FRONT COVER
Laboratory
Morse Clinic of North Raleigh 3209 Gresham Lake Rd, Bldg 10, Ste 113 Raleigh, NC 27615 919-977-5993
www.morseclinics.com
No matter where you are on your journey to recovery, our staff is committed to helping you succeed during treatment . www.morseclinics.com
CONTENTS To send a comment or question, write to: Morse Clinics 8300 Health Park, Ste 201, Raleigh, NC 27615 (919) 676-9699 Morse Clinics Magazine is published by theinfluence.org Copyright 2016 by theinfluence.org . No part of this publication may be reproduced in any form or by any means without the prior written permission of the publisher, excepting brief quotations in connection with reviews written specifically for inclusions in magazines or newspapers, or limited excerpts strictly for personal use. Printed in the United States of America. All rights reserved.
6830 West Villard Ave Milwaukee, WI 53218 FEATURES 08 THE RIGHTMEDICINE Dr. Morse explains the importance of treating addiction like a chronic illness 12 BRIDGING BRAIN AND BEHAVIOR COO brings two decades of neuropsychology experience 16 THE PRICE OF PAINKILLERS John Mattocks explains the complexity of opioid addiction 46 10 REASONSWHY I DONOT LIKE BENZODIAZEPINES By Dr. Eric Morse, MD 50 PROGRESS YOU CAN SEE CMO of Morse Clinics explains importance of medication-assistance for opioid users 54 HOWTOCHOOSE BETWEENMETHADONE AND BUPRENORPHINE Halfway house program supports lasting recovery 60 A HARMFULMISCONCEPTION Morse Clinics counselor shares the importance of using medication-assistance programs
IN THE NEWS 24 BEND BUT DON’T BREAK Yoga is being used to help people maintain recovery and avoid relapse 26 COPINGWITH DISCRIMINATION Discrimination remains largely ignored as a cause of substance abuse 28 FIGHTING FIREWITH FIRE Researchers look to combat addiction through repurposed pharmaceuticals 30 HIDDENDANGERS Alcohol poses whole host of health concerns 32 MORETHAN SKINDEEP Implant represents revolutionary approach to treating opioid addiction
34 UNDERSERVED AND UNDETERRED Overcoming the unique challenges LGBTQ individuals face with addiction 36 RELAPSETRACKERS Fitness trackers can help prevent relapses 38 PROLONGINGTHE PAIN Study suggests painkillers may be having the opposite effect in the long run 40 GROWING CONCERNOVER HEROIN USE New poll shows Americans are increasingly concerned with the dangers that heroin use poses to the country 44 BOOM, BUST, ANDDRUGS Study says economic downturn leads to increase in substance use disorders
INFLUENCE AD 1
Your source for news and information on Addiction, Recovery, and Everything in Between politics society culture incarceration crime reentry poverty
INFLUENCE AD 2
6
The best things are yet to come.
3209GreshamLake Rd, Bldg 10, Ste 113 Raleigh, NC 27615 (919) 977-5993 Call Us www.morseclinics.com 7
Dr. Morse explains the importance of treating addiction like a chronic illness Medicine The
When Dr. Eric Morse told his colleagues he was going to do an addiction fellowship, they didn’t understand his interest in that eld. In Dr. Morse’s experience, there’s a stigma attached to substance abuse services within the medical community. Some doctors believe addiction is a mental issue rather than a chronic illness. Dr. Morse, who now oversees four medication-assisted treatment clinics, says there is no evidence to support this belief. “It’s been proven that addiction is as much of a disease as diabetes is,” says Dr. Morse, a board-certi ed addiction psychiatrist. “If you have a disease, you want to go to a doctor for it.” INADEQUATE TREATMENT Dr. Morse graduated from Northwestern University’s Feinberg School of Medicine and completed his residency at the University of North Carolina at Chapel Hill. Starting his training in Maryland, where recovery services were more widespread and advanced, he led several methadone clinics before returning to North Carolina and opening the rst Morse Clinics center in 2006. That’s when it became clear to him that substance abuse was not being treated properly in North Carolina, naming a signi cant lack of resources and awareness as possible causes. His clients were reluctant to consider maintenance programs, only inquiring about them after years of failed attempts at recovery through non-medical practices. Viewing maintenance programs as a last resort is a misconception that Dr. Morse hopes to end. “We really need to be providing maintenance therapy rst. There’s only a 10% chance of recovery with programs like NA or AA alone. With medical treatment, the chance of recovering is 60%. Not recommending treatment that has been proven as more effective is close to malpractice,” says Dr. Morse. The disconnect between medicine and addiction is
“If you have a disease, you want to go to a doctor for it.” -Dr. Eric Morse, founder and CEO of Morse Clinics largely resulting from a lack of knowledge and understanding, according to Dr. Morse. North Carolina currently doesn’t offer training programs for any physicians in addictions. There is also an issue of countertransference, in which a medical analyst might have an emotional bias against their patient’s issue. That’s why Dr. Morse partners with the Governor's Institute to educate medical personnel and state of cials on addiction as a chronic illness, and the importance of treating it as one. A HEALTHY MINDSET When clients enter his clinics, they often experience high levels of guilt and shame. This can stem from believing their addiction is a personal fault or was a result of poor choices, rather than being a result of genetics and exposure like other medical conditions. Beginning to treat their illness with medication can help lift away some of this self-blame, empowering clients to get stabilized and begin dealing with underlying personal issues. While Dr. Morse believes counseling and 12-step
programs are effective processes for dealing with such issues, they need to be combined with medical treatment to create a holistic approach. This approach creates a healthier mindset so the patient can better handle the dif cult process of confronting their internal state. The process eventually leads to tapering off the medicine for most patients, though this could take several months or several years depending on the individual. Some patients may choose to stay on medication inde nitely, not wanting to risk their sobriety. “I encourage my patients to use the maintenance program for as long as they feel is right,” says Dr. Morse. “Some people think medicine is a crutch. Well if you break your leg, wouldn’t you want a crutch?”
