Education and support channels better outcomes

Sauk County was one of 11 programs across 11 states to be awarded the Medication Assisted Treatment- Prescription Drug and Opioid Prescription Program Grant in 2015. Three million dollars was to be used to target four groups affected by the opioid crisis: inmates, pregnant women, under-insured individuals and persons without access to resources.

Stepping up to the plate

After an alarming number of drug-related deaths in Sauk County, Wisconsin, a group of high-level county stakeholders came together to try put an end to the epidemic. One of the stakeholders was a nurse who reported that her granddaughter’s successful life fell apart because of opioid use. The nurse knew that if her granddaughter could be affected, anyone could be affected.

The sheriff, local police chief, the hospital staff, county officials, public health nurses, school administrators, tribal members and the chief district attorney attended an information meeting, where attendees learned how much opioids had permeated small towns in rural Wisconsin.

“Based off gathered statistics, we knew there was a high level of overdoses among ages 19 to 32,” Deputy Director of Sauk County Department of Human Services, Sharon Boesl said. “Knowing the county didn’t have the funds or resources to fight the epidemic, we applied for a Substance Abuse and Mental Health Service Administration (SAMHSA) grant in order to build up treatment options in outpatient clinics.”

Sauk County clinicians were able to work with substance use providers and clinics across our community in order to assure care coordination and fluent data sharing.

Sharon Boesl, Deputy Director of Sauk County Department of Human Services

In 2015 alone, there were 450 individuals who would need Medication-Assisted Treatment (MAT). MAT is a combination of behavioral therapy and use of FDA-approved medication to treat opioid use disorders (OUD). It was a cutting-edge initiative at the time and was barely available to rural counties with limited resources. Funds were used by Sauk County to meet three goals specified by SAMSHA: increase the number of individuals receiving MAT, increase the number of OUD individuals receiving integrated care and decrease illicit drug use at the 6-month follow-up.

The Medication Assisted Treatment Recovery & Support (MATRS) program was spearheaded in rural Wisconsin by Tellurian, Inc. in collaboration with MAT staff at Sauk/Columbia Counties’ Departments of Health and Human Services.

“The program is designed to develop and expand medication assisted treatment to individuals identified as heroin and opioid addicted in rural communities,” Boesl said. “MATRS is person-centered and uses evidence-based models of treatment concurrent with psychosocial rehabilitative services including employment, housing, improving financial stability, interpersonal skill building and so on to achieve long-term sobriety.”

This MATRS program provides rapid response to patients, including a 24-hour phone number where they can speak with a community recovery specialist (CRS) 24/7. The CRS is an addictions-trained professional assigned to each patient who serves as an ongoing advocate and case manager and connects MATRS clients to MAT providers and appropriate treatment professionals and services.

For Sauk County, one of the first tasks after receiving the grant was to find providers who were willing to prescribe the medications that would be used at the front door of treatment for this model of care. Sauk County started with two physicians approved to provide MAT. Their partner county, Columbia County, did not have any approved MAT prescribers. In order to make this model of treatment successful, they needed to invite doctors to participate in this style of care; however, these doctors needed training and had to commit to be readily available to provide MAT within 24-48 hours once contacted about a client in need.

Primary care physicians who knew little about addiction saw the damage and were willing to be trained and educated on how to fight this no matter their prior expertise. Their support made all the difference.

Sharon Boesl, Deputy Director of Sauk County Department of Human Services

Initially, there were objections from the local medical community due to prejudice of patients who are addicted to illegal drugs.

“There are some challenges here as typically there are a lot of no-shows with these individuals for reasons like transportation not to mention a lot of the specialists in family practice, internal medicine, emergency care didn’t know a whole lot about addictions,” Boesl said. “Nevertheless, thanks to the leadership and commitment of a local medical director from a large hospital, who personally provided education on MAT and how to introduce this practice within medical settings, physicians and medical staff became supporters in this initiative.”

Sauk County started with two MATRS physicians and had 25 after just six months, eventually recruiting more than 50 participating prescribers of MAT across both counties.

Initially, 253 MATRS clients were selected for treatment. Most were young adult males age 26 to 35 years old. They all lived in Sauk or Columbia county and had an opioid use disorder. After six months of MAT treatment, illicit opioid use among the patients was down 81 percent, while drug abstinence was up 105 percent. MATRS clients agreed that success is unique to each person, and that the program requires commitment and continuous contact with the care team. Forty-six percent of individuals left the program with satisfactory progress toward their recovery plans. Readmission rates were only 15 percent.

Technology also played a major role in the success of the MAT program. Boesl said integration and care coordination was a key component in this style of treatment. Sauk County used a Netsmart electronic health record (EHR) to keep patient records updated, organized and accurate.

“Sauk County clinicians were able to work with substance use providers and clinics across our community in order to assure care coordination and fluent data sharing,” Boesl said. “This was vital not only for quality care but also to meet outcome reports required by SAMHSA.”

The SAMHSA grant concluded on July 31, 2018. However, Sauk County is now on an expansion grant that was awarded through the state of Wisconsin for 12 extra months. As far as keys to MAT success, Boesl said getting physician involvement should be a top priority.

“Once our community understood how much this epidemic was affecting its people, no one hesitated to jump in and help,” Boesl said. “Primary care physicians who knew little about addiction saw the damage and were willing to be trained and educated on how to fight this no matter their prior expertise. Their support made all the difference.”