NEW CASTLE (Nov. 12, 2021) – Atlantic Family Physicians plans to expand access to lifesaving Medication for Opiate Use Disorder (MOUD) for more than 100 patients with opioid use disorder this year. The Georgetown-based family practice, headed by Dr. Fabricio Alarcon, currently has 12 patients on MOUD. Two full-time nurse practitioners have been hired to help provide treatment for additional patients. The expansion is funded by a federal grant provided through the Division of Substance Abuse and Mental Health in response to the state’s opioid epidemic.

Dr. Alarcon said he was inspired about the use of medication-assisted treatment for opioid use disorder eight years ago when he filled in as the medical director for a nearby outpatient treatment center. “I loved that helping patients stay sober could change their lives,” he said. “I’ve seen marriages be saved, and families get stronger when people get treatment.” Dr. Alarcon went on to obtain his board certification in addiction medicine. He began treating patients with opioid use disorder years ago, but says he’s now focused on integrating medication-assisted treatment into the primary care office setting.

Sussex County ranks high for overdoses, and its rural setting creates challenges for getting to office visits for patients who may lack transportation. “It’s critical for the state to expand the number of treatment providers in Sussex County,” said Joanna Champney, Director of the Division of Substance Abuse and Mental Health.

Champney said that expansion of treatment and overdose prevention in the state’s rural areas is a major focus of the Overdose System of Care Committee, which she co-chairs with Dr. Rick Hong, Medical Director for the Division of Public Health. “Rural areas are particularly vulnerable because people are isolated,” she said, “and they can’t get to treatment as easily, and there are fewer providers to choose from.”

The Department of Health and Social Services’ Division of Substance Abuse and Mental Health (DSAMH) is funding additional staffing and supports for Atlantic Family Physicians to expand its MOUD practice through a federal grant. The State Opioid Response (SOR) grant brought in $37 million in discretionary funds for the state to expand opioid and stimulant use treatment and overdose prevention initiatives. The Atlantic Family Physicians initiative is one of 56 sub-grant applications currently received by the division for SOR funding. In addition, 37 of the applications are focused on helping a variety of health care programs screen existing patients for opioid use disorder.

Offering medication for opiate use disorder (MOUD) in a primary care setting not only expands the provider network, but it also helps reduce the stigma around patients seeking treatment from a formal drug and alcohol treatment center. In response to the transportation barrier common in rural settings, Atlantic Family Physicians will coordinate transportation to patients in need.

Medical office manager Jessica Riddle said she enjoys the long-term relationships formed with patients who regularly come in for treatment. “It is important to us that patients don’t feel judged coming in for treatment,” she said. “We treat all patients with respect.” Special bonds form with patients as they engage in treatment. “We see them regularly, and we get to know them and then if they miss an appointment, we worry about them and call and check to make sure they are OK,” Riddle said.

Depending on the specific medication a patient is taking for opioid use disorder treatment, the frequency of office visits varies. Initially, patients come in weekly. As they continue to engage in treatment and begin to improve, office visits can begin to be spaced out. Most patients end up coming in monthly. Patients who are coming out of active addiction typically are prescribed buprenorphine, Dr. Alarcon said. Those who may be coming out of an inpatient or outpatient treatment program can be prescribed Vivitrol, especially if they are also using alcohol.

Alarcon says patients may stay on medication-assisted treatment for 6 months or up to 10 years or longer. “It really depends on the patient,” he said. “You have to let your brain retrain itself. People who are still emotionally unstable, experiencing mood swings, may not be ready. Their brains are still reacting to the addiction. You’ll know you can consider tapering off treatment when you start to feel more leveled.” In his experience, patients who stop treatment too early often struggle to manage their cravings and are at higher risk to relapse. Last year, there were 447 fatal drug overdoses in the state, with 122 in Sussex County.

Two nurse practitioners in the office completed 24 hours of training to obtain the necessary credentialing to prescribe medication for opioid use disorders. The credential is commonly referred to as the “x-waiver.” Dr. Alarcon also recently hosted a meeting to train and educate all the office staff about how to talk with patients about treatment for opioid use disorder. “It’s new to a lot of medical staff, and we want our patients to feel welcome at the practice,” he said.

