Patients of NCCo Doctor Whose Medical License, Controlled Substance Registration Suspended Urged to Seek Ongoing Care

DOVER (Aug. 1, 2019) – On July 30, 2019, the medical license and controlled substance registration of Damon Cary, MD, were suspended temporarily by the Delaware Board of Medical Licensure and Discipline. The suspension was the result of a request made by the Delaware Attorney General’s Office following investigations into the prescribing and treatment practices of Dr. Cary. The Board and the Secretary of State can temporarily suspend a license pending a hearing if a complaint concerning the activity of a licensee presents a clear and immediate danger to the public health and safety.

Patients being treated over a long period of time with certain medications at Dr. Cary’s practice locations in Newark or Wilmington will be in need of providers with expertise in treating similar types of patients with opioids and benzodiazepines. That’s why the Department of Health and Social Services’ Division of Substance Abuse and Mental Health (DSAMH) is providing suggested resources for patients of Dr. Cary in need of accessing ongoing care.

Patients of Dr. Cary who were receiving treatment and need assistance with withdrawal symptoms can contact DSAMH’s Mobile Crisis Helpline for New Castle County at 1-800-652-2929 to be connected to needed services or they can visit HelpIsHereDE.com.

Patients of Dr. Cary who are seeking referrals to physicians may contact Dr. Cary’s offices, their insurers or local hospitals. Referrals may be limited based on the availability of specialists who are accepting new patients. Patients need to be aware that each prescriber is different and may not continue the medications in the exact dose or on the same schedule as their previous prescriber.

Opioid withdrawal can be serious and potentially life-threatening. Commonly prescribed opioids include: hydrocodone (Norco), oxycodone (Oxycontin, Percocet), oxymorphone (Opana), morphine (Kadian, Avinza, Oxycontin), hydromorphone (Dilaudid), and fentanyl (Duragesic). Signs and symptoms of opioid withdrawal may include:
• Restlessness
• Anxiety
• Nausea
• Vomiting
• Diarrhea
• Sweating
• Tremors
• Rapid heart rate and changes in blood pressure
• Confusion
• Hallucinations (auditory and visual)
• Increased pain

Symptoms of abrupt opioid withdrawal can be severe and are best managed with medical assistance. This most often includes monitoring of heart rate and blood pressure, and administration of medications to ease withdrawal symptoms.

Benzodiazepine withdrawal can be serious and potentially life-threatening. Benzodiazepines include Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam) and Valium (diazepam). While most patients will not experience withdrawal symptoms, those who do will need to seek immediate medical attention. Signs and symptoms of benzodiazepine withdrawal may include:
• Sweating
• Tremor
• Increased heart rate
• Increased blood pressure
• Nausea and vomiting
• Hallucinations
• Seizures

Patients who are unable to secure an alternate treatment provider and who experience any of the above symptoms for opioid or benzodiazepine withdrawal should seek immediate treatment at the nearest emergency room.

While opioids and benzodiazepines do serve medically needed purposes, they each are in families of prescription drugs that can be easily subject to dependence. Twice as many Americans regularly abused prescription drugs than the number who regularly used cocaine, hallucinogens, heroin and inhalants combined. Accidental poisonings have surpassed minor vehicle accidents as the number one cause of fatalities in Delaware.


Partnership for Drug-Free Kids, DHSS Bring New Statewide Resources for Families in Crisis

The Delaware Department of Health and Social Services (DHSS) and Partnership for Drug-Free Kids are collaborating to bring dedicated, science-based resources and support to Delaware families. The two entities will work together to provide innovative, digital resources and one-on-one support to parents and caregivers as they help a loved one struggling with opioids or other substances.

With 192 overdose deaths occurring in the U.S. every day, underscored by a vast majority of people unable to access treatment, the combined effort between DHSS and Partnership for Drug-Free Kids aims to be a vital part of an integrated solution to affect statewide change.

In 2017, Delaware ranked sixth in the nation in drug overdose death rates, with most of these deaths directly linked to opioids, including heroin, prescription opioids and fentanyl, a synthetic opioid that is 50 times more powerful than heroin. Last year alone, Delaware lost 400 lives to overdose, marking an increase of 16% in overdose deaths from 2017 – and almost 3 in 4 of those deaths involved fentanyl.

“With thousands of Delawareans and their families continuing to be impacted by the disease of addiction, we need collaborations like this one with Partnership for Drug-Free Kids to offer critical support for parents and other caregivers,” said DHSS Secretary Dr. Kara Odom Walker, a board-certified and practicing family physician. “We need to listen to the challenges that families face and help them find a path to recovery for their loved ones.”

