Q&A: Silver Hill Launches Outpatient Opioid Addiction Program

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Here’s a startling statistic from Dr. John Douglas, clinical director at New Canaan-based psychiatric hospital Silver Hill: Without professional treatment, the relapse rate people addicted to opioids is 90 percent.

New Canaan, like every other community in the region, has seen a sharp rise in heroin use in recent years, including among youth. State officials report that opioid-related deaths increased from 490 in 2013 to 558 in 2014.

As Douglas tells us in a back-and-forth that’s printed in full below, insurance companies are moving in the direction of not covering inpatient treatment for people who are addicted to heroin or pain pills.

To meet the need, Silver Hill is launching a new Outpatient Opioid Addiction Program that will be covered by most insurance plans.

It will be led by Douglas, who completed his Addiction Psychiatry Fellowship at New York University, where he worked at both Bellevue Hospital and the Manhattan VA Medical Center. Douglas completed his General Psychiatry Residency at Emory University where he served as Chief Resident. Prior to completing his training in psychiatry, he received his M.D. from Georgetown University and M.B.A. from University of California, San Diego.

Silver Hill President and Medical Director Dr. Sigurd Ackerman said Douglas “has a unique set of talents.”

Here’s our exchange.

New Canaanite: We know heroin, among other opioids, is out there and attainable for New Canaan youth and other residents. Talk to us about what prompted the creation of this new program.

Silver Hill Hospital's Outpatient Opioid Addiction Program will be led by Clinical Director Dr. John Douglas. Contributed

Silver Hill Hospital’s Outpatient Opioid Addiction Program will be led by Clinical Director Dr. John Douglas. Contributed

Dr. John Douglas: Deaths from overdose with heroin or pain pills have been steadily increasing in the United States over the past two decades, particularly in suburban communities and New Canaan is no exception. More people now die in the U.S. from drug overdose than traffic accidents. At the same time, insurance companies are trending toward not covering inpatient treatment for people who abuse heroin or pain pills. Silver Hill recognized this gap of care for many patients and decided to create an outpatient program covered by insurance to help people addicted to heroin or pain pills become stable in recovery and not die from overdose.

What would you say to a New Canaan family that has a son, daughter or other member who is going through the absolute hell of addiction, and perhaps not getting treatment just now?

Addiction is destructive to entire families, not just the person addicted. It is important for all family members to get the support they need and to look for treatment programs which include family in the recovery process. The first step in finding these programs is often contacting your insurance company and learning what addiction treatment options are available in your area.

We have seen young people from New Canaan die of heroin overdoses, though the deaths did not physically happen in our town. Talk to us, if you can, about how most New Canaan kids start on a path that leads to heroin.

Most people with addictive disorders begin using substances in adolescence under social pressure. Having friends who use substances is one of the strongest predictors of substance use. People usually start with substances that are more widely available like alcohol, cigarettes and marijuana. The longer they associate with people who use drugs the more likely they are to try other drugs, like pain pills. People usually obtain pain pills from friends or relatives who were prescribed them legitimately by a doctor. Once that supply runs out, people who have become addicted often turn to buying pain pills on the street that are extremely expensive. They quickly learn that heroin when injected gives the same high and is much cheaper. This is how many people from suburban communities, like New Canaan, progress from associating with people who use drugs in high school to becoming fully addicted to IV heroin in their early twenties.

Your approach is a combination of psychiatric and pharmacological. Talk to us about how this works.

Opioids, like heroin and pain pills, are some of the most addictive drugs in the world. They affect the brain differently than alcohol. People addicted to opioids often require taking medications like buprenorphine or extended-release naltrexone for months to years. These medications have been shown to significantly reduce the risk of relapse and death from opioid addiction. Using these medications in combination with psychotherapy is the optimal approach.

What is the best that an opioid addict—say, a heroin addict—can hope for after going through this treatment? To what degree are former addicts returned to the people they were prior to using?

Without professional treatment, the relapse rate on opioids for people addicted to them is 90 percent. That means most people need professional help to overcome their addiction to these drugs. Through completing all three phases of our Outpatient Opioid Addiction Program, patients are well prepared to live satisfying lives, stable in their recovery.

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