In addition to obtaining the required x-waiver, Alarcon’s staff participated in the Office-Based Opioid Treatment (OBOT) Fellowship, which teaches treatment providers how to help patients manage opioid use disorder through treatment approaches. “The course was amazing and taught us how to design office workflows for this type of treatment. It also showed us how to bill insurance. It was probably the best training we’ve ever received,” Dr. Alarcon added. DHSS’ Division of Medicaid and Medical Assistance sponsored the OBOT fellowship this year, supported by the SUPPORT Act Planning Grant from the Centers for Medicare and Medicaid Services. DSAMH plans to offer the trainings to additional providers this year using federal funds.

The next challenge Dr. Alarcon hopes to address is the high number of patients who leave emergency departments after a non-fatal overdose, but never show up to start treatment. His dream is to offer 24-hour induction, meaning patients could be brought to his practice anytime, day or night, after leaving an emergency department, to begin treatment for their opioid use disorder. An expansion of this type would require additional staff. However, Alarcon admits that since he is always on call, he already sees patients on a totally flexible schedule, with no set time windows. “We are here. We are willing to help people not only get sober, but to get their lives back together.”

Asked what advice he would give to other doctor’s offices considering expansion to include treatment for opioid use disorders, Alarcon said he would tell them to “absolutely do it.” He said he is willing to mentor doctors in the process and welcomes the opportunity to show medical professionals first-hand how expanding their practices to include these patients can be incredibly rewarding. “Honestly, the patients are great. I had one patient who would literally go out during a hurricane or a tornado to get his next heroin fix. That’s how much he was in the grip of addiction. And now he’s sober. He tells me that I saved his life. Even though he actually saved his own life by getting sober, we helped him in the process.”

The state’s Bridge Clinics, which are operated by the Division of Substance Abuse and Mental Health, are also partially funded with the federal SOR grant funds. Three Bridge Clinics statewide – one in each county – see walk-in clients, at no cost, for any type of mental health or substance use disorder. Clients are evaluated promptly and a connection to a longer-term treatment plan is arranged.

Grant funds are also being utilized to add substance use clinicians within the Delaware State Police. The program, which is operational in three troops and seeks to double its reach this year, connects people with substance use disorder to a clinician in lieu of arrest when they have contact with police. Naloxone, the lifesaving overdose reversal medication, is also being distributed with the grant funds. During the past year, more than 13,000 naloxone kits have been distributed, along with training on how to appropriately respond to an opioid overdose and use the medication.

If you or a loved one are struggling with substance use, you are encouraged to call the Delaware Hope Line at 1-833-9-HOPEDE or text CONNECT to 55753.

Funding for these initiatives is supplied by grant number 5H79TI083305-02 from the Substance Abuse and Mental Health Services Administration (SAMHSA). The content of this publication does not necessarily reflect the views or polices of SAMHSA or the U.S. Department of Health and Human Services (HHS).

Commissioner Navarro to provide Naloxone kits and training at event

Insurance Commissioner Trinidad Navarro, in collaboration with Public Health’s Kent County Community Response Team, the First Presbyterian Church of Smyrna, and the Smyrna-Clayton Ministerium will provide free training and opioid rescue kits to residents on Wednesday, October 14 from 2:00 to 5:00PM. The event, taking place outdoors at the First Presbyterian Church of Smyrna, 118 W. Commerce St. will offer both drive-through and walk up options in order to maintain social distancing.

“Amidst the COVID-19 pandemic, we can’t forget about the opioid epidemic. Addiction has its grip on our community, and with this event and others, we can make sure that Naloxone gets to individuals and families who may need it during an opioid overdose emergency” said Commissioner Navarro. “While we continue to work to ensure that treatment for those with drug dependencies is affordable and accessible, events like these offer an opportunity to increase awareness and education life-saving techniques and tools.”

Attendees will spend roughly ten minutes being trained to recognize and respond to an opioid overdose emergency, as well as learning about local treatment and support resources. Opioid Rescue Kits, each containing two doses of Naloxone, an opioid overdose reversal medication, will be distributed. Residents who are at risk of experiencing and overdose, or individuals whose loved ones may be at risk, are strongly encouraged to attend.

If you or a loved one are struggling with substance abuse, do not wait, find help today. The Division of Substance Abuse and Mental Health launched the 24/7 Hope line to serve as a single point of contact for resources, info, clinical and peer support, and crisis assistance. Call 1-833-9-HOPEDE or visit HelpisHereDE.com.