“
Not recommending treatment that has been proven as more
effective is close to malpractice. -Dr. Eric Morse
9
AGENCY AD 1
10
AGENCY AD 2 Your Source for News and Information on Addiction, Recovery, and Everything In Between
11
Dr. Vicki Ittel has worked in the addiction Pennsylvania, Dr. Ittel received her PhD from SUNY Stony Brook, completed a Postdoctoral Fellowship at Boston University, and an MBA from New Hampshire College. Since divesting her previous addiction clinics, Dr. Ittel relocated to Raleigh to help address the need for increased treatment resources in eastern North Carolina and has partnered with Drs. Morse and Stanton as an owner PROVIDING ACCESS After attending a meeting in Washington D.C. to discuss substance abuse, Dr. Ittel was asked to expand Mountain Health Solutions, treatment centers for opioid addiction. At the time, North Wilkesboro, North Carolina had the highest death rate per capita, but no treatment resources. She and colleague Elizabeth Stanton opened another outpatient treatment center, which provided medication-assisted treatments such as suboxone and methadone to assist opioid recovery. Not long after the center opened, death rates in the area went down. “I’m proud of the work we did there,” Dr. Ittel says. “We provided a lot of people with the treatment they didn’t have access to before.” When it comes to the alarming drug-related death rates in North Wilkesboro, Dr. Ittel says it’s a common problem for small towns where the economy is dependent on physically challenging labor. “You tend to see more opioid addiction in places where the jobs are more dangerous,” Dr. Ittel says. “Workers start taking pain pills for an injury and it becomes an addiction.” Dr. Ittel believes our current opioid use epidemic impacts all ages, socioeconomic status, and
geographic areas. One of the contributors to the epidemic is that opioid use may begin for legitimate purposes and is prescribed by a physician. Though there are guidelines doctors must follow, Dr. Ittel says there’s a need for more training in regards to prescribing painkillers and monitoring the process with patients. Another distinction is an opioid’s ability to “hijack” your body, according to Dr. Ittel. Stopping use such as body aches, vomiting, diarrhea and pain sensitivity. With methadone-assisted treatment, methadone or buprenorphine attaches to opioid receptors in the brain to normalize brain chemistry, so patients can taper off their addiction slowly without the overwhelming physical symptoms.
COO OF MORSE CLINICS BRINGS TWO DECADES OF NEUROPSYCHOLOGY EXPERIENCE
12
HOLISTIC TREATMENT At the beginning of her career, Dr. Ittel worked as an addiction counselor. Her interest is in understanding the interaction between the brain and behavior. In the case of addiction, brain chemistry and function are affected by behavior and vice versa. Dr. Ittel believes addiction is a symptom of root causes that must be addressed through counseling. Drug use has been linked with depression, anxiety and other mental health issues. To reduce the chances of relapse, treating underlying issues is as critical as stopping physical use. Medication assistance helps normalize the client and creates a quieted mindset, which helps them begin to explore the emotional and psychological causes.
“WORKERS START TAKING PAIN PILLS FOR AN INJURY AND IT BECOMES AN ADDICTION.” - Dr. Vicki Ittel, Chief Operating Officer, Morse Clinics
The staff of physicians and counselors at Morse Clinics collectively bring immense medical knowledge and counseling strategies, working to provide a holistic treatment option for clients. “We’ve formed a great team here,” Dr. Ittel says. “Everyone here has a lot of experience and a large network of resources. We bring together our different strengths to offer the best possible treatment for every client.”
