Featured Articles: Pain Management/Opioids

Opioid Crisis: Treasure Valley Gets it Right!

Tuesday, March 13, 2018   (0 Comments)
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Lynn Gerlach, Tamarack Communication
- an interview with Cindy Miller, RN, Program Director, Allumbaugh House, TRHS


Continuing our conversation about the crisis of prescription opioid abuse, diversion and addiction, we travel today to Idaho, specifically to the Treasure Valley. Here we encounter a one-of-a-kind treatment center, born of community passion to do the right thing, and ultimately managed by a highly respected community health center.

Well over 15 years ago, the City of Boise recognized the need for a treatment center that would provide medically monitored detoxification, treatment and referral services for individuals suffering from addiction.  City leaders convened community conversations in order to cultivate partnerships and clarity regarding community needs.  County Commissioners from the surrounding areas (Ada, Elmore and Valley Counties) also recognized the need and joined the City of Boise in the exploration of models from across the country.  

As the community conversations continued, it also became clear that there was a need for alternative services for individuals struggling with mental illness.  The result of these community conversations was Allumbaugh House (AH).  Allumbaugh House has served the community for the past eight years, providing medically monitored detoxification and mental health crisis services, including help for opioid addiction, for about 970 patients each year.

The story of Allumbaugh House is full of surprises. Virtually all the patients who receive care are of the “underserved” category.  They are individuals who are uninsured or underinsured, homeless, low-income or without income – and no one gets a bill for their care. Funding for Allumbaugh House comes from a consortium of government and nonprofit partners who all collaborate in funding this shared community resource.  The facility is in turn operated under contract with – a community health center!

Once that consortium, including Ada County, the Department of Health and Welfare, the cities of Boise and Meridian, St. Alphonsus and St. Lukes (the two regional medical centers), and others got their plan on paper, they sought a reliable, established community partner to manage the center they would build. Heidi Hart was Director of Behavioral Health at Terry Reilly Health Services (TRHS) at the time, and she thought this looked like something her health center should take on.  Heidi was successful in securing the contract for AH operations for TRHS and she engaged the support of a respected, long-time Boise psychiatrist, Dr. Charles Novak to serve as the facility Medical Director.

In 2009, facilty construction began on donated land on Allumbaugh Street in Boise, Idaho.  Facilty costs were covered as the result of funding obtained by the Boise City Ada County Housing Authority (BCACHA).  As construction began, Heidi sought a Program Director to partner in bringing the facility to life and to oversee daily operations and the care provided to patients.  Dr. Novak recommended a registered nurse, Cindy Miller, who had many years of experience working in field of behavioral health and addiction. Six months before Allumbaugh House opened, Cindy was hired.  As they watched the building construction from their shared office window, Cindy and Heidi developed the care model and protocols, and then hired and trained the staff in time for the facility opening.

Today, Heidi Hart is the CEO of Terry Reilly Health Services and Cindy Miller, RN, continues as the facility’s Program Director.  That original consortium of government and non-prpofit partners continues to fund hope in the health care safety net of the Treasure Valley. Allumbaugh House serves as the first step in addressing addiction, diverting patients from costly, high-level treatment such as ERs. But the challenges continue to evolve.

“In the past three years,” Cindy shares, “we have seen a tremendous increase in the number of individuals abusing polysubstances.”   She explained that for many patients, increased prescribing of opioids led to diversion and abuse and overuse. Hooked on prescription pain killers, the typical patient begins periodic use of heroin, which is much cheaper. Now fully addicted, that person is likely to begin abusing other substances to reduce the opioid withdrawal symptoms. These might include methamptetamine, other opioids (including Suboxone), alcohol, and/or marijuana. If they are lucky, they end up at Allumbaugh House. Of course they aren’t all lucky.  Prospective patients far outnumber the beds available. The facility remains at capacity at all times and actively manages a waiting list.  Cindy shared that one of the most demanding parts of her job is managing access to Allumbuagh House because the need far outweighs capacity.  

More than half the patients served at Allumbaugh House are established at Terry Reilly Health Services as health center patients. As a result, “We work very closely with the health center staff,” Cindy said. “All Allumbaugh House staff are employees of TRHS. We have RNs on duty 24/7, and we have direct access to the medical, dental and behavioral healthcare providers at the health center.” 

The typical patient stays about seven days, though polysubstance users might stay longer.  “We get them through the most acute phase,” Cindy said, “but they are far from recovered when they leave the program. When their original detox is complete or they are stabilized on their mental health medications, we make every effort to access continued outpatient care.”  In addition to providing the medical care associated with detoxification or psychiatric medication management, AH has an active treatment schedule of group and individual therapies, psychoeducation, recreational and in-house 12 step groups. The multi-disciplinary team includes Registered Nurses, LMSW, CADC, Case Manager, and Psychiatric Technicians, all working closely with the psychiatrist and medical clinicians to run an actual dual disorder treatment facility.

When asked about opiod treatment specifically, Cindy shared that Allumbaugh House does not presently use buprenorphine because of the high cost and the limited number of buprenorphine-waivered physicians and nurse practitioners who deliver outpatient care in the local community.  As a result, the AH team currently uses a clonidine protocol for opioid detoxification.  Additional therapies might include muscle relaxants, analgesics, anti-emetics, and more. 

Cindy explained that this patient population is very medically complex. Almost all have comorbidities in addition to corollary issues like malnutrition, dental problems, infections and abscesses. “Many have had little or no health care for a long time except the occasional visit to an ER. We are so blessed to be part of the Terry Reilly Health Services system. Because TRHS is a Joint Commission-accredited patient-centered medical home, our patients have access to psychiatry, chronic disease education, medical and dental care. This is truly a holistic, integrated care system.”

Cindy emphasized her gratitude for the funding stream on which Allumbaugh House relies, tight as the budget might be. She believes this project is truly an example of what the broader community can accomplish when they all come together. “We actually have 24 beds,” she admitted, “although we are only currently funded to operationalize 16. Some day, if funding allows, we will offer this wonderful service to even more patients.”




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