Ch dc march interactive final final

2017

BEST OF

Local Living Healthcare

Your Home. Your Community. Your Life.

Volume 2, Issue 1 www.ch-dc.org

This issue of our quarterly magazine is long past due. Community Health & Dental Care (CHDC) has been

working hard to fight the battle with opioid disorders in our community. Opioid drugs are a powerful class of drugs that are used to reduce pain and can be highly addictive with side effects:

In order for us all to understand what it means to have a “opioid use disorder”, I thought it would be beneficial to provide a list of commonly used terms:

1.

Prescription opioids can be prescribed by doctors to treat moderate to severe pain, but can also have serious risks and side effects. Common types are oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone.

2.

Fentanyl is a synthetic opioid pain reliever. It is many times more powerful than other opioids and is approved for treating severe pain, typically advanced cancer pain.

Illegally made and distributed fentanyl has been on the rise in several states.

3.

Heroin is an illegal opioid. Heroin use has increased across the U.S. among men and women, most age groups, and all income levels.

Commonly Used Terms Opioid use disorder A problematic pattern of opioid use that causes clinically significant impairment or distress. A diagnosis is based on specific criteria such as unsuccessful efforts to cut down or control use, as well as use resulting in social problems and a failure to fulfill obligations at work, school, or home. Opioid use disorder has also been referred to as “opioid abuse or dependence” or “opioid addiction.”

Physical dependence Adaptation to a drug that produces symptoms of withdrawal when the drug is stopped.

Deaths from drug overdoses are the number one cause of injury death in the US. Overdose Injury to the body that happens when a drug is taken in excessive amounts. An overdose can be fatal or nonfatal.

Medication-assisted treatment (MAT) Treatment for opioid use disorder combining the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.

Tolerance Reduced response to a drug with repeated use.

Drug misuse The use of prescription drugs without a prescription, or in a manner other than as directed by the prescriber.

www.ch-dc.org 2 Local Living Volume 2 Issue 1

NOTE FROM PUBLISHER

Karen A Kovacs Publisher Patti Fitzpatrick/You & I Designs Art Director Blair Johnson Director of Sales Susanna Koppany Marketing & Sales Manager Melinda Kovacs Accounting Manager Local Living Magazine is published by Blue Water media LLC. For more information about Local Living Magazine pleaae visit our website at www.Locallivingmag.com, email us at info.bluewatermedia@gmail.com or call at 609-788-0443 All Rights Reserved No Part of this publication may be reproducded without the expressed written permission of Blue Water Media LLC. This magazine purpose if for information & entertainment only.

It is NOT an attempt to solicit business.

Designed in the United States 2016

CHDC recognizes that drug overdose deaths and opioidinvolved deaths continue to increase in the United States.

The majority of drug overdose deaths (more than six out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled.

From 2000 to 2015 more than half a million people died from drug overdoses. 91 Americans die every day from an opioid overdose. https://www.cdc.gov/drugoverdose/opioids/index.html We have people right here in our community who are dying daily from overdose deaths. Who are these individuals? This can be anyone-your neighbor, daughter, son, friend, church member, niece, nephew-there is no “perfect” picture of who is at risk for overdosing or who has an opioid disorder. CHDC received a federal grant award and a Center of Excellence (COE) grant from the PA Department of Human Services to provide services for MAT (CHDC is not providing methadone services at this time) for our patients we serve in the Pottstown community and 15 mile radius of surrounding communities.

What is important to understand is CHDC has a team of support for the Provider treating the patients. People need more than medication to succeed and CHDC has experienced staff to assist-registered nurse, licensed clinical social workers, licensed practical nurses, intense case management support, certified recovery specialists and many other support staff who have received training to understand how to treat this disease-yes, a disease, not an addiction.

I personally believe that everyone needs to understand this is a disease because the stereotypical image of an “addict” needs to go away. Unfortunately, this disease can affect anyone at any age with any income level. CHDC is here to help our community and coordinate care for patients that may need all levels of care, such as dental, vision, OBGYN, integrated behavioral health, MAT- your patient centered home at CHDC. CHDC provides free transportation to and from our locations and has the staff on site to assist with social and economic barriers in people’s lives with a personal connection with our caring staff. If you know someone who you may suspect of having an opioid disorder, do not wait one more day to get them connected to services as it could very well be their last chance.