“EVERYONE HERE HAS A LOT OF EXPERIENCE AND A LARGE NETWORK OF RESOURCES.” - Dr. Vicki Ittel 13
YOUR PATH TO RECOVERY STARTS TODAY
14
JOHNSTON RECOVERY 1699 Old Highway 70 West Clayton, NC 27520 919-359-1699
www.morseclinics.com
15
JOHN MATTOCKS EXPLAINS THE COMPLEXITY OF OPIOID ADDICTION
As program director at Morse Clinic’s Vance Recovery, John Mattocks ensures that the clinic is operating at its best daily. This includes everything from keeping the books to vacuuming oors, all to ensure that guests feel comfortable during their stay. He also helps resolve individual client problems and works to meet their speci c treatment needs. “We try very hard to make this a welcoming and comfortable environment for our guests,” Mattocks says. “Treatment is a long process that can’t happen unless they feel safe with us.” PRESCRIPTIONS GONE WRONG Morse Clinics provide maintenance therapy for opioid addiction recovery. Opioid addiction is generally different from other substance abuse because of the intensity of cravings and severe withdrawal symptoms, Mattocks explains. Addiction can result after being prescribed painkillers for an accident or sports injury. A person may respond pleasurably to the prescription medication, creating a need to maintain that state of euphoria. Medication-assisted treatment helps block the “high” caused by opioid use and lessens withdrawal pains. For many, this is the last hope for recovery. “No one comes to our clinic who isn’t ghting for their life,” Mattocks says. “They’re unable to meet basic survival needs. I’ve had clients who can’t function without drugs in their system. They’re not using to get high anymore. If they don’t have the drugs, they can’t get out of bed.” Medications such as methadone and buprenorphine suppress drug cravings to stabilize
clients and enable them to make informed decisions on starting their recovery. Given a clear and steady mindset, they can begin to work on other aspects of recovery such as lifestyle changes, primary care treatment and mental health counseling. REBUILDING FROM WITHIN A majority of Vance Recovery patients have experienced some sort of trauma or mental illness in their life. Mattocks believes it’s essential to combine medication with counseling and behavioral therapy in order to face these issues and form a holistic approach for treatment.
16
“ NO ONE COMES TO OUR CLINIC WHO ISN ’ T FIGHTING FOR THEIR LIFE. ” -John Mattocks, program director at Vance Recovery
The center encourages every individual to participate in the variety of counseling programs available. Their art therapy group provides a unique way of handling the complex emotions that arise during treatment. The group meets once a week to work on different projects that usually re ect their internal struggles. One such project was building two masks—one for how the world sees the patient and another for how they perceive themselves. Mattocks thought this might help them deal with the stereotypes and generalizations about their disease made by the general public. He believes these projects give powerful and healing insight into their personal journey with addiction, an essential step towards healing.
To contact Vance Recovery give us a call: (252) 572-2625 We are located at: 510 Dabney Drive, Suite B Henderson, NC 27536
IT ’ S ALL THEM. THE MEDICINE JUST HELPS. ” -John Mattocks
“
After working through these inner issues, clients begin restoring their external world. They grow stronger by learning life skills, emotion regulation skills and other methods for maintaining their sobriety when facing triggers. It’s a challenging process and something they will have to work hard to manage after leaving the center. According to Mattocks, those who recover successfully don’t receive enough merit for their recovery. “There’s a stigma for people who take medication to stop drug use,” Mattocks says. “My patients aren’t given enough credit. They work hard to rebuild their life. It’s all them. The medicine just helps.”
Does someone you care about need help treating their substance addiction?
www.morseclinics.com
18
ASSISTING OUR PATIENTS IN ATTAINING A MATURE AND PRODUCTIVE LIFESTYLE, FREE OF SUBSTANCE ABUSE. www.morseclinics.com
19
Are you seeking treatment or want to learn about treatment options for yourself ?
www.morseclinics.com
20
LEARN THE BASICS ABOUT
METHADONE AND BUPRENORPHINE, AS WELL AS HOW TO SUCCEED IN TREATMENT AT MORSE CLINIC.
919-359-1699
www.morseclinics.com
21
If you need immediate assistance, please call one of our offices. 919-977-5993
22
AT CCL WE PRIDE OURSELVES ON EVIDENCE BASED IMPLEMENTATION OF CLIENT CENTRIC
INITIATIVES, WHICH ALSO RESPECTS THE UNIQUE NUANCES OF PHYSICIANS AND THEIR PATIENTS
Laboratory
24555 Southfield Rd., Suite 100 Southfield, MI, 48075
888 . 392 . 6042 248 . 864 . 8592 www.clinicalconnectlaboratory.com
Clinical Laboratory Testing with Clinical Connect
Clinical Connect is a leader in Clinical Laboratory testing, offering laboratory services as well as practice management tools to help clinicians coordinate and optimize patient care.
Clinical Connect was originally founded in 2011 with a laboratory in Southfield, MI focused on the esoteric testing using liquid chromatography – mass spectrometery (LC/MS) technology. In 2014, Clinical Connect established a Scientific Advisory Board, comprised of leading experts in various fields of medicine, providing guidance on our in-house research programs. Based on the recomendations of the SAB, Clinical Connect developed a custom therapeutic drug monitoring report that provides customers with clear and concise insight into a patient’s medication use.
Clinical Connect currently offers a variety of tests for urine, oral fluids and blood samples.
"Clinical Connect currently offers a variety of tests for urine, oral fluids and blood samples."
24
Clinical Laboratory Testing with Clinical Connect Clinical Connect, our mission is commitment to high quality toxicology laboratory testing and outstanding customer care service. Our goal is to assist physicians with patient outcomes which lead to patient satisfaction. We are dedicated to patient-centered care providing timely information and diagnostic testing. Our vision is to be a respectable and leading authority of reliable testing and results while providing healthcare professionals the needed information in making treatment decisions. We value our patients where we focus on providing the best in both product and service to the evolving and dynamic healthcare specialty of toxicology. The combination of physician and patient outcomes is the principle behind our commitment to high quality toxicology laboratory testing and outstanding customer care service.