“We are honored to partner with the Delaware Department of Health and Social Services on this important project that will help close a gap in desperately needed support for Delaware families,” said Marcia Lee Taylor, Executive Vice President, External and Government Relations at Partnership for Drug-Free Kids. “Delaware has proven to be at the forefront of finding and adopting solutions to help those impacted by addiction. We are grateful to collaborate with a like-minded partner that understands the importance of bringing together a national family service infrastructure, coupled with local expertise and resources to make sure that more Delawareans get the help they need.”

This collaboration will be comprised of:

• A co-branded landing page tailored for Delaware families with resources, help and support.

• A dedicated Helpline for Delaware families (855-DRUG-FREE), where parents and other caregivers can connect with Parent Support Specialists who can listen to families’ challenges and help them develop an action plan that will help their child work toward recovery. Specialists will also be able to speak to state-specific issues like getting their loved one connected to treatment services through the START Initiative, finding needed clinical support through the Division of Substance Abuse and Mental Health’s Bridge Clinic, exploring treatment and recovery services at HelpIsHereDE.com, learning where naloxone is available and finding out how Delaware’s Good Samaritan Law works.

• Public service announcements (broadcast, radio, print and digital) to run in donated, pro-bono space thanks to the generosity of Delaware media.

“I’m pleased that families in Delaware will benefit from these best-in-class resources,” said Delaware Governor John Carney. “Across our state, I’ve heard from so many parents who are struggling to make that initial treatment connection for their adult children. Being able to provide parents with valuable, supportive and free resources will make a difference in their families’ lives.”

Josette Manning, Secretary of the Delaware Department of Services for Children, Youth and Their Families said, “We see the impact of substance use in families across the lifespan, from substance-exposed infants to parents and grandparents struggling with addiction. We welcome any partnership that increases prevention efforts and treatment opportunities so our families can achieve positive outcomes.”

The collaboration between Partnership for Drug-Free Kids, DHSS and the Delaware Department of Services for Children, Youth and Their Families (DSCYF) complements ongoing work to increase treatment and recovery services, reduce harm and expand prevention efforts by DHSS’ Division of Substance Abuse and Mental and Division of Public Health, and by the Behavioral Health Consortium, chaired by Delaware Lt. Governor Bethany Hall-Long. The Division of Substance Abuse and Mental Health (DSAMH) has partnered with atTAcK addiction, a grassroots advocacy group led by parents impacted by addiction, and the National Alliance on Mental Illness (NAMI) Delaware to train parents and other adults to handle Helpline calls.

“When I discovered that my son was struggling with heroin addiction, I didn’t know where to turn, or how to go about finding help for him. I never felt as helpless, hopeless and ashamed as I did during that time in my life,” said Belinda Wilson, a North Wilmington mom whose son is in now in recovery. “Finally, I was able to get my son the help he needed, but I realized I also needed support for my own self-care so that I would have the emotional and physical strength required to continue to help my son. Bringing these necessary resources to our state will help so many other families in Delaware, families like mine, have better outcomes for their loved ones who are struggling with substance use.”

For more information, visit https://drugfree.org/delaware.


Patients of Sussex County Doctor Whose Medical License, Controlled Substance Registration Revoked Getting Resources

DOVER (May 9, 2019) – On May 8, 2019, the medical license and controlled substance registrations of Nihar B. Gala, MD, were permanently revoked by the Delaware Board of Medical Licensure and Discipline. The revocation was a result of allegations of unprofessional conduct related to the prescription of opioids to a patient at high risk of addiction.

Patients being treated over a long period of time with certain medications are in need of providers with expertise in treating similar types of patients with opioids, benzodiazepines and stimulants along with Medication Assisted Treatment (MAT). That’s why the Division of Substance Abuse and Mental Health (DSAMH) is providing suggested resources for patients of Dr. Gala in need of accessing ongoing care.

Patients of Dr. Gala who were receiving treatment for substance use disorder can contact DSAMH’s Mobile Crisis Helpline for Kent and Sussex counties at 1-800-345-6785 to get connected to new treatment services. Patients seeking to access additional supportive services including detoxification, recovery support, and recovery living, can visit Help Is Here at: www.helpisherede.com/Resource-Guide/Here-for-me

Patients of Dr. Gala who are seeking referrals to physicians may contact Dr. Gala’s office or local hospitals. Referrals may be limited based on the availability of specialists who are accepting new patients. Please be aware that each prescriber is different and may not continue your medications in the exact dose or on the same schedule as your previous prescriber.