Bridgette McGivern, CEO

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Local Living 3

Opioid Addiction

within

Our Community pioid addiction is headline news as it is so common and devastating on multiple fronts: societal costs, personal devastation, broken families, loss of productivity, increased crime and overburdened criminal justice systems. There are currently 2 million Americans addicted to prescription opioids and an additional 500,000 heroin addicts. Opioid deaths, now outnumbering deaths from motor vehicle accidents, have tripled since the 1990s. Indeed, this crisis affects all segments of our community. We need to recognize that once addicted, many people experience permanent brain changes, which makes opioid

4 Local Living Volume 2 | Issue 1

addiction a relapsing and unremitting, chronic illness. Many celebrities have been victim to opioid related fatalities, like Prince and Phillip Seymour Hoffman, to name a couple.

Per the National Institute on Drug Abuse, Opiates are medications that relieve pain by blocking pain receptors and reducing intensity of pain signals. Taken after a serious injury or in any kind of pain, they are very powerful in relieving that pain. Examples of drugs in this class are hydrocodone, codeine, oxycodone, and heroin (which is illegal). Many people do not know this, but heroin, which is an extremely dangerous and addictive drug, was used in the Civil War to

relieve pain after, for example, a soldier’s leg was blown off in combat. Opioids have their own receptors in the brain, so they work by binding to those receptors to block/relieve pain signals from reaching the brain.

It is important to note that opioid abuse does not just concern heroin. Many opiate addictions in fact start off by a simple prescription written by a doctor. Addiction does not discriminate, so it is important to educate everyone about this issue.

It can truly happen to anyone, especially if one gets into a car accident and ends up needing a prescription for Vicodin or another opiate painkiller. Drug overdoses represent a public health crisis that is as urgent as any we have ever confronted.

1. Community linkages are essential to shift

public perception, decrease stigma and to spread the understanding of opioid addiction as a chronic illness.

Fostering partnerships in the community to link resources to promote better health, health care providers need to forge partnerships with state agencies, courts, schools and colleges, faith organizations, businesses and clubs. This effort must extend to liaison with treatment provided in prisons to ensure continuity of care upon release. There must also be an increased availability of naloxone (overdose rescue injection) to prevent overdoses in all settings. Community linkages, including mandatory education in school settings, are also essential to shift public perception and stigma. These policies must address workforce development; increased access to services; and prevention and maintenance.

If you are struggling, or know anyone who is struggling with addiction, please ask for help.

It is literally a life and death situation. People are dying.

2. Individuals must be key members of their

own treatment team. To do so, they must be fully informed of the treatment options, alternatives, risks and benefits.

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Local Living 5

T IC

D D

A

N IO

Touches All of Our Lives

By Jillian Dunn

Addiction does not just affect the person who is suffering from the addiction

but touches everyone in that person’s life. Those suffering from addiction face each day with the challenge of how to survive a day without pain. Families face each day knowing that their loved one might not win their battle with addiction.

Both of them live with the knowledge that if not helped the addiction can eventually end in death.

David and Mary share their personal stories of how addiction affects their own lives. Their stories share their pain, loss, frustration and hope for lives without addiction.

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PATIENT PROFILES My whole life I have been worrying and putting other’s first in my life.

This program is helping me make myself a priority and focus on what I need to do to get myself on the road to the life I want.

Hi my name is David and I am 37 years old and I moved back home to Pottstown from Massachusetts 5 months ago. I live with my Aunt and have a daughter in Arizona and two step children in Massachusetts.

My future goal is to be able to drive long distance for the truck company I work for but this is on hold until I can manage my addiction to Subonex.

This is how the conversation I had with David about his story of struggles and challenges on his road to recovery from opioid addiction began.

David was very open about his life story and his Medication Assisted Program (MAT) sessions with Community Health & Dental Care. It is the mission of Community Health & Dental Care to identify gaps in health services and ensure access to appropriate levels of care for all people in the service area regardless of their ability to pay.

Research indicates when treating substance use disorders, a combination of medication and behavioral therapies are most successful. Medication Assisted Treatment (MAT) is clinically driven with a focus on individualized patient care.

Medication Assisted Treatment or Therapy is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders, usually related to opioid and heroin addiction.

David’s life story began in Pottstown but he moved to Arizona when was 20 years old to create a new life for himself out west. He said he was always a casual user of alcohol and sociable pot smoking, he stated he could stop and start when he wanted to and did not have an addiction to either. He had a good job driving trucks and was married with two step children. After 8 years of living in Arizona he separated from his wife and moved to Massachusetts.

While living in Massachusetts for 7 years he got remarried and had a daughter and life was pretty much how we wanted it to be and still no major addiction issues. Until one day a friend he met had him try Subonex, an opioid blocker. In David’s words he liked the way

it made him feel and did not realize how his body would come to crave it and would be part of his daily routine.