"Our goal is to assist physicians with patient outcomes which lead to patient satisfaction."
Compliance Program At Clinical Connect, we adhere to the importance of trust, integrity and leadership that play in the healthcare industry. Thus, Clinical Connect is committed to the highest standards of compliance and ethics. Clinical Connect’s Compliance Program was designed to ensure that the organization upholds all legal, ethical and regulatory laws, policies and standards in the industry. As the national leader in independent clinical laboratory testing, Clinical Connect owes its success to its long-standing commitment to support science, its national ethical standards and a compliance program based on guidelines and recommendations set forth by the Office of Inspector General (OIG). Through its Corporate Compliance Plan, Code of Conduct and other related policies and procedures, Clinical Connect has established standards and procedures to promote the highest ethical culture and discourage inappropriate conduct. It is the fundamental policy of Clinical Connect to conduct its business in compliance with all applicable laws and regulations and the ethical standards and practices of the industry and the organization.
25
Laboratory
WE ARE THE PREMIER SOURCE OF GUIDANCE IN THE LABORATORY INDUSTRY.
26
27
Laboratory
Q A CLINICAL CONNECT
FAQ
Why is Clinical Connect ISO important to me? The International Organization for Standardization (ISO) establishes strict quality-assurance standards to guarantee consistently high-quality results. Organizations certified under ISO have been inspected to ensure that all company processes and practices meet and maintain the quality of output. At Clinical Connect, we believe that meeting these standards is the best way to demonstrate our commitment to quality in all of our services. I don't see the test I need. Can you still help me? Clinical Connect is a full-service reference lab. If you have specific needs or are interested in having a test created to meet your specific needs, please contact your sales representative. We will work to satisfy your request in a professional, timely manner. How do I get my reports? For your convenience, reports can be viewed online, faxed, and mailed.
How accurate are my test results? Laboratory testing results are accurate and reliable.The identification of individual drugs at Clinical Connect is achieved using a highly selective methodology called mass spectrometry (MS), which allows the laboratory to make unequivocal identifications. For this reason, all urine specimens should be submitted to our laboratory for testing, as instant devices such as urine cups or dipsticks do not offer this level of selectivity or accuracy. How are samples sent to your lab? We use UPS for all of your shipping needs. No matter where you are in the country, we can receive your sample the next day. In addition, we will provide you with specimen-collection kits that come pre-addressed and ready to ship back to us. Who supplies the collection kits? Clinical Connect supplies everything that
you need to do your testing, at no cost to you. If you have never placed an order with Clinical Connect, contact a member of our sales team or Client Services at 888-392-6042 to get started. What else is involved in confirmation testing? Confirmation analysis comprises chromatographic separation and mass spectrometry identification to detect and verify the presence of drugs in a specimen. Confirmatory testing is performed utiliz- ing LC/MS, and LC/MS/MS method- ologies and encompasses additional steps before and after the actual analysis.These steps include chemical extraction, which is performed prior to analysis in order to remove any interfering substances, data review, and data certification. Clinical Connect's confirmation process ensures that the results we deliver are accurate and precise every time.
"There are two common ways that users attempt to “cheat” a urine drug test: modify their urine sample with chemicals or drink large amounts of water prior to testing in order to dilute their sample."
What if I have questions about my results? Our full-time toxicologists and chief medical officer are always willing to assist you with the interpretation of results. Simply call Client Services at 888-392-6042. One of our representatives will connect you with an available expert. You may also e-mail questions to toxicologist@completetox.com. When reviewing a lab report, what does "Canceled: due to interference" mean? Interference is an unknown signal that prevents accurate identification of drugs during the confirmation analysis. Its origin cannot be determined, but it may be an endogenous compound (a naturally occurring compound within the body), a prescription medication, or something added to the specimen after collection. In instances where a definite positive or negative result cannot be determined for a drug, the test is conducted a second time. After the second attempt, if the drug in question still cannot be accurately determined, the test for that drug is canceled. What does a negative result mean? Did the donor have anything present in their sample at all? A negative result does not necessarily mean there is zero trace of a drug in a given sample. Rather, it indicates that the drug was not detected above the pre-determined cut-off concentration. For example, a cut-off of 300 ng/mL for benzodiazepines means that the combined total of cross-reacting benzodiazepines in the specimen must be above 300 ng/mL to register on the test and produce a positive result. Specimens that contain a combined total benzodiazepine concentration of fewer than 300 ng/mL will register on the test as negative.Therefore, in some cases, low concentrations may be present, but a negative result shows up on the report and is still considered to be an accurate test result.
