michelle aceto, carn. introduce chna to new program model present mission of program educate (or...
TRANSCRIPT
Harbor Health Wellness Program
Michelle Aceto, CARN
Introduce CHNA to new program model Present mission of program Educate (or re-educate) on brain/addiction
Objectives
Nursing experience Coaching experience Harbor experience
About Me
How many of you argued with your parents, even when you knew you were wrong?
Do you want to know why?
Limbic System
The Emotional Brain Dopamine Based - JOY Emotions and motivation SURVIVAL, Fear, Anger
Fight or Flight - related to survival Think Food and Water - Hunger and Thirst
Billions of Synaptic Connections
Compared to the Galaxies in the Universe!!
Terrible Twos
Process Repeats in Adolescence
AHHHHHH!
You were Limbic, as are most of our patients!
Teens = Ruled by Limbic Systems
Make dopamine one day - not the next Swayed by their emotions are prone to risky behavior understand risk but will still take risks. make poor decisions when emotionally aroused experience stronger emotions and have weaker
impulse control Don’t always think logically, are more impulsive Get angry easily and are Moody Don’t THINK before ACTING Live for Instant Gratification
WHY AM I TELLING YOU WHAT YOU ALREADY KNOW???
12 for males14 for females
Nicotine and Caffeine and now Energy drinks set the stage for dependence and addiction
Average age of first drug use
Brain Development Front to Back
Remember, back-to- front development
Prefrontal Cortex Boss of the brain Cognitive analysis Abstract thought Moderation of “correct” behavior Ability to exercise “good judgment”
Not fully developed until 25 years old What does this mean????? Teenagers can’t “Just Say NO!”
Why is it all so different and worse now??
Big Challenges
Drugs and Alcohol, Addiction
My developing theory
% increase in sugar consumption since 1983
Here a some more facts you have likely seen….
But that’s just my theory….
Annual Number of New Recreational Users of Prescription Painkillers, Ages 12 and Older: 1970-2001
1995-2002 Admissions to Tx
Frequency of Treatment Admissions for Prescription Painkillers Among Persons Ages 18-25
You blink your eyes over 10,000,000 a year.
Deaths, Admissions, Sales
Here’s Why
AND Why we need Treatment!!!
% increase in sugar consumption since 1983
Look Familiar?
Let’s be clear here: Drugs Do Not Cause AddictionInteraction between these things does:
1. Drugs2. People3. Environment4. Genetics5. Learned Behavior6. Lack of Family Support7. Other influences
Limbic system taken over First is the chasing of the first HIGH, which never repeats itself
Reward system of brain which normally tells you “hunger” and “thirst” now screams “you are going to DIE”
Then it is just chasing the sick away
Why don’t they stop
Early symptoms of withdrawal include: Agitation Anxiety Muscle aches Increased tearing Insomnia Runny nose Sweating Yawning Late symptoms of withdrawal include: Abdominal cramping Diarrhea Dilated pupils Goose bumps Nausea Vomiting
Withdrawal Symptoms
And the brain telling you it can’t survive without the drug! (Think Limbic)
All that is left is
to chase the
withdrawal away…
An unrelenting game of trying to get enough drug to keep from getting sick…
Heroin When the money runs out and the $300 per day habit is too hard to keep up, Heroin is your friend.
WHAT HEROIN GIVES YOU: Hepatitis, HIV, some very shady new friends and overdose, of course!What are friends for???
Treatment Options
Only works for very few Mostly highly motivated Employed Housed Strong family No Mental Health history
Abstinence
MAT OBOT (Office Based Opiate Treatment)
Both use medication to help a patient manage the chemical imbalances
can be long term or short term Usually patient driven care plans
Medication Assisted Treatment
Full Agonist◦ oxycodone, methadone, codeine, heroin and
morphine◦ bind to mu opioid receptors◦ Give pain relief or euphoria/HIGH
Partial Agonists◦ bind primarily to mu opioid receptors◦ Do not allow for euphoria/NO HIGH◦ Suboxone, Subutex, buprenorphine◦ Hold on to receptor stronger than full agonists so
in a sense, create a “block”
OPIATES
Antagonist Fully binds to the mu receptor Prevent all other opiates, and alcohol, from
stimulating the receptors. Injection is every 28 days , as part of OBOT
comprehensive program We give the medication every 21 days
Vivitrol and oral naltrexone
Suboxone, Subutextablets and film
How it is taken - Sublingually
Half-Life
Goal is to reduce the adverse health, social and economic consequences of the use of substances or practice of harmful behaviors that are causing a person and their life harm without necessarily stopping the consumption/behavior altogether.
