Joining Forces to Fight Opioid Abuse

Reid Health and Meridian Health Services come together to tackle substance abuse at the regional level

Hank Milius, president/CEO of Meridian Health Services, and Craig Kinyon, president/CEO of Reid Health

One doesn’t always see an acute care hospital and a community health organization specializing in behavioral health partnering together this closely—that is, until the opioid epidemic hit. “It was time to stop the bleeding,” said Hank Milius, president/CEO of Meridian Health Services in Muncie.

The residents of east central Indiana, which has been hit especially hard by addiction and substance use disorder, now benefit from wraparound services to provide what Milius and Richmond-based Reid Health President/CEO Craig Kinyon refer to as the “continuum of care.” According to Milius and Kinyon, the collaboration is just a first step in addressing the opioid epidemic at the community level.

“We often refer patients that come through Reid to Meridian for outpatient behavioral services and detox treatment. Sharing and referring patients allows us to best treat the person along a full continuum of care, not just one piece of the puzzle,” said Kinyon.

“No one entity can do all things for all people,” said Milius. “Only by bringing great people and ideas together can great change happen.”

According to Kinyon, a holistic approach was needed after Wayne County saw a 92 percent increase in 911 calls reporting an overdose compared to just one year before. And in 2016, the overdose reversal drug Narcan (naloxone) was administered every three days on average in Reid’s emergency department. Kinyon made it the hospital’s mission to further develop services to address prevention, education and treatment options for patients suffering from substance use disorder.

“It’s time to move away from the stigma of mental health and addiction, and come together to talk about what we can do differently,” said Kinyon. “We have several tools to address this  problem together.”

To that end, Reid brought together more than 60 organizations across the region to form “Heroin Is Here,” a local effort to address the issue from the ground up. Reid works alongside law enforcement, policymakers, educators and other health care providers, including Meridian Health Services, in a collaboration that has received buy-in from the entire community.

“Patients walk into the ER, and they just need services,” said Milius. “Our partnership allows us to combine resources to better serve these patients and provide follow-up care after they’re released.”

The challenge is highlighted by alarming stats, including a spike in the number of infants born diagnosed with Neonatal Abstinence Syndrome (NAS). Most often caused by a mother taking opioids during pregnancy, NAS can cause serious problems for infants, such as low birth weight, breathing problems and post-birth withdrawal from drugs. In Indiana, infants are 25 percent more likely to die within their first year of life than infants born nationally, according to a 2014 Indiana Youth Institute report. Milius says those state numbers tie back to east central Indiana in large part due to high drug use locally.

Milius’ wife, Terri Milius, wanted to do more. Terri began volunteering as a “cuddler” for Indiana University Health Ball Memorial Hospital’s Cuddler Program. Between January 2014 and August 2015, 11 percent of infants born at IU Health Ball Memorial, or 280 out of 2,500 infants, were diagnosed with NAS. Last year she returned home from volunteering and asked her husband, “What is Meridian doing?”

“After that, we collaborated with IU Health Ball Memorial to help create solutions for this problem and we made it our mission to provide long-term guidance and support for these mothers,” said Milius. “Meridian began leading the charge to create outreach programs for infants with NAS and mothers who are struggling with addiction. A patient would report to the residency program, and we’d put an advocacy group around her.”

Meridian Health Services is the region’s largest provider of outpatient addiction services, serving over 8,000 people in the program with 350 patients on medication-assisted treatment.

Earlier this year, Meridian unveiled a new residential treatment center in Richmond with 30 beds to better serve the growing patient population seeking treatment of substance use disorders in Wayne County.

“Reid has been very supportive of our maternal treatment program and our new residential treatment center,” said Milius. “The collaboration with Reid and IU Health Ball Memorial is just another example of how Meridian has partnered  with various hospitals and organizations throughout the state to help our communities fight the drug epidemic.”

In 2016, 58 babies delivered at Reid Health were born addicted, and one in four mothers giving birth tested positive for some type of illicit drug or high-risk medication. “This is a statistic that speaks to the severity of the heroin epidemic and the innocent infants affected by it,” said Kinyon.

Like IU Health Ball Memorial’s Cuddler Program, Reid’s Baby Rocker initiative welcomes volunteers to make newborns’ first days a little better.

“Baby Rocker volunteers help not only the babies in withdrawal, but the nurses too,” said Kinyon. “The volunteers provide an extra set of arms to cuddle infants during this challenging time. The extra personal attention means better care for everyone.”

Last year, Wayne County saw 56 drug-related overdose deaths, compared to 11 deaths from automobile accidents. Since May 2015, 511 Narcan kits have been distributed by Reid Health Pharmacy.

“We should not look at our region as being unique, either from a state or national perspective,” said Kinyon. “While Fayette and Wayne County have a large number of drug poisoning deaths, our population density is lower than many other Indiana counties.”

Scott County, for example, has seen nearly 219 HIV outbreaks from needle sharing since 2015, and nearly 95 percent of those individuals are co-infected with hepatitis C. These are staggering statistics that represent 219 lives in a small, rural community.

According to Kinyon, the data suggest that rural areas have swapped death rates with urban communities over the past several years due to higher rates of drug deaths. The toll would be much worse, he said, if not for syringe exchange programs that have provided testing and connections to treatment and medical care in these communities.

To date, only eight Indiana counties have syringe exchange programs in place, with nearly 2,800 participants. According to the Indiana State Department of Health, more than 800 Hoosiers across the state have engaged in substance abuse treatment as a result of the connections made through a syringe exchange program. This includes 119 people in Fayette County.

The Centers for Disease Control and Prevention estimates that every case of HIV costs up to $400,000 over a person’s lifetime. In Scott County alone, more than 300 people who were identified as being at risk during the outbreak investigation remain free of HIV, due in large part to the syringe exchange program implemented in the area.

“Every county in Indiana should be lining up to implement these programs,” said Milius. “These Hoosiers now have access to testing for disease, referrals to housing, health insurance, social services and most importantly, to treatment.”

Milius and Kinyon urge health care leaders to lead the charge in their communities.

“Prevention is the No. 1 most actionable behavior in this fight,” said Kinyon. “The best defense is keeping people out of the user community. This must start with education, including a K-12 curriculum in schools. It also requires emergent action from the health care community.”