Stimulant medications are prescribed for the treatment of ADHD and include medications such as Ritalin (methylphenidate), Adderall (amphetamine sulfate), Concerta and Vyvanse. While stopping these medications abruptly may lead to a return of ADHD symptoms and possible fatigue and irritability, there are no life-threatening complications associated with their discontinuation.

Benzodiazepine withdrawal can be serious and potentially life-threatening. Benzodiazepines include Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam) and Valium (diazepam). While most patients will not experience withdrawal symptoms, those who do will need to seek immediate medical attention. Signs and symptoms of benzodiazepine withdrawal may include:
• Sweating
• Tremor
• Increased heart rate
• Increased blood pressure
• Nausea and vomiting
• Hallucinations
• Seizures

Patients unable to secure an alternate treatment provider and who are experiencing any of the above symptoms should seek immediate treatment at the nearest emergency room.

While benzodiazepines and stimulants serve a very real purpose, they are also in a family of prescription drugs that can be easily subject to dependence. Twice as many Americans regularly abused prescription drugs than the number who regularly used cocaine, hallucinogens, heroin, and inhalants combined. Accidental poisonings have surpassed motor vehicle accidents as the number one cause of fatalities in Delaware.

-30-

The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.


DPH Launches Statewide Campaign to Prevent Opioid Abuse from Starting After Dental Procedures

DOVER — The Delaware Division of Public Health (DPH) is engaging dental providers in the launch of a statewide campaign directed at increasing awareness about the addictive nature of opioid medications used after dental procedures. Dentists are among the leading prescribers of opioid medications, particularly for surgical tooth extractions. In fact, dentists and oral surgeons are commonly in a position to prescribe adolescents their first opioid prescription after the removal of the third molars, also known as “wisdom teeth.” The highest number of dental-related opioid prescriptions are for teenagers ages 14 to 17, followed closely by young adults ages 18 to 24.

DPH has begun distributing a toolkit to every dental office in the state with resources for both dentists and patients to encourage safe and healthy pain management. Included is a provider letter and fact sheet, a patient brochure, and posters for display in dental offices. The campaign drives home the message that “all pain is not the same,” and therefore should be treated effectively without opioids whenever possible. The American Dental Association (ADA) strongly recommends considering non-steroidal anti-inflammatory drugs (NSAIDs) such as Motrin or Aleve as the first-line of therapy for acute pain management.

“Dental professionals have a unique opportunity to help curtail the opioid epidemic by suggesting opioid alternatives for pain management when possible, counseling patients on the risks of opioid use, and educating on proper disposal procedures,” said Dr. Nick Conte, Director of the DPH Bureau of Oral Health and Dental Services (BOHDS).

A 2011 study in the Journal of the American Dental Association (JADA) estimated that dentists are responsible for 12 percent of prescriptions for fast-acting opioid pain relievers, just below general practitioners and internal medicine doctors. The opioid drugs most commonly prescribed by dentists are hydrocodone and oxycodone, which are highly addictive and have the highest potential for abuse.

This statewide campaign supports a larger state initiative to lower the rate of opioid prescriptions, with the ultimate goal to reduce opioid-related overdoses and deaths. In 2018, DPH launched an expanded section on HelpIsHereDE.com for health care providers, loaded with information; tools, such as forms and screening templates; and resources, including patient materials. Patient and dental provider materials from the oral health toolkit have now been added to the health care provider section of the website. HelpIsHereDE.com is a website providing addiction prevention, treatment, and recovery resources and information for individuals, families and health care providers in Delaware.

According to the CDC, Delaware is ranked first in the nation for prescribing high-dose opioids, and is also ranked first for prescribing long-acting opioids. DPH Director Dr. Karyl Rattay says that while a small percentage of providers (1 percent) are writing 32 percent of opioid prescriptions, almost all providers are struggling with how to better help their patients.

“This isn’t just about telling providers what they need to do,” said Dr. Rattay of the expansion of the health care provider section of the website. “It’s about motivating them by telling them why they need to do it. It’s also about providing comprehensive, evolving support to the trusted caregivers in our community. Certainly, the entire crisis surrounding opioid addiction and drug-related deaths doesn’t lie solely in the hands of health care providers, but they are the critical starting point, and offer the greatest potential for impacting our state’s continual move toward safer use of opioids.”

Preliminary estimates for 2018 indicate 419 overdose deaths across the state, an increase of 21 percent from the 2017 total of 345 deaths, according to the Division of Forensic Science. The CDC ranked Delaware number six in the nation for overdose mortality rate in 2017.