Any residents having problems obtaining insurance approval for treatment or prescriptions related to substance abuse or mental health needs, contact the Delaware Department of Insurance’s Consumer Services Division by emailing consumer@delaware.gov or calling (302) 674-7300.

Event attendees and media representatives must observe social distancing and wear a face covering.

NOTE TO MEDIA: If you plan to attend, please RSVP to Christina.Haas@Delaware.gov.

Health Officials Fear Rising Death Toll May Be Consequence of COVID-19

NEW CASTLE (June 16, 2020) – In what Department of Health and Social Services (DHSS) officials fear may be a consequence of the uncertainty associated with the COVID-19 pandemic, deaths from suspected overdoses in Delaware during May tied a previous monthly total set in 2018, according to death investigation reports from the Division of Forensic Science.

In May 2020, 39 people died from suspected overdoses in Delaware. That ties the previous monthly high total set in August 2018. Among the 39 deaths in May, 20 were from New Castle County, 14 from Sussex County and five from Kent County.

Through May 31, 160 people have died from suspected overdoses in Delaware. That total is a 60% increase over a similar period in 2019 and a 48% increase over the same period in 2018.

“We are worried about the impact that COVID-19 is having on Delawareans who already are struggling with substance use disorder,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “The pandemic is difficult for all of us emotionally, but none more so than people struggling with addiction, mental illness or both. And with such public health measures as social distancing in place to reduce people’s risk for COVID-19, treatment referrals for those with substance use disorder can be more difficult to access and the actual treatment can look different than what people are used to receiving.”

To help Delawareans cope with stress and address behavioral health needs during the coronavirus pandemic, DHSS’ Division of Substance Abuse and Mental Health in May launched the 24/7 Delaware Hope Line – a single point of contact where callers can connect to a variety of resources and information, including support from clinicians and peer specialists plus crisis assistance. For support, Delawareans can:

• Reach the free Hope Line at 1-833-9-HOPEDE or 1-833-946-7333.
• Get behavioral health tips and reminders by texting DEHOPE to 55753.
• Search for treatment services and resources in Delaware or nearby states at DHSS’ one-stop website, HelpIsHereDE.com.

Elizabeth Romero, director of the Division of Substance Abuse and Mental Health (DSAMH), urged individuals in active substance use to consult with a medical provider immediately or to call the Delaware Hope Line to be connected to trained crisis professionals who can discuss treatment options. “We know this pandemic has been especially difficult for those with substance use disorder,”

Romero said. “The Hope Line can help. Every call is answered by a trained crisis counselor, 24/7, ready to assist you in any way.”

Romero said the division is preparing for the correlating wave of despair with providers and increasing access to care and flexibility with telehealth. DHSS’ Division of Substance Abuse and Mental Health and Division of Public Health also have teamed up with several partners across the state to provide naloxone, a medication that can reverse an opioid overdose. A key partnership with the Food Bank of Delaware provides drive-through food pantry and life-saving naloxone distribution. These events will happen across the state in the upcoming weeks. “If you have a loved one with substance use disorder, please have naloxone on hand,” Romero said.

The increase in deaths from suspected overdoses during the first half of 2020 follows another increase in overdose deaths for all of 2019. In its annual report for 2019, the Division of Forensic Science reported 431 overdose deaths, an increase of almost 8% over 2018. The 431 deaths by county:

• New Castle County: 278
• Sussex County: 100
• Kent County: 53

Of the 431 total deaths, the Division reported that 341 (79%) involved fentanyl, a synthetic pain reliever that is 50-100 times more potent than morphine. The percentage of total cases in 2019 involving fentanyl was 5 percentage points higher than in 2018.

Romero encouraged anyone who is using or suffering from addiction to call for help, see a medical provider, or ask a police officer or another first responder for help. “Too many times, our police officers, EMTs and other first responders see first-hand the dangers of overdoses,” she said. “Our first priority is to save lives.”

Under Delaware’s 911/Good Samaritan Law, people who call 9-1-1 to report an overdose and the person in medical distress cannot be arrested for low-level drug crimes.

Division of Public Health Director Dr. Karyl Rattay urged those in active use to get naloxone through one of DSAMH’s Bridge Clinics, at a participating pharmacy – where no prescription is required – or at a naloxone training.

