Treating the community: Cook County Health CEO Dr. John Jay Shannon answers 5 questions on the opioid epidemic

From June 2015 to June 2016, as the rate of opioid overdoses nationwide continued to swell at record levels, the state of Illinois operated without a budget. State-funded behavioral health services suffered during the crisis. On June 30, Gov. Bruce Rauner signed a stopgap measure to fund state operations until the end of the year, but the cuts made to substance abuse services during the budget impasse forced group providers to close substance abuse programs and reduce care availability. The gaps in behavioral care created by the crisis will not be easily mended.

Cook County Health & Hospitals System is the safety-net healthcare provider for the city of Chicago and suburban Cook County. During the budget crisis, the system and its CEO John Jay Shannon, MD, worked to expand behavioral health services in the vulnerable communities the system serves.

Dr. John Jay Shannon, a graduate of Rush Medical College in Chicago and a native Illinoisan, recently spoke with Becker's about budget cuts, behavioral health services and the opioid epidemic.

Question: What are the biggest challenges your hospital faces regarding the opioid epidemic? Has the Illinois budget crisis contributed to these challenges?

Dr. John Jay Shannon: The biggest problems have been caused by a mismatch between the needs for services and their availability. Budget cuts have led to a decrease in funding for behavioral health programs. Our emergency departments in Chicago are caring for an ever increasing number of people presenting behavioral health problems. At our Stroger campus alone, we've seen our ED visits confounded by opioids: 14 percent of ED visits and 16 percent of inpatient visits are attributed to addiction. At our Provident campus, the number of those presenting for opioid abuse tripled from 2011 to 2014. The Chicago area has a significant problem with this.

Q: How helpful do you think recent actions taken by the federal government will be in curbing the rates of opioid abuse?

JJS: I think they are going to be helpful. Part of the challenge is that there was a significant pressure on providers to treat pain in the 1980s and 1990s, and now, the pendulum has probably swung too far to one side. Senator [Dick] Durbin (D-Ill.) is calling on the drug manufacturers to cap the amount of opioids produced each year. At the federal level, there's also been action to expand access to buprenorphine. A substantial grant [$2 million] from the Health Resources and Services Administration has aided the expansion of medication assisted treatment at Chicago community centers. These actions are helping fill the gaps in needed care.

Q: What unique measures does CCHHS take to treat opioid addicted patients?

JJS: We are working to build addiction treatment competence across our community based providers. Community centers are likely a more therapeutic place for these patients. In July, we opened a Community Triage Center on the Southside of Chicago. The center is staffed by behavioral health professionals 24 hours a day, 365 days a year. This is a more appropriate setting to these patients than a jail or hospital emergency department. The center treats patients picked up by police for minor offenses. Patients can detox and setup with drug treatment service. It's uncommon that the first time in treatment is a success. Opioid addiction is marked by relapses. An addict who comes in near death and is brought back by naloxone is not feeling well. It's ideal if the individual has a partner in recovery.

Q: How high is the demand for the anti-overdose drug naloxone at CCHHS campuses?

JJS: Most people don't come in asking for it. These medications are most helpful when asked for by patients and patients' family members. The introduction to naloxone happens in [addiction] treatment. We make it available in our emergency departments. We don't use it as a silver bullet. It's more part of a package we hand off to the community.

Q: What do you see as the national solution to this epidemic?

JJS: It's going to take a lot of different things. We've got a significant charge to educate both the public and healthcare professionals about pain. We were taught in medical school if someone has pain and you give them narcotics, they won't get addicted. That's clearly incorrect. We need to develop safer treatments for pain. We've got a long way to go. We've got to destigmatize addiction problems so people come forward for treatment. We have to make sure community based services are available to people who need them. The relief of pain has to be treated seriously, but at the same time we could all benefit from different expectations regarding pain relief. I don't think it's going to be any one thing that brings this health crisis to a close.

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