If you or a loved one is struggling with addiction in Delaware, call DHSS’ 24/7 Crisis Hotline to be connected to treatment and recovery options. In New Castle County, call 1-800-652-2929. Or in Kent and Sussex counties, call 1-800-345-6785. To search online for treatment and recovery services in Delaware or nearby states, visit www.HelpIsHereDE.com.

A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing person’s spoken words back to the TTY user. To learn more about TTY availability in Delaware, visit http://delawarerelay.com.

The Department of Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. DPH, a division of DHSS, urges Delawareans to make healthier choices with the 5-2-1 Almost None campaign: eat 5 or more fruits and vegetables each day, have no more than 2 hours of recreational screen time each day (includes TV, computer, gaming), get 1 or more hours of physical activity each day, and drink almost no sugary beverages.


DHSS Launches START Initiative to Engage More Delawareans Suffering from Substance Use Disorder

WILMINGTON (Oct. 3, 2018) – As a way to engage more Delawareans suffering from substance use disorder in treatment, while also meeting their accompanying needs for housing, employment, education and other wraparound services, the Department of Health and Social Services (DHSS) today launched its START Initiative with a press conference and a daylong forum for stakeholders.

With the START Initiative, DHSS’ Division of Substance Use and Mental Health (DSAMH) will increase access to care and treatment for individuals living with substance use disorder by fostering system-wide improvement based on a framework that measures client outcomes. Last week, DSAMH launched a new online treatment referral system called Delaware Treatment and Referral Network (DTRN) that allows Delaware health care providers seeking substance use disorder treatment or mental health services for their patients to make an online referral with one of 24 organizations included in the first phase. Additional addiction and mental health treatment providers will be included in subsequent phases.

“These are important steps forward in meeting the immediate needs of people suffering from addiction in our state,” Governor John Carney said. “When I was running for Governor, I heard from many Delawareans about the problems their loved ones had in accessing treatment. With the new online treatment referral dashboard and peers in emergency rooms and at other contact points, we will engage people in getting the connection to treatment that they need and also be the support they can turn to in order to remain connected to treatment.”

In its first year, the Substance Use Treatment and Recovery Transformation (START) Initiative is expected to engage and treat more than 900 new clients using certified recovery peers connected to emergency departments, primary care, urgent care, EMS, police officers and families as the gateway. The peers will assist individuals suffering from substance use disorder as they navigate their way through both the treatment and social services systems, helping meet their needs for housing, transportation, employment, social services, legal or financial counseling, and other behavioral health or medical care. The START Initiative builds on the best evidence-based treatment and wraparound services needed for long-term recovery, but also offers technical supports to providers in the community to evaluate for quality and standards.

As part of the START Initiative, DSAMH awarded contracts to Brandywine Counseling & Community Services and Connections Community Support Programs as Level 4 providers, the highest level in Delaware for SUD treatment. That means the two organizations can provide clients with every level of treatments and services, including all three FDA-approved forms of medication-assisted treatment. Later this fall, DSAMH expects to add more treatment providers at each level of care. DSAMH also awarded a peer recovery specialist contract to Recovery Innovations International to help navigate individuals into treatment and to maintain their connection to that care.

“To reduce the toll that addiction is taking across our state, we must engage people suffering from substance use disorder in treatment available today. We know what works, now we need more patients with access to medication-assisted treatment combined with behavioral counseling and social supports,” said DHSS Secretary Dr. Kara Odom Walker, a board-certified family physician.

In April 2017, Secretary Walker asked a team of researchers and clinicians from the Johns Hopkins Bloomberg School of Public Health to conduct a review of Delaware’s treatment system. In July 2018, the Johns Hopkins team issued a 33-page report that proposed four main strategies:

  •  Increase the capacity of the treatment system.
  •  Engage high-risk populations in treatment.
  •  Create incentives for quality care.
  •  Use data to guide reform and monitor progress.

“The START Initiative is one of the first steps forward in embracing the recommendations of the Johns Hopkins report to strengthen the treatment system in our state,” Secretary Walker said. “Our goal is to offer care to individuals suffering from opioid addiction that is high-quality, comprehensive, coordinated, evidence-based and person-centered. The treatment hubs will care not only for the individual’s treatment needs, but also navigate the social determinants of health that often matter more in achieving overall health and positive treatment outcomes.”

In DHSS’ Fiscal Year 2019 budget, the General Assembly approved new addiction-related funding:

  • $990,000 for SUD assessment and referral to treatment of people who have overdosed or are suffering from addiction and have been brought to emergency rooms.
  •  $328,500 for 20 additional sober living beds.
  •  $100,000 for naloxone – the prescription medication that can reverse the effects of opioid overdoses – for first responders statewide.

