Question: A recent local article from WJCT in Jacksonville touted the early signs of success for a Jacksonville opioid addiction treatment pilot program, Project Save Lives. What are the takeaways from this? Does it show that the real key to recovery is getting into treatment?
Dr. Mirabile: This is looking like a very bright spot for Jacksonville and opioid addiction treatment. It seems to be quite promising, and it’s not surprising to me, actually, from a medical professional standpoint. We have known for years in the treatment community, as physicians and providers, that the key to really helping people with this medical disease, this condition, is to intervene and get them into treatment. Once someone has a negative consequence that is potentially life-threatening or just plain scary, the phrase “strike while the iron is hot” really applies.
The nature of this condition is that because it lives within the central nervous system and in the brain, specifically, it affects one’s judgment. So, if one is going about his or her daily activities and life, they’re not going to find the will or the impetus to get into treatment or therapy, something that may make them uncomfortable. Often, only a potentially near-death event or a trip to the emergency room allows someone to connect the two, which creates the magic recipe to get people healing and into recovery. This is what we’re seeing in the pilot program with St. Vincent’s Medical Center and Dr. Raymond Pomm, getting people into treatment directly from ER visits, which is referenced in the article.
So this really is a good time to get people into treatment. However, we may see that the level of care (residential versus outpatient) is really crucial to the long-term success and efficacy of this program. Because of the nature of this disease and because it is so strong, people suffering are often not open to receiving help and treatment until they’ve had significant health consequences.
Question: So what do the results of this Jacksonville opioid addiction treatment pilot program tell us about capitalizing on such moments?
Dr. Mirabile: The early findings six months in show that the program has had just one out of 30 relapse. This goes along with what we licensed healthcare professionals have seen in treatment throughout the years. Relapse rates are lower when there is something on the line to lose.
After entering treatment and reaching some sense of stability, it’s really important to lock into an accountability program. This involves monitoring, testing, and staying mindful of the fact that they have the condition. Often, complacency is what really takes a patient backwards – when an individual starts to think, “Well, maybe I don’t really have this disease or this medical condition. Maybe it was just circumstances.” That can really set a person up for relapse.
It is still early in this study to see if it’s going to affect long-term recovery rates, for two years, five years out – what are these people going to be doing then, and what is the relapse rate at that point? But certainly, if you have just one out of 30 relapse at six months, those are very good numbers, so far. As mentioned previously, the level of care (residential versus outpatient) is really crucial to the long-term success and efficacy of this program.
Question: It sounds like the key takeaway here is really about getting into treatment at the right time – maybe less about the specific treatment program and more about capitalizing on the right time. Is this something to share with families who have loved ones struggling with opioid addiction? That they should watch for such a moment if they’ve been unsuccessful in getting them into treatment up to now?
Dr. Mirabile: Absolutely. That is something that can be applied generally to all families struggling with addiction that we are learning from a specific program. While it is good that the city of Jacksonville has taken the initiative to start this program, it is also helpful to apply it more broadly to other Jacksonville addiction treatment programs and even nationwide.
I am thrilled they have also tied this into what we would consider to be a more comprehensive treatment. There has been a recent movement and focus on providing Naltrexone or Narcan injectors to first responders in order to revive people suffering from an overdose in the field. It is important to save lives, but if they just get revived and then receive no follow-up treatment, they could end up back in the same place. The real key is to get the therapy, counseling, and maybe medication to help with cravings or other disorders. This program has a more complete view of the problem. Instead of taking all of the money from the grant and putting it into providing only medication, Jacksonville has committed to treating this disease by also providing therapy and counseling. The comprehensive biological, psychological, social, and spiritual approach has been the most effective way of treating the disease of addiction.
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