How do urine alcohol levels compare to blood alcohol levels? Ethanol (drinking alcohol) may be detected in blood and urine after consumption of alcoholic beverages. Blood and urine ethanol concentrations may be very different, depending on the time between ethanol consumption and specimen collection and frequency of urination.The ethanol concentration will often be higher in urine than in blood. In some cases, urine ethanol may be highly positive and the blood completely negative.Therefore, urine ethanol cannot be used to estimate a blood ethanol concentration. Is there anything that can be used to "cheat" a urine test? There are two common ways that users attempt to “cheat” a urine drug test: modify their urine sample with chemicals or drink large amounts of water prior to testing in order to dilute their sample. Many products are available on the Internet claiming to enable a person to produce a negative test result after drug use if that product is added to a urine sample. Most of these products contain strong chemicals known as oxidants, which are capable of modifying the chemical structure of a drug. Complete Toxicology Laboratories (Clinical Connect) tests every urine sam- ple for the presence of oxidants to identify potential adulteration. How do I deal with marijuana? This a complex issue. Marijuana is currently classified as a Schedule 1 drug by the DEA. For that reason, many providers will not prescribe opioids to patients using cannabis. Other providers reference State ‘Medical Marijuana Use’ laws and feel comfortable prescribing opioids to cannabis users. Some providers adopt a “don’t ask, don’t tell” policy, and request the lab to remove marijuana from the UDT so that positive results are not seen. Do your homework and create an office policy.Then disclose this policy to your patients.
29
Laboratory
WHERE YOU HAVE THE COMFORT OF KNOWING EVERY TEST IS DONE I N - N E T W O R K 24555 SOUTHFIELD RD, SOUTHFIELD, MI 48075 888.392.6042
30
Laboratory
Clinical Connect Laboratory (CCL) is your source for navigating patient centric laboratory medicine in the ever changing healthcare landscape.
31
Substance Abuse Millions of Americans are addicted to alcohol and drugs. In order to properly treat substance abuse, it is critical to identify the addiction and create a plan of action to combat it. Effective drug monitoring is crucial to formulate the right plan of care and take the first step to rehabilitation and prevent further disease and complications. At Clinical Connect, we offer a wide range of optional panel selection, giving you the tools you need to monitor and eliminate any type of substance abuse. We make it easy for you to test your patient population, receive results and handle any questions or concerns you may have. Our professional staff has years of experience and promises to exceed your expectations.
32
Individual Drug Test Selection Clinical Connect provides health care professionals with the choice of individual test selection, as opposed to pre-set panels of tests. Collect specimens (urine or oral fluid) and send to Clinical Connect to identify the individual drugs and metabolites selected based on medical necessity. MethodTesting Selection Clinical Connect provides health care professionals with the choice of testing methods, either by an immunoassay, immunoassay with quantitative results by liquid chromatography tandem mass-spectrometry (LC-MS/MS), or a single quantitative test by LC- MS/MS for each individual drug ordered based on medical necessity. Clinical Supplies for Testing Specimen cups, test requisition forms and shipping supplies are available to customers through Clinical Connection's Laboratories Order Supplies.* CLIA license required for in-office urine drug test devices.
Together, we can control drug abuse in your practice and enhance the quality of care. Don’t become a victim of preliminary findings delivered by point-of-care testing cups or bench top screens.These methods provides a fast turnaround, but not the accuracy or precision of an in-depth toxicology report available from liquid chromatography mass spectrometry (LC-MS/MS). Many physicians don’t use point-of-care cups because they are unreliable and misleading. Confirmation testing is the only reliable method that is 99.99% accurate and checks for metabolites as well as the parent drug. Your quality of care depends direClinical Connecty on how well you monitor your practice and patient compliance in any treatment plan. Let Clinical Connect work for you to ensure practice compliance. Start Monitoring Clinical Connect’s medication monitoring and drug detection services provide more than just test results to health care professionals. We deliver the comprehensive scientific data backed by service and clinical consultation to help interpret results for more informed clinical decisions. Complete Toxicology Laboratories provides health care professionals with choices to design their medication monitoring and drug detection program to best suit the unique needs of their patients and their practice.
33
Pain Management Why is it important to monitor abuse and diversion of controlled substances while providing the right care for your pain patients? Pain medications are being abused all across the United States.Therefore, as a physician you must help abolish the trend while providing an effective treatment plan for your patients. In this day and time, no patient should have to suffer by experiencing the unpleasant sensation of pain due to physician’s fear of prescribing controlled substances to well deserving patients. To control abuse, physicians must monitor pain medications to ensure practice compliance. Clinical Connect provides you with an easy and efficient way to monitor compliance.
34
Cli icl Confidence Instilling
Laboratory
24555 Southfield Rd., Suite 100 Southfield, MI, 48075
888 . 392 . 6042 248 . 864 . 8592
www.clinicalconnectlaboratory.com
WWW.CLINICALCONNECTLABORATORY.COM VISIT US
Laboratory
36
Testing Methods In-office Urine Drug Testing (UDT) In-office (point-of-care) testing can be conducted with CLIA-waived instant-read devices, as well as instrumented devices (e.g. analyzers). hese devices perform qualitative immunoassay tests only. In-office urine drug test devices are used to provide health care professionals with immediate information, particularly on initial patient intake. While providing certain clinical value to the treating health care professional, these qualitative immunoassay tests identify the presence of a drug class, and a few specific drugs.The limitations of point-of-care testing, including cutoff levels and known cross-reactivity, is important to consider. When it is clinically necessary to identify all specific drugs and illicit substances, laboratory quantization provide more comprehensive results for patient care decisions.