Lt. Governor Bethany Hall-Long, who chairs the Behavioral Health Consortium, said the START Initiative dovetails with the action items in the consortium’s Three-Year Action Plan. “Better connecting people to care when they need it most was something we heard loud and clear from the community during the Behavioral Health Consortium’s statewide forums,” she said. “Peers who have been through the recovery process will play an important role in not only connecting individuals to those services, but also supporting individuals through treatment and involving family members as needed. The START Initiative is the next step to ensuring a more comprehensive and robust behavioral health treatment system for all Delawareans.”

In June, Governor Carney signed a budget passed by the General Assembly that included $3 million in funding for the Behavioral Health Consortium, more than half of which is allocated to increase treatment and recovery services, and $2 million for improvements to the Delaware Health Information Network (DHIN) that will include behavioral health claims.

The START Initiative received a boost of $2 million in federal funding through the State Targeted Response to the Opioid Crisis grant, made possible through the signing of the 21st Century Cures Act. Through the federal grant from the U.S. Substance Abuse and Mental Health Services Administration, Delaware received $2 million per year for two years. START also will receive funding from Medicaid reimbursements and state general funds.

“Opioid and heroin addiction is a disease that affects communities throughout Delaware and our nation. The devastating effects of addiction cut across geography and do not discriminate along racial, gender, socio-economic, or party lines,” said Congresswoman Lisa Blunt Rochester. “As a member of the Bipartisan Heroin Task Force, I was proud to support the 21st Century Cures Act, which provides funding for the START Initiative and works to expand treatment and recovery services. The human cost of addiction is too great, and we must continue to work toward collective solutions that make communities across the country healthier and safer for everyone. I look forward to seeing the positive impact the START Initiative will have on the lives of those in need.”

The new system of care ensures 24/7 support through certified peer recovery specialists who will meet with individuals suffering from addiction wherever they connect with the system – a hospital emergency department, a doctor’s office, EMS transport, a police encounter or through a family or self-referral. Once individuals are in treatment, peers will help clients to navigate and stay engaged in their own care. Peers also will engage family members as appropriate to discuss treatment questions, issues, needs, options and preferences. In addition, peers will connect pregnant women to existing programs that provide home visiting and prenatal care.

Help is Here LogoElizabeth Romero, director of the Division of Substance Abuse and Mental Health, said peers are critical to building trust in the treatment system among individuals suffering from addiction. “Relying on someone with a similar lived experience will help individuals suffering from substance use disorder to believe that treatment can work in their case and they can begin the road to recovery,” she said. “We know that addiction is a disease with a high rate of relapse, so peers can be the person that someone calls at 2 o’clock in the morning when they are afraid they might be tempted to use again.”

Under the START Initiative, providers will be required to track and report aggregate outcomes, including intake assessments, clinical progress and receipt of supplementary services. The first step in understanding that level of accountability came with today’s forum for treatment partners in which they learned about evidence-based practices and the need to improve the coordination of care.

That coordination will be enhanced by an Overdose System of Care, which will establish EMS and emergency department protocols to improve acute response, initiate medication-assisted treatment to manage withdrawal, and rapidly engage individuals with treatment. In September, Governor Carney signed legislation making Delaware the first state in the nation to have an Overdose System of Care.

“The Overdose System of Care will be an important complement to the START Initiative,” said Division of Public Health Director Dr. Karyl Rattay. “Once the protocols are established, we will have another way to engage high-risk populations into treatment through a statewide system that ensures consistent, humane, evidence-based treatment and care is available and provided to those requiring acute management for overdose or substance use disorder. The goal is simple: to save more lives and to engage more people into treatment.”

In 2017, emergency medical service responders administered 2,711 doses of naloxone – a prescription medication that can reverse the effects of an opioid overdose – to 1,905 patients in Delaware. Both totals were up more than 16 percent from the 2016 totals. Additionally, law enforcement officers administered naloxone to 149 people in 2017.

Deaths from overdoses also increased in 2017, with 345 people dying in Delaware, according to the Division of Forensic Science (DFS). That total was up about 12 percent from 2016. Through Oct. 1 of this year, 218 people have died from suspected overdoses in Delaware, including a record monthly total of 39 lives lost in August, according to DFS.

If you or a loved one is struggling with addiction in Delaware, call DHSS’ 24/7 Crisis Hotline to be connected to treatment and recovery options. In New Castle County, call 1-800-652-2929. Or in Kent and Sussex counties, call 1-800-345-6785. To search online for treatment and recovery services in Delaware or nearby states, visit www.HelpIsHereDE.com.