During his time in Massachusetts his need for Subonex grew stronger every day and he was hooked. His daily life became difficult as he could not start his day without it and for 6-7 months he had a $200 a week addiction for Subonex which he purchased on the street. This addiction took a toll on his marriage, finances and his ability to drive trucks.

After realizing he had a problem and this was not a casual thing he could stop and start like marijuana and alcohol he started treatment at a clinic in Massachusetts for MAT. David has been enrolled in a MAT program on and off for the last 5 years in order to try to break the addiction.

In that time his relationship with his wife dissolved and he was unable to do the long distance driving required to do the job he loved. David made the decision to move home to Pottstown try to beat his addiction and start a new life. His Aunt Mary had a part time job at Community Health & Dental Care in Pottstown and assisted him in enrolling in their MAT program. In his journey to plan a future without addiction Community Health & Dental Care not only treats his addiction but addresses his need to plan a future and focus on what his life without opioid addiction will look like.

David is currently seeing his counselor every two weeks where he gets a prescription for Subonex which he cannot manage his daily life without taking. He is working on life skills and creating future plans and goals with his counselor so he can take a better job offer where he can drive long distance trucks.

He currently cannot take any new job opportunities being offered to him because he has to take Subonex daily and cannot be away for any long periods of time from the MAT program. David’s future can only happen after he is addiction free.

As he said in the interview, my whole life I have been worrying and putting other’s first in my life. This program is helping me make myself a priority and focus on what I need to do to get myself on the road to recovery.

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Local Living 7

Many opioids addictions start off by a single prescription written by a doctor. Addiction does not discriminate, so it is important to educate everyone about this issue.

Mary’s granddaughters’ name was Alyssa and when Mary spoke of her she spoke with love and confusion.

Mary wondered how so many medical professionals could get what Alyssa suffered from during her life so wrong.

Addiction is only part of Alyssa’s story and not what she should be remembered for. Her addiction was a bi- product of the pain medicine she was prescribed by doctors’ to alleviate her daily pain from an undiagnosed skin disease.

Alyssa passed away at 32 years old while recovering from addiction to pain medicine and simply taking over the counter medicines to help with a cold she was suffering from for a few days.

The combination of cold medicine Lyrica for allergies and a cough medicine Benadryl was too much for Alyssa’s system to handle. Alyssa was home after a 30 day detox in a Methadone clinic to assist her in getting off of her opioid addiction. She took the medicine in an effort to get some relief and she went to bed and stopped breathing.

She was taking less than 45 milligrams of Methadone but her body was so worn out that she could not handle the normal medicine that a non-addicted person would take for a cold. Alyssa’s death was deemed accidental by the coroner and that is when Mary became confused as to how this could happen to her granddaughter.

Alyssa’s story with addiction started when she was 16 years old and she developed puss like sores on her underarms and groin area, which she had lanced to release the toxins from her body. Her only treatment for the skin condition was lancing her skin which caused excruciating pain. Alyssa was given Subonex by her doctors’ to relieve the pain she was experiencing.

For the next 16 years Alyssa had to visit the hospital and have her skin lanced when the sores occurred and even going through major surgery to remove part of her stomach and cervix. Over time, Alyssa became addicted to pain medicine and was even arrested for trying to 8 Local Living Volume 2 | Issue 1

fill falsified Doctor Prescriptions. During this time she lived with her grandmother Mary in Pottstown, who had a part time job at Community Health & Dental Care as a greeter and at patient registration.

Mary mentioned that despite the horrible pain and surgeries that Alyssa endured due to her disease and her addiction she managed to always have a job and always went back to work after she recovered from her surgeries. Alyssa was a young woman with hopes and dreams for a bright future and a happy life despite her daily pain; she was even planning on enrolling in beauty school after she got back from her detox program. No doctor diagnosed her correctly until Aliyssa was 32 with Hidrandenitis Suppurativa. This diagnosis was made when she was in a Drug Court program by an addiction expert who was reviewing her case of addiction to Subonex for her pain.

Hidradenitis Suppurativa is a long-term (chronic) inflammatory skin disease with recurrent boil-like lumps. These boils often become bigger and turn into collections of puss (abscesses). The abscesses leak puss and become difficult to heal. Women tend to develop it more commonly in the armpits, groin and under the breasts. In severe cases, the puss tunnels down under the skin surface and eventually healed areas are full of thick scar tissue.