Laboratory Testing with LC-MS/MS Technology
Laboratory testing, such as liquid chromatography tandem mass-spectrometry (LC-MS/ MS), is a more specific method, and returns a quantitative analytical result.These results provide precise identification of all drugs and metabolites present or absent. When used alone or in combination with qualitative immunoassay testing, LC-MS/MS testing can provide health care professionals with critical information to support patients’ overall treatment plans. Laboratory testing by LC-MS/MS uses significantly lower cutoff levels than in-office drug tests and is, therefore, more accurate in determining medications and other substances present in, or absent from, a patient’s system at the time of the test.
"When it is clinically necessary to identify all specific drugs and illicit substances, laboratory quantization provide more comprehensive results for patient care decisions." 37
Clinical Connect currently offers a variety of tests for urine, oral fluids and blood samples using liquid chromatography – mass spectrometery (LC/MS) technology.
Billing Policies Patients with Insurance
Upon completion of the testing services, Clinical Connect will file a claim for services rendered on the date of your office visit. Once this is claim isprocessed, you will receive an explanation of benefits (EOB) from your insurance company.This not a bill. If a balance is due, you will receive a separate invoice from Clinical Connect stating the amount owed and the date payment is due. Clinical Connect has relationships with an extensive number of insurance networks and offers flexible payment options to best meet your needs. For more information, call us at 888-392-6042 and ask to speak with a billing specialist.
Patients without Insurance Clinical Connect which flexible payment plans are available to you. To learn more, call 888-392-6042 and ask to speak with a billing specialist. Clinical Connect offers financial assistance to patients that are experiencing hardship.
38
Women's Health OB/GYN using drug screening as part of their daily routine are increasing across America. American Congress of Obstetricians and Gynecologists (ACOG) recommends physicians to test their patients for illicit drugs so they can seek help and reduce complications during pregnancy and delivery. Drug and alcohol abuse have a direct correlation with obstetric and pediatric complications. Birth defects and developmental disabilities due to prenatal alcohol exposure can be easily prevented in the United States. If more women are tested for alcohol and drug abuse, they are more likely to take action to stop it. It is a moral and ethical obligation on obstetricians to implement a protocol for drug screening in their practice. No child should have to suffer for a lifetime due to birth defects that could have been prevented by taking the neccesary steps of analyzing your patient’s urine or oral specimens for potentially harmful drugs.
Primary Care Practice Prescription medications are necessary to run a practice effectively and providing the right treatment plan is vital to your practice. With prescription drug abuse on the rise, physicians must take action to mitigate risk of running a practice that is highlydependent on controlled substances.Therefore, it is crucial to monitor medication compliance within your practice population. Clinical Connect can be your key partner to monitor and ensure patient compliance. We offer an easy drug-monitoring program that is accurate and allows you to focus on quality care. Our low detection levels allow you to see what drugs your patients are taking. If physicians are unaware of patient’s drug abuse, medical care can be jeopardized. For example, abrupt placenta separation may occur with acute cocaine use resulting in the harm of the mother and child. Women are less likely to take action or seek help if they are not screened and referred to a treatment facility or specialist. You can make a positive difference in creating a safe environment for your expecting mothers and their unborn child by just adding a universal screening program to your practice.
39
Cli icl SERVICES Laboratory URINE AND ORAL TOXICOLOGY
IN-NETWORK CONNECTOR
WELLNESS PANELS
CUSTOMIZED TESTING
EXPERT CONSULTATION
24555 SOUTHF IELD RD, SOUTHFIELD, MI 48075 888 . 392 . 6042
40
SPECIALTIES Pain Management Mental Health Addiction Clinics Women’s Health Primary Care
24555 Southfield Rd., Suite 100 Southfield, MI, 48075
888 . 392 . 6042 248 . 864 . 8592 www.clinicalconnectlaboratory.com
Laboratory
41
LOOK NO FURTHER 24555 S UTHFIELD RD, S UTHFIELD, MI 48075 888 . 392 . 6042
Laboratory
42
Your family is important to us.
www.morseclinics.com
43
Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.
“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.
Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.
“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University
44
Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.
Brought to you by:
When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”
“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University
10
Reasons Why I Do Not Like
Benzodiazepines
By Dr. Eric Morse, MD
Benzos kill people in combination with methadone and buprenorphine by suppressing breathing. At the Morse Clinics, we limit doses of methadone or buprenorphine to minimize this risk as part of our Benzo Policy. I believe that is why we have a much lower death rate than the national average.
Benzos are addictive, especially in folks who already suffer with an addiction. They lead to relapse.
Benzos cause dementia. September 2014’s British Medical Journal published a study that showed just 91 days of taking Benzos in your lifetime increased your risk of developing dementia by over 40%.
46
Benzos disinhibit. I have seen many patients not acting like their usual self while on Benzos.
Overdoses – in North Carolina, Benzos have overtaken opioids as the leading cause of unintentional poisoning deaths.
Impaired reaction time in driving.
Benzos are often used to treat dif cult emotions. No new coping mechanisms can be developed. Folks use Benzos to change their feelings, not living life on life’s terms.
Benzos are not considered 1st, 2nd or 3rd line recommended treatment by the American Psychiatric Association’s treatment guidelines for any anxiety disorder (other than the rst 2 weeks of treating Panic Disorder whilst a serotonin medication is being titrated up).
There is no medical evidence that shows Benzos need to be used for more than a few weeks. Benzos have been shown not to be effective long-term to treat any anxiety disorder.