“Naloxone saves lives,” said Division of Public Health Director Dr. Karyl Rattay. “We urge anyone who needs access to naloxone to go to a Bridge Clinic, a training class or distribution event, or to a participating pharmacy to buy the overdose-reversing medication. We also encourage Delawareans to download OpiRescue Delaware, a smartphone app that provides lifesaving step-by-step instructions on how to respond to an overdose, including administration of naloxone.” To find the Bridge Clinic in your county, training or distribution events, or a participating pharmacy, go to HelpIsHereDE.com, and click on the overdose prevention tab.

Opening of New Treatment Facilities, Tightened Regulation of Medication Assisted Treatment, and Additional Reforms In Prescribing Practices Among Recommendations

On the heels of a federal report last week that showed Delaware with the fastest rising rate of fentanyl-related overdose deaths in the country, government leaders and advocates gathered at the Delaware Department of Justice today to highlight critical next steps for the state in its battle against opioid abuse. Several of the recommendations made today were based upon the release of a formal inventory of Delaware substance abuse treatment options commissioned by DOJ.

The treatment needs assessment released today by DOJ, independently written by Hornby Zeller Associates, found that Delaware is treating just over half of the individuals in need of opioid abuse treatment, with 11,000 persons in need of treatment and only 6,000 receiving it. The full treatment assessment report can be found here.

Lt. Gov. Bethany Hall Long, DHSS Secretary Kara Odom Walker, State Senator Stephanie Hansen, State Representative David Bentz, state Public Health Director Dr. Karyl Rattay, state Police Chief Councils head and Camden Police Chief William Bryson and atTAacK addiction founders Don and Jeanne Keister gathered with Attorney General Denn to release the treatment assessment, reflect on progress made in the last few years and discuss future steps in addressing the opiate crisis.

Attorney General Denn released a third annual plan from the Department of Justice on additional steps that should be taken to deal with an “opioid epidemic that is ruining lives, shattering families, and wreaking havoc on our criminal justice system.” Denn noted that the DOJ plan is “quite specific in what should be done, who should do it, and on what time frame. Most of those time frames are quite aggressive. Because people are dying, and there needs to be a focus and urgency about our work.

Based on a calculation in the treatment assessment report that the state needs more treatment facilities, Attorney General Denn on Wednesday said he believes that the state should use economic development financing to help start them.

“The state has spent economic development funds on all sorts of initiatives over the past two decades, including the expansion and maintenance of other health care facilities,” Attorney General Denn said. “Now it is time to use economic development funds to create jobs in an area where Delaware desperately needs them: substance abuse treatment.”

The Department of Justice plan includes nine points:

1. The State Should Allocate $4 Million In One-Time Funds To Expand the Availability of Quality Treatment Facilities That Allow for Extended Residential and Outpatient Treatment.
2. Improved Monitoring and Regulation of Existing Medication Assisted Treatment Programs.
3. Development of a Recovery High School for Delaware.
4. Institutionalization of Naloxone Funding for First Responders.
5. Addressing Co-Prescription of Benzodiazapenes and Opioids.
6. Evaluation of Involuntary Treatment.
7. Funding of Support Services to Ensure Coordination Between Actors in the Substance Abuse Treatment Community.
8. Expanded Use of Naltrexone for Persons in Corrections System.
9. Insurance Coverage For Alternative Pain Treatments.

Details on these recommendations can be found in the DOJ plan here.

The plan released Wednesday follows previous plans released by Attorney General Denn in 2015 and 2016 laying out steps for addressing what he has referred to as “the public health crisis of our generation.” Progress cited Wednesday includes much stricter controls on the prescription of opioids, laws passed to help break down insurance and Medicaid barriers to getting people treatment, and dramatic increase, thanks to the hard work of advocate and the public safety community, in the number of police and other first responders who now carry Naloxone, which has been used hundreds of times to resuscitate overdose victims and prevent fatalities.

“An average of 20 Delawareans die of an overdose each month,” said Lt. Governor Hall-Long. “Each of those deaths represent the loss of a person with hopes, dreams, and families who loved them. As policy makers and leaders, we must fix our broken system, and save lives. This report highlights recommendations that will work jointly with the efforts of the behavioral health consortium in setting short-term and long-term strategies to combat the greatest public health epidemic of our generation.”