Addressing the Unique Challenges of Opioid Use Disorder in Women Deaths from drug overdoses are the number one cause of injury death in the U.S. Most of these deaths are related to the misuse of prescription opioids and heroin. While men were more likely than women to die of opioid overdose, the number of overdose deaths from opioids among women has increased substantially. Since 1999, women’s deaths have quadrupled from prescription opioid overdose.

Consider the following: • Nearly 48,000 women died of prescription opioid overdose between 1999 and 2010.

Mary’s comments that resonated during her interview regarding Alyssa’s situation was that addiction to pain medicine can happen to anyone and affects everyone in that person’s life. No one and no family is safe from something like this happening to a loved one. Addiction affects all walks of life and does not discriminate in its’ ability to change one’s life forever.

Due to Alyssa’s passing at 32, Mary was unable to continue her part-time job with Community Health & Dental Care in Pottstown. While she missed the patients and the staff who are like family to her, she was unable to disguise her sadness at her granddaughter’s passing from those around her who knew her story and what had happened.

Mary is finding ways to help others that might be in the same situation Alyssa was in and is thinking of going into addiction clinics to tell her story. Her hope is that awareness might bring light to how everyday medicines can be deadly when people with addiction issues are not aware of the side effects of taking them because of their unique situation.

Mary hopes by sharing her and Alyssa’s story, it can help her healing process and help others at the same time. She mentioned her belief that people find a way to rebuild their lives and move forward despite the challenges and losses they suffer.

• For every woman who dies of a prescription opioid overdose, over 30 of them go the emergency department for opioid misuse or abuse.

Women’s biological differences may influence susceptibility to substance abuse, which could have implications for prevention and treatment.

In order to identify and treat women most at risk, health care providers must be able to recognize and consider these differences.

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Local Living 9

PREGNANCY AND OPIOID PAIN MEDICATIONS Women who take opioid pain medications should be aware of the possible risks during pregnancy.

Talk to your provider before

WHAT ARE OPIOID PAIN MEDICATIONS?

starting or stopping any medications to help you understand all of the risks

Opioid pain medications are prescribed by doctors to treat moderate to severe pain. Common types are codeine,

and make the safest choice for you and your pregnancy.

oxycodone, hydrocodone, and morphine.

ARE OPIOID PAIN MEDICATIONS SAFE FOR WOMEN WHO ARE PREGNANT OR PLANNING TO BECOME PREGNANT? Possible risks to your pregnancy include1,2: • Neonatal Opioid Withdrawal Syndrome (NOWS): withdrawal symptoms (irritability, seizures, vomiting, diarrhea, fever, and poor feeding) in newborns3 • Neural tube defects: serious problems in the development (or formation) of the fetus’ brain or spine • Congenital heart defects: problems affecting how the fetus’ heart develops or how it works • Gastroschisis: birth defect of developing baby’s abdomen (belly) or where the intestines stick outside of the body through a hole beside the belly button • Stillbirth: the loss of a pregnancy after 20 or more weeks • Preterm delivery: a birth before 37 weeks

I JUST FOUND OUT THAT I’M PREGNANT. Should I stop taking my opioid pain medication?

What are the risks?

• First, talk to your provider. Discuss all risks and benefits of continuing any medication use during pregnancy • Some women need to take opioid pain medication during pregnancy and quickly stopping your medication can have serious consequences.

• In some cases, avoiding or stopping medication use during pregnancy may be more harmful than taking it.

WHAT ABOUT BREASTFEEDING?

The information provided here applies to the use of opioid medication for pain. Opioid medications may also be used in medication assisted therapy (MAT) for treatment of substance use disorders. There are unique benefits and risks associated with MAT. To learn more about opioid medication use for substance use disorder treatment and considerations in pregnancy, visit www.samhsa.gov/medication- assisted-treatment/treatment

• Women without HIV who are already taking opioid pain medications regularly (and not using illicit drugs) are generally encouraged to breastfeed.

• Be sure to ask your doctor about breastfeeding if you are taking any other medications.

• During breastfeeding, avoid codeine whenever possible, and if used, ask your doctor for the lowest possible dose due to possible risk of newborn illness and death

For more information on opioid and other medication use in pregnancy or breastfeeding, go to:

Broussard CS, Rasmussen SA, Reefhuis J, et al. Maternal treatment with opioid analgesics and risk for birth defects.

Am J Obstet Gynecol 2011; 204:314:e1–11. 2 Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstet Gynecol 2011; 204:259:e124. 3 Hudak ML, Tan RC, Committee On Drugs, Committee On Fetus and Newborn, American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012;129:e540–60. 4 National Opioid Use Guideline Group. Canadian guideline for safe and effective use of opioids for chronic non-cancer pain; 2010. Available at: documents.html.

