and CCHF (continued) 4
clinics at a glance Three hundred clinics nationwide are striving to deliver distinctively Christian healthcare to the poor. There’s almost always two or three dozen groups in various stages of development. Here are three clinics who are a valuable part of our community. Please offer them your prayer, counsel and encouragement.
MERCY MED columbus, ga
EAST LIBERTY FAMILY HEALTH CARE
OASIS OF HOPE grand rapids, mi
9,000 sq feet in MercyMed’s expanded facility, up from 3,100 sq feet, includes 12 exam rooms with a space for procedures and 4 dental chairs. The grand opening for the new space is December 2016.
Barb and Dan Grinwis followed the Lord’s lead to open Oasis of Hope in 2006.
locations throughout urban Pittsburgh. Two offer primary care, and one offers dental care.
For the first time since Oasis of Hope's inception, the clinic has a new executive director. Founders Dan and Barb Grinwis are retiring on December 1st. Please welcome Jonathan Reid to the CCHF family.
Looking for a second medical provider to join their clinical staff. Pray for MercyMed as they enter the next phase of their ministry.
A pastor and a medical student began praying for God to call like-minded people to a ministry of healing to an urban area of Pittsburgh. Out of this effort, ELFHC was born.
REFUGE CLINIC LEXINGTON, KENTUCKY The idea for Refuge Clinic was birthed out of a pastoral challenge from the pulpit of Southland Church. The clinic opened in March of 2009, and has grown steadily ever since. The clinic leans heavily on volunteer manpower, and is able to maximize its resources to provide care to many of Lexington’s uninsured residents. Since opening, Refuge Clinic has expanded service offerings from just primary care to include dental care, onsite behavioral health and counseling services, and a new program to address the opioid addiction within pregnant mothers. Kentucky ranks among the most at-risk states for perinatal opioid exposure. Refuge Clinic is hoping to break cycles and see families restored through this program— offering primary care, counseling, and addiction services to pregnant women throughout the region.
Employment Opportunities Jobs are frequently posted on the CCHF website, and through social media. Take a look at some of our most recent postings. Bilingual Dentist at Herald Christian Health Center (Los Angeles, CA) Medical Provider at Christ Health Center (Birmingham, AL) Nurse Practitioner at Crossroad Health Center (Cincinnati, OH) Family Medicine Doctor at Dayspring Family Health Center (Jellico, TN)
THE OPIOID EPIDEMIC & CCHF (CONTINUED) In the wake of Frank’s visit, I began calling friends at CCHF clinics around the country to find out what is being done within our network to help people like Frank. I was shocked by how little we were doing directly through our clinics, how inadequate the current outside resources are relative to the need, and how controversial this issue seems to be among Christians who care for the poor. Christian clinics vary in their response to heroin addiction and the related problem of managing chronic pain. “We don’t want to be known for managing chronic pain” was the response I got from quite a few CCHF clinics. Some that I talked to said they were morally opposed to prescribing opioids; while others felt they were morally obligated to use opioids while employing risk-stratification efforts such as pain contracts, pill counts and urinalysis. Dr. John Boll grew up in a home where his mother suffered with chronic pain as a result of an automobile accident. During his years working in Appalachia at Dayspring (Jellico, TN), Dr. Boll served as coroner. He saw the impact of opioid addiction and the alarming number of deaths from overdose. Now on faculty at Williamsport Family Medicine Residency in central Pennsylvania, he works on QI projects involving non-malignant pain management. “As Christian providers we have much insight into how to treat chronic pain. We must figure out how to offer hope and encouragement in the midst of suffering.” We discussed a variety of approaches with Dr. Boll. “Our answer from clinic to clinic may be different, but within a single CCHF clinic it is important to come together as a group, talk about the issue, and all be on the same page. Providers doing different things within the same practice can be harmful to patients.” Dr. Bob Paeglow of Koinonia Primary Care in Albany, NY is no stranger to patients with chronic pain. “Growing up and working in the inner city, I’ve been keenly acquainted with these two major problems – the horrors of addiction and patients with chronic pain.” He likens people who deal with chronic pain to “modern-day lepers”; they don’t trust the medical system, and the system doesn’t trust them. Dr. Bob and Koinonia developed a chronic pain program to address the needs of their patients while trying to avoid addiction. They use the usual tools like pill counts and urinalysis; but they also require attendance at a monthly pain group led by a volunteer psychiatric social worker. In groups of ten to twelve, patients address socio and spiritual issues as well as ways of managing pain without escalating use of opioids. The program has been wildly successful, and has not put a strain on the clinic’s operations or resources. Most CCHF clinics refer their addicted patients to rehab programs, or external addiction counseling. Several organizations are in the early stages of providing opioid replacement therapy (ORT) such as buprenorphine programs. Los Angeles Christian Health Center is partnering Homeless Healthcare Los Angeles’s Center for Harm Reduction. The Center for Harm Reduction provides replacement needles to addicts in an effort to reduce the spread of blood borne diseases like HIV and Hepatitis. LACHC plans to open a clinic inside their facility to provide addicts with drug replacement and maintenance therapy. We talked to Dr. Katy White, medical director for LACHC. “This is absolutely where Jesus would be. Many of our addicted neighbors don’t trust the medical system and feel like everyone hates them.” Supplementing drug replacement therapy, they will provide integrated behavioral health, and build long-term relationships where they can address whole-person issues. Programs like ORT are not without controversy. Many feel that clinics offering buprenorphine are trading one addiction for another. Others argue that it is unreasonable to expect legitimate pain sufferers to manage without prescription drugs, and that it is better to have a trained, compassionate health professional manage them than to turn them over to the street dealer. What is clear is that we cannot ignore the problem. We must prayerfully and thoughtfully wrestle through these issues for the sake of those who are truly “the least of these”.
Would you like to share your questions or experiences? Send us your comments!
At a GLANCE Quick facts regarding the opioid epidemic in the United States. (source: CDC)
78 Americans die each day from opioid linked overdoes
Patients who abuse prescription opioid painkillers are 40 times more likely to use heroin
80% of the global supply of opioids is consumed by the United States
Baby Boomers are up to four times more likely to abuse opioids than Millennials
Since 2000, the rates of overdose death involving opioids has increased 200%
Many opiate addicts switch to heroin because it is cheaper and easier to obtain
Announcing two new CCHF initiatives…
We’ve launched our podcast AND technical assistance website. Discover these & more online at CCHF.org
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