Benzos are like whiskey in the form of pills. They act similar to alcohol on the brain via GABA. They can easily cause intoxication.
47
www.morseclinics.com
SCHEDULE A
SCREENING A screening is the first step in the treatment process. Submit a form and a licensed counselor will contact you to perform a no obligation, no cost screening to determine what level of care you require.
48
Our Medication Assisted Treatment (MAT) programs treat the physical symptoms of addiction, reducing or eliminating cravings and severe withdrawal symptoms. www.morseclinics.com
49
. Elizabeth Stanton is an owner and chief medical of cer for Morse Clinics. Dr. Stanton has over 25 years of experience in treating patients with addictions and psychiatric illnesses. She previously was the founder and chief medical of cer of Mountain Health Solutions, opiate treatment centers in Asheville, NC, and North Wilkesboro, NC. She divested the MHS clinics prior to relocating to Raleigh NC. Originally from Mississippi, Dr. Stanton received her medical degree from The University of Mississippi School of Medicine, her residency and fellowship from Duke University Medical Center, where she was chief administrative resident in Child and Adolescent Psychiatry. She is board certi ed in General Adult Psychiatry, Child and Adolescent Psychiatry, and Addiction Medicine. Dr. Stanton is also a fellow of the Society of Addiction Medicine and fellow of the American Psychiatric Association. At Morse Clinics, she works with Dr. Morse to oversee all clinical and medical functions in their opioid treatment centers. Their primary goal is making sure the center is following all state regulations and that patients are receiving the most up to date forms of treatment. “I make sure our medical staff is fully trained, including nursing staff and program physicians,” Dr. Stanton says. “I also keep up with all the recent studies and literature related to addiction to insure that patients at the Morse Clinics receive the most up to date evidenced based treatment.” The center is dedicated to serving their community, constantly looking for ways to improve treatment and provide more resources for patients. A clear mindset “We are passionate professionals and see patients the same day or next day after they call us. We are in the midst of a nationwide opiate epidemic. It is a
deadly illness, and we respond to what our patients need ASAP, to save lives.”
Morse Clinics’ treatment approaches match the magnitude of the disease, involving medication, therapy, medical/nurse visits, and during daily interactions between patients and staff. The ideal outcome is to stabilize clients long enough for them to make needed behavioral changes, including improved relationships with family and friends, improved health status, regular employment and housing if needed, and improved nancial health. At Morse Clinics, staff assist patients in exploring career opportunities, creating resumes and preparing for interviews. They also connect patients with medical resources to get examined and tested for other possible conditions. Sexually transmitted diseases and psychiatric orders are commonly neglected by drug users, as well as multi-substance dependence that could require additional help outside of opioid treatment. Real progress The procedures set up at Morse Clinics are intended to sustain long-term recovery. Once the most acute problem of stabilization is dealt with, clients begin to see the need for structure in their lifestyle. “I’m privileged to be able to help them put their lives back together,” Dr. Stanton shares. “Our patients trust us with the opportunity to care for them and we don’t take that lightly.” She recognizes the need for medication-assisted treatment because it is the only treatment option that will dramatically interrupt the cycles of addiction and bene t her high-risk patients, many of whom are homeless, unemployed, isolated from their families and have histories of criminal activity. The treatment helps them make changes that
CMO OF MORSE CLINICS EXPLAINS IMPORTANCE OF MEDICATION-ASSISTANCE FOR OPIOID USERS
50
“ It ’ s an honor to take care of our patients. ” -Dr. Elizabeth Stanton
produce real results. The reward of seeing progress in others is what brought her to Morse Clinics. The company shares her passion for improving lives and caring for others. She found the staff to be compassionate and dedicated, from counselors to front desk workers. “It’s an honor to take care of our patients,” Dr. Stanton says. “We’re committed to treating them with the utmost respect that they deserve.”
“ Addiction is a full - time job. ” -Dr. Elizabeth Stanton, Chief Medical Officer, Morse Clinics
Can See
51
AGENCY AD 11
www.morseclinics.com
You are encouraged to take advantage of a variety of services offered through the Morse Clinic, including:
Case Management Healthcare
Education Sessions HIV/AIDS Methadone and Buprenorphine Maintenance Drug Information
Housing Nutrition
52
MORSE C L I N I C
In most cases, the power of addiction is too strong for an individual to battle on their own.
(919) 977-5993
53
The medical evidence for any form of maintenance therapy for opioid addiction is very strong. The success rates for methadone are about 60-70 percent and buprenorphine are 70-80 percent. Which one to choose is an excellent question. WHAT’S THE DIFFERENCE? Methadone is a long-acting mu opioid analog. Buprenorphine is a partial mu opioid agonist with a high receptor af nity and occupancy - 93 percent at 16 mg a day (also the Morse Clinics’ maximum dose). Both create a blockade or attenuated effect of the use of additional opioids with buprenorphine having greater blockade. They essentially stop you from getting high. Buprenorphine has a favorable safety pro le due to a ceiling effect (you cannot overdose on buprenorphine alone – unlike methadone). Buprenorphine has lower street value and lower abuse potential – folks who suffer with opioid addiction cannot get high on opioids while on buprenorphine.