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• •

www.cdc.gov/treatingfortwo toxnet.nlm.nih.gov/newtoxnet/lactmed.htm

L EARN MOR E | www.cdc.gov/drugoverdose/prescribing/guideline.html

Professional Education

Board Certified, Family Medicine

CHDC COE PROVIDERS Residency, Family Medicine, Abington Memorial Hospital, Abington,

PA (2001) M.D., Dartmouth Medical School, Hanover, NH (1996)

Gary Davis, MD Gary Davis, MD B.A., Biology, Dartmouth College, Hanover, NH (1992) ProfessionalProfessional Education Education Board Certified, Family Medicine Board Certified, Family Medicine

Residency, Residency, Family Medicine, Abington Memorial Hospital, Abington, Family Medicine, Abington Memorial Hospital, Abington, PA (2001), M.D., Dartmouth William Haug, DO Medical School, Hanover, NH (1996), B.A., Biology, Dartmouth College, Hanover, NH (1992)

PA (2001)

Professional Education M.D., Dartmouth Medical School, Hanover, NH (1996)

Internship, Delaware Valley Hospital (1971‐1972) B.A., Biology, Dartmouth College, Hanover, NH (1992)

William Haug, DO D.O., Philadelphia College of Osteopathic Medicine (1971) Professional Education B.S., Miami University, Oxford, OH (1967) Internship, Delaware Valley Hospital (1971-1972), D.O., Philadelphia College

William Haug, DO A.S., York Junior College (1965) of Osteopathic Medicine (1971), B.S., Miami University, Oxford, OH (1967),

A.S., York Junior College (1965) Professional Education

Jacek Obara, MD Internship, Delaware Valley Hospital (1971‐1972) Jacek Obara, MD Professional Education ProfessionalD.O., Philadelphia College of Osteopathic Medicine (1971) Education

Board Certified, Family Medicine B.S., Miami University, Oxford, OH (1967) Board Certified, Family Medicine

Residency, Southern Illinois University Family Practice, Springfield, IL (2005-2008) A.S., York Junior College (1965) Residency, Southern Illinois University Family Practice, Springfield, IL M.D., Memorial University of Newfoundland, St. John’s, NF Canada (2003) (2005‐2008)

M.D., Memorial University of Newfoundland, St. John’s, NF Canada

Jacek Obara, MD (2003) Marlelle Fromuth, M.Ed, MSW/LCSW Professional Education Professional Education Board Certified, Family Medicine

Licensed Clinical Social Worker (2010), MSW, Temple University (2007) Residency, Southern Illinois University Family Practice, Springfield, IL M.Ed, Alvernia University (2004), BASW, University of Pittsburgh (2001)

(2005‐2008) Marlelle Fromuth, M.Ed, MSW/LCSW

CHDC COE PROVIDERS

M.D., Memorial University of Newfoundland, St. John’s, NF Canada Professional Education

PamelaPamela DeLoretta MSW, LSW DeLoretta MSW, LSW (2003) Licensed Clinical Social Worker (2010) Professional Education ProfessionalMSW, Temple University (2007) Education LicensedLicensed Social Worker (2014) Social Worker (2014), MSW, West Chester University (2013) M.Ed, Alvernia University (2004) MSW, West Chester University (2013) BSW, Shippensburg University (2008) BASW, University of Pittsburgh (2001) BSW, Shippensburg University (2008)

Marlelle Fromuth, M.Ed, MSW/LCSW Professional Education Ramona Yeary-Leap, RN, BSN Licensed Clinical Social Worker (2010) Professional Education MSW, Temple University (2007) NIHSS Certified, Temple University, Phila., PA – M.Ed, Alvernia University (2004) Ramona Yeary‐Leap, RN, BSN

Bachelor of Science Nursing, cum laude, 1991 BASW, University of Pittsburgh (2001)

Professional Education NIHSS Certified Temple University, Phila., PA – Bachelor of Science Nursing, cum Lisa Neri, MSN, CRNP laude, 1991

Professional Education Board Certified by the ANCC 1999-2019, MCP-Hahnemann University of the Health Sciences, Phila., PA, Received MSN and Certification as a Family Nurse Practitioner (1999), Thomas Jefferson University, Phila., PA Lisa Neri, MSN, CRNP Professional Education Board Certified by the ANCC 1999‐2019 MCP‐Hahnemann University of the Health Sciences, Phila., PA Received MSN and Certification as a Family Nurse Practitioner (1999) Thomas Jefferson University, Phila., PA

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