“Addiction is a public health crisis that has taken far too many lives and impacted far too many families in Delaware and across the country,” Department of Health and Social Services (DHSS) Secretary Dr. Walker said. “As with any public health crisis, we need an ‘all-hands-on-deck’ approach. DHSS is working hard to evolve the treatment system so that it is comprehensive, coordinated, high-quality and person-centered. None of us can address this complex and deeply challenging issue alone, and I look forward to working with our many partners.”

“For someone lucky enough to have a person who cares about them, and who can get them into an in-patient detox facility, they’ve navigated the first step,” said Senator Hansen. “But discharge to the street after a week or less in treatment with no plan for the next stage in the treatment continuum, is a recipe for failure. It nearly guarantees a revolving door, and this happens a lot.”

“I am proud to stand alongside Attorney General Denn and support these efforts to improve our drug treatment policies,” said Rep. Bentz, who chairs the House Health Committee. “It’s vital that we all recognize that we are dealing with addiction and need to treat it as such. Having the Department of Justice’s support is a big step in the right direction. It’s going to take a concerted effort by all stakeholders to truly make a difference because we are facing such a substantial opponent in addiction.”

“The Division of Public Health has been hard at work taking a comprehensive approach to addressing the opioid crisis working with many partners through the Prescription Drug Action Committee, now the Addiction Action Committee,” said Division of Public Health Director Dr. Rattay. “An important priority for us is to engage individuals including a ‘warm handoff’ to treatment, or back into treatment, at opportune times – such as following an overdose or when an individual is involved in the criminal justice system. Building upon the Help is Here website and campaign, we join our other colleagues at DHSS to work with the community to reduce barriers to accessing treatment.”

“I’m not a doctor, I’m not a lawyer, but I am a dad with a little bit of experience. However, I am an educator,” said atTAcK addiction member Don Keister, “and I can tell you this recovery high school is needed.”

NEW CASTLE (April 22, 2017) – In the wake of a significant increase in heroin overdoses in western Sussex County, including one that was fatal, from Thursday through early Saturday, health and law enforcement officials are warning users, families, treatment providers and health care professionals of the dangerous spike.

For users and families who want to be connected to treatment immediately, call the Department of Health and Social Services’ 24/7 Crisis Helpline at 1-800-345-6785 in Sussex and Kent counties, or 1-800-652-2929 in New Castle County. If individuals see someone overdosing, they should call 911. Under Delaware’s 911/Good Samaritan Law, people who call 911 to report an overdoses and the person in medical distress cannot be arrested for low-level drug crimes.
Sergeant Richard D. Bratz, director of the Public Information Office for the Delaware State Police reports that a significant spike of heroin overdoses has occurred over the past several days in Sussex County. The Sussex County Drug Unit is actively investigating and seeking information on any of the drug overdoses. The public is encouraged to call Sergeant M. Dawson of the Sussex County Drug Unit at 302-752-3815 with any information.

Michael Barbieri, director of the Division of Substance Abuse and Mental Health, alerted treatment providers statewide of the surge in overdoses in western Sussex. Hospitals and urgent care centers were notified of the increase by the Division of Public Health’s Emergency Medical Services, which oversees the state’s paramedic service. EMS responded to seven reported overdoses in a 24-hour period beginning Thursday in the Seaford and Laurel areas. In several of the cases, paramedics used naloxone, the overdose-reversing medication, to save the individual before transporting each person to the hospital.
“This spike in overdoses is alarming,” said Dr. Kara Odom Walker, a family physician and Cabinet Secretary for the Department of Health and Social Services. “Even one use of heroin or another opioid can end a life. For people in active use and their families, please convince your loved ones to seek treatment for their addiction or keep naloxone in your home. Addiction is a disease and treatment does work. Our staff at the DHSS Crisis Helpline will listen and they will connect you to treatment options.”

In 2016, 308 people died from overdoses in Delaware, almost triple the number who died in traffic accidents. In 2015, a total of 228 people died from overdoses in Delaware, with 222 overdoses deaths reported in 2014.

Prevention, treatment and recovery information and resources in Delaware and nearby states also are available on DHSS’ www.HelpIsHereDE.com website. DHSS will initiate a community outreach campaign in May that will include an unveiling of the revamped website, materials for medical providers on prescribing pain medications, and information on how to screen patients and connect them with addiction treatment resources, as well as materials on preventing substance exposure in infants.

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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.