BY ERIC D. MORSE, MD THIS ARTICLE WAS ORIGINALLY A BLOG POST
54
At the Morse Clinics, methadone is dispensed by our nurses in the form of a cherry- avored, red liquid that is swallowed every morning. Because we use the liquid, we can dose down to the exact milligram. There is no limit to the dose of methadone, but we do check blood levels at 120 mg and every 30 mg thereafter to insure safety. Buprenorphine is dosed in 2 mg or 8 mg tablets – dosing options are limited to 1, 2, 4, 8, 12 or 16 mg taken sublingually and absorbed within about 5 minutes. An advantage of buprenorphine is that you do not need a gut to absorb the medication. If you have the u or a GI bug that causes you to vomit, you cannot vomit up your buprenorphine. However, you can vomit up methadone. For our patients who have extensive GI surgeries, gastric bypasses, IBS, or Crohn’s Disease, buprenorphine may be more effective. It is not unusual for folks to get addicted to opioids due to pain conditions. Methadone is usually more effective treating pain than buprenorphine. To get started, if you are actively using, methadone is easier on you. Buprenorphine can cause precipitated withdrawal. Buprenorphine displaces full opioid agonists (because of its higher receptor af nity and lower level of receptor activation). The severity of withdrawal varies. Common features include sweating, cramps, diarrhea, nausea, anxiety, cravings, yawning, and restlessness – typical opioid withdrawal symptoms that you are probably accustomed to experiencing. Precipitated withdrawal usually occurs about 30 minutes after the rst dose and peaks at 90-180 minutes after the rst dose. Minor symptoms may last 2-3 days and may persist with continued heroin/opioid use. “Methadone is usually more effective treating pain than buprenorphine.” -Dr. Eric Morse, founder, Morse Clinics
“MANY OF OUR PATIENTS CHOOSE TO REMAIN ON THEIR MAINTENANCE MEDICATION INDEFINITELY.” -Dr. Eric Morse
COST AND COMING OFF If you have Medicaid, your treatment at any Morse Clinic is free for methadone. It may be free for buprenorphine as well – if your MCO is Sandhills or Cardinal Innovations. If you do not have Medicaid, the cost of methadone is $80 per week and Buprenorphine is $120 per week – regardless of the dose. The difference in cost makes some of our patients choose methadone over buprenorphine. Which is easier to come off of? First of all, we recommend at least a year clean, sober and stable (same job, living situation, relationship) before starting a gradual taper down. Many of our patients choose to remain on their maintenance medication inde nitely. Addiction is a chronic disease and most chronic diseases require chronic medications. Because you can lower 1 mg a time of the methadone liquid, a methadone taper can be easier and more gradual. Because buprenorphine is only a partial agonist, an abrupt detoxi cation off buprenorphine is easier than methadone. So if there is a possibility that you may be going to jail or prison, I would suggest buprenorphine over methadone. Please come into a Morse Clinic and talk to one of our doctors for more information.
Thanks, Eric D. Morse, M.D.
MORSE CLINIC F NORTH RALEIGH
3209GreshamLake Rd, Bldg 10, Ste 113 Raleigh, NC 27615 (919) 977-5993 Call Us www.morseclinics.com
56
Morse Clinic strives to provide you with the highest quality treatment and care at all times.
57
58
BY 2020 , MENTAL AND SUBSTANCE USE DISORDERS WILL SURPASS ALL PHYSICAL DISEASES AS A MAJOR CAUSE OF DISABILITY WORLDWIDE .
59
ANNA STANLEY believes that the world of addiction recovery services has taken a long time to catch up with the science of treatment. Abstinence-based practices have long been the only methods acknowledged by addiction counseling professionals who saw medication as a crutch, rather than a valid tool to aid recovery. The argument against medication-assistance therapy is now weakening due to evidence that these programs are in fact more effective than counseling alone. In 2015, President Obama voiced the need for health care providers to expand medication-assisted treatment options. Stanley, who serves as program coordinator at Morse Clinic’s Chatham Recovery, says it was an important step in bringing national attention to a harmful misconception. “It’s time to raise awareness that maintenance programs are an FDA approved, completely legitimate method for treating addiction,” Stanley says. “Opioid addiction is an epidemic and we need to use the most effective form of treatment.” NOT A STREET DRUG Stanley regularly deals with the stigma surrounding medication-based treatment, even having faced a client’s enraged mother who thought the treatment would keep her son addicted. She often has to explain to family members that a patient is still sober while taking their dosage of methadone or buprenorphine. “Sometimes people think we’re licensed drug dealers. That couldn’t be further from the truth,” Stanley explains. “These aren’t the same drugs you get on the street. This is government approved medication, just like taking insulin for diabetes.”
Morse Clinics provides resources for family members to understand the physical changes that occur in the brain through addiction and how these changes are treated by medication. They hope that educating family members will prevent them from imposing shame on the recovering patient and instead create a supportive, On a larger scale, Stanley also educates court systems who voice concern about the safety and side-effects of medication-assistance therapy. She explains that properly administered methadone and buprenorphine doses are safe and compassionate environment. LESSENING SYMPTOMS
60
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64Made with FlippingBook - Online Brochure Maker