The Wright Center for Community Health announced last month that it is one of just 16 sites nationwide chosen to participate in a new project to advance education and training on substance use disorder treatment.
The “3Cs Framework for Pain and Unhealthy Substance Use” is an initiative of The National Academy of Medicine’s Action Collaborative on Combatting Substance Use and Opioid Crises.
Wright Centers for Community Health and Graduate Medical Education.
That program comes as officials nationwide work to combat an epidemic that claims more than 100,000 lives annually in the U.S.
Scott Constantini, associate vice president of primary care and recovery services integration at The Wright Centers for Community Health and Graduate Medical Education, spoke about the challenges, successes, and trends he has seen in addiction treatment in recent years, and what the pilot program will mean for the Scranton-based organization.
Highlights of that conversation, edited for length and clarity, follow.
Q: In conjunction with last month's announcement, there is some research into Centers for Disease Control statistics, and it is surprising to see that estimated drug overdose deaths did decrease by 3% nationwide in 2022 — the first annual decrease since 2018. State statistics show a decrease of over 13% here in Pennsylvania through February of this year.
The statistics did not decrease everywhere — in some states they went up by double digits — but what are your thoughts on these trends?
A: During COVID, we did have a bit of a spike, and I think that was primarily due to a couple things, including isolation.
For people who were trying to stay busy and be involved in recovery, the light switch just got shut off. It was a difficult time for all of us, but it was particularly difficult for individuals who were struggling or were in early recovery, or people with pre-existing mental illness.
So we had a spike, and then it began to come down.
But my take is we have done a lot — not just as a nation, but as a state — to expand treatments that are evidence-based for opiate use disorder.
Q: What are those?
A: You know, the use of medication assisted treatment or medications. We have flooded our communities with Narcan, right? (Ed: read more about Narcan here.)
We're getting innovative, and we're thinking about who else's hands we can get Narcan into. You know, is it really just about the person who comes through the door who has an opiate use disorder?
No, we want to get Narcan into the hands of a family member, a mom, a dad, a brother, a sister who has another family member that is struggling with opioid use disorder.
We want to get it in the hands of our elderly and long-term care facilities. We want to get it in the hands of the churches, the libraries, all first responders, whether it be fire, EMS, police. We want to get it in the colleges, the high school nurses.
So if you really look around now, Narcan is pretty much everywhere. And we've done a good job at overdose reversals.
Q: Are there also social challenges to overcome in fighting overdose deaths?
A: We've done a lot of work to reduce and eliminate stigma so people can get help. We've educated people about the disease, about the condition of addiction, and we compare it to other chronic diseases and other chronic conditions, but there is more work to do.
If it becomes more acceptable to people to be empathetic and show that they want to help people, we should start seeing (deaths) go down, because people will be more comfortable coming forward to get treatment.
Q: Here in Northeast Pennsylvania it is said that in recent years every family has someone who has been affected by addiction, and that this epidemic doesn't discriminate. Has the universality of it finally opened people's eyes to just how many people are struggling?
A: I think you hit the nail on the head. Addiction doesn't care how much money is in your bank account. It doesn't care what color your skin is.
Q: There are so many facets to understanding and fighting this epidemic. How important is cooperation between disciplines?
A: I spent pretty much my whole career in the behavioral health addiction silo. And I'm going to use that word, silo.
If you really look at most states, we have siloed treatments, right? Physical health sits on one side. Mental health sits on another, addiction sits on another. And the right and the left hand don't talk.
So when I came to The Wright Center in 2016, it was the first time I ever worked truly in the medical field because we're primarily a primary care office.
We have embedded medication-assisted treatment and addiction services, and now we're trying to integrate it into primary care, which I think is a big win-win for our communities.
You go to see your primary care doctor a lot, and lot of times you'll talk to your primary care doctor about things that you typically wouldn't talk to anyone else about, right? Or your primary care doctor does lab work on in your liver enzymes come back and they're like, "wait a minute, what's going on with this?" Or you have an infection that could be created by IV (intravenous drug) use. So you have a conversation with your doctor.
In the past, your doctor would say to you, "oh, I don't deal with that. I'm going to refer you elsewhere." And then there'd be this lull in referral.
At The Wright Center, if you come in today for some kind of medical condition and we find out that you have a drug or alcohol issue, we're going to send one of our case managers right down to the exam room. You've probably heard of the warm handoff concept. I like to use the term scalding hot handoff, so there's no lull in their referral. If you come in and you're vulnerable, we want to help you right then and there.
Q: The fact that the Wright Center is one of just 16 in the nation to be chosen for the 3Cs program is certainly significant. What was the reaction here to the news?
A: We're a micro system compared to some of the big systems, but we applied. We love learning, collaboratives, and any type of platform that we can gain new knowledge from. Our goal really was to better ourselves, learn from what others are doing across the nation.
So we put it together, and we got it. When we saw the list of others, it's impressive. These are medical leaders across the nation.
Q: How is this going to help The Wright Center and the communities it serves?
A: You always want to be looking at what you're doing and how you could do it better.
If I only compare myself to the centers of excellence that I'm on meetings with in Pennsylvania, I only know what they're doing.
But what's Virginia doing? What's California doing? What's New York doing? What are these other states doing in arenas of addiction that maybe we don't know about? Is there anything that we can learn through this 3C pilot program to enhance what we're doing here?
The second piece would be sharing that information with our community partners. The Wright Center has a really good relationship with the (Pennsylvania) Department of Health, with the Bureau of Drug and Alcohol programs, with the Office of Mental Health and Substance Abuse. And I think we're recognized as a voice and an advocate within our state to make change.
So to me, bringing all these people together is going to enhance the way we treat addiction.
Q: The Wright Center serves an area that's a mix of urban and rural. Addiction is an issue in the valleys — in Scranton and Wilkes-Barre — but it also is an issue in every small town throughout our region. Can you could speak to that, to how addiction affects different communities and very different walks of life.
A: Let's talk about the rural areas. We have a clinic in Wayne County, but we may not have the resources in Wayne County that we have in Lackawanna County, so we have to develop innovative strategies in Wayne County to get people access to care.
In Lackawanna County, we have a bus that passes right by The Wright Center. We can get people to their appointments. In Wayne County, we don't have a bus. We might have to coordinate with the county for transportation, we might have to utilize telehealth, we might have to send the case manager out to the house to see them.
I think that this 3C project is going to help us better understand and serve all of these underserved areas.