EXAMPLE: reduce from a 12pack to a 6pack Creates Opportunity Suboxone = harm reduction
Harm Reduction
A man walks into a doctor’s office
BSAS funded, through DPH Many running across the State currently Nurse Managed Care Programs Patient sees the NCM weekly until stable Only gets week supply until NCM feels can
manage more, is in safe environment, etc Will be expected to be engaged in a BH
program that is individualized to themRegular team meetings held to discuss case loads and issues
Reporting to State weekly, monthly, etc
OBOT PROGRAMS
One NCM to 125 Wellness (OBOT) patients One MA to One NCM One MD to 100 patients prescribed
suboxone Will need second MD after 100 is reached MD or NP can have unlimited Vivitrol
patients Currently have 45 + patients on panel
How will this work at Harbor
Compliment what Harbor Comm Health Center is already providing for the community – quality, comprehensive, wrap-around health and dental services
Provide Quality Healthcare to all Harbor and OBOT Patients in Catchment area
Respect the privacy and goals of the patients Create an accepting environment where these
patients can feel they can make changes in their lives
Create change in the community
Wellness Program goals:
Catchment Area
Carver, Duxbury, Halifax, Hanson, Kingston, Lakeville, Marion, Marshfield, Middleboro, Onset, Pembroke, Plymouth, Plympton, East Wareham, Wareham, and West Wareham
Family Friends Self-referral Plymouth County Jail – will create bridge for
inmates Hospital/ER Detox facilities Inpatient psych facilities Local BH agencies and private offices
Referrals and Community Connections
Dedicated phone line which the MA, also known as the Program Coordinator, will screen and direct all calls
Inquiries will be screened by Program Coordinator (MA), forwarded to NCM
NCM will do intakes, determine if patients is appropriate for treatment. If not, will make necessary referrals. If appropriate, will schedule for required appointments, as necessary.
Patient Screening
Will determine individualized Care Plan for each patient
Will decide if Suboxone, Vivitrol or abstinence is best choice
Will determine length of treatment Will start process immediately to reduce
harm◦ Induction◦ Stabilization◦ Maintenance◦ Tapering off if patient chooses
OBOT Team – includes Patient
The Wellness Program will not be able to have no walk-ins, but this will not be avoided
All patients will be STRONGLY encouraged to be primary care patients. All need to establish as new patients, will need to have insurance checked etc.
Will always be a work in progress
Some Specifics
Weekly visits to start Referral to our integrated BH or outside BH,
as soon as possible Connection to our Medical Providers
immediately Bloodwork including Hep C, HIV testing at
start of care Connection to CSP (case management) Encouragement for family connections to
attend
Patient Flow
Suboxone◦ Lower dosing used◦ Smaller quantities allowed◦ Attendance required◦ Do treat pregnancy◦ Do treat 16-18 year olds
Naltrexone◦ Oral version must be started first for opioids◦ Can be started sooner for alcohol◦ Vivitrol shot started as soon as we get insurance
approval
Medication
Please don’t call them: “SUBOXONE PATIENTS”. We use no labels, no identifiers. They are patients.
And I am not a “Suboxone” Nurse. Can refer to us as the Wellness Nurse, Health Coaches, Wellness Program Staff, Wellness Program Staff, etc, not the SUBOXONE Program – Please
Some Things We ask you to AVOID
We will see people’s lives change in positive ways
We will be a part of a team that helps to make that change possible
We will be a part of an organization that will make changes in our own community
Some Positives our entire staff get to enjoy – Because there will be MANY!!
We want all of you to be a part
of that team!
508-778-5469
Wellness Program Hotline
