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VOL. 132 | NO. 256 | Wednesday, December 27, 2017

UTHSC's Stern Proposes Substance Addiction Network

By Michael Waddell

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For Dr. David Stern of the University of Tennessee Health Science Center, his interest in proposing a new pilot program to benefit those with mental health and substance use problems comes from a deeply personal as well as professional place.

In 2008, his late son, Alan Robert Stern, passed away at age 23 following mental health and substance use disorder problems.

“My wife and I are both physicians, and we couldn’t get the health care for Alan, particularly the mental health and addiction care,” said Stern, Robert Kaplan Executive Dean of the College of Medicine and vice chancellor for UTHSC Clinical Affairs. “The primary care physicians who treated him as a psychiatrist just were not up to the task and certainly were not contributing.”

Dr. David Stern

Stern’s wife, Kathleen, who was an ophthalmologist at the time, decided she no longer wanted to practice medicine and became a full-time artist.

“Looking for a way in which I could contribute to people that have mental health and substance abuse problems became one of the things that’s very important to me,” Stern said.

“In the meantime, since Alan passed, the opioid addiction crisis – and in fact more widely we would say a problem with substance use disorder in the United States – has really taken hold in a very firm and negative way, so a focus on this seems like something that’s appropriate.”

Stern formed the UTHSC Center for Addiction Science to have a setting for clinical care, research and education.

Across Tennessee, problems with opioids are the worst in the eastern half of the state, while the western side struggles more with the use of methamphetamines, benzodiazepines, cocaine and heroin laced with all sorts of things. Three percent of people have an addiction to opioids, but it’s estimated that only 10 percent of people who need treatment for an addictive disorder are actually getting treatment.

“The proposal is basically to train a health care workforce that is more knowledgeable about substance use disorder, and have this workforce operate within a network in a more coordinated way,” Stern said. “One of the big problems that all of us know with American medicine is that it’s pretty fragmented, so one of the things that’s most important is coordination of care.”

Alan Robert Stern in a portrait painted by his mother, Kathleen Stern. 

Stern’s plan is to take in fellows from across Tennessee – 10 per year for three years – who would take one year in additional fellowship training for addiction, initially focused on opioids. Loan forgiveness would be a way to invest interested parties into the network.

Everyone in the network would be linked by electronic medical records, and IT connectivity would be important for tracking financial and claims data.

“The important thing is that providers talk to each other via this network, and the way they can talk to each other is via telemedicine and conferences,” Stern said.

He cited a hub-and-spoke treatment model where multiple primary care physicians would be trained by specialists in the hub, with stable patients in the spokes and less stable patients or those that need more support treated in the hub.

“I would hope to create this kind of coordinated network for Tennessee because this is really what it takes to help a patient,” he said. “If you just take one isolated doctor and put him or her in an office, that’s not enough to help these patients.”

Wraparound treatment areas include medication-assisted treatment or abstinence, counseling, behavioral health and case management for things like job placement, housing, transportation and adequate food.

Physicians are not currently equipped to deal with the opioid epidemic, so the goal is to produce an informed, accessible, strategically positioned health care workforce, starting with primary care physicians.

Considering that approximately 60 percent of Tennessee is rural, another major piece of Stern’s network is a rural component.

Fellows in the network would visit rural sites, spend time with the primary care physicians and be connected with specialists, Stern said. Training peers, or having patients go through long-term recovery, is also a critical piece of the network, along with seminars for educating the community.

Funds to support the program’s budget of $26 million over six years could come from the state, insurers and foundations. The more than $2 billion impact of opioid abuse on the state includes $1.3 billion in lost wages and $422 million in hospitalizations.

“If you can get the patient stable so that they can go back to work, suddenly they’re a contributing member of society for themselves and for all of us,” Stern said. “That probably is the best definition of recovery in this, that the person regains control of his or her life and can go to relationships with family and friends and be economically productive so they can provide for those around them.”

Cherokee Health System is a federally qualified health center and a community mental health center – the only entity of its kind in the state with both designations. The organization operates 25 clinics throughout Tennessee.

“We’re excited about Dr. Stern’s initiative. We think it’s going to address a real need,” said Cherokee CEO Dr. Dennis Freeman. “I see the shortage of providers around the state. I’ve encouraged Dr. Stern to place a lot of graduates when they finish the program in the federally qualified health centers around the country because many of the people who need this kind of care are in those clinics.”

Cherokee will be opening a new clinic in Frayser on Jan. 1, collaborating with the UT Family Practice Residency clinic on Poplar Avenue. At Cherokee, embedded in primary care is a combination of addiction medicine and behavioral health approaches.

“There’s some promising medication approaches, but there aren’t enough providers who have prescriptions or are using those medications,” Freeman said. “The other component is that for almost all of these people, they’ve had some problems negotiating life. So many of them really need some psychological help, too.”

In Memphis, Cherokee will also help train health care providers, psychologists, social workers, nurse practitioners and family physicians.

“If folks have a chronic medical condition, it really needs to be treated over time, and I think addictions are the same,” Freeman said. “We’ve made the mistake in health services to treat people and then tell them go on and live life, and a lot of times there needs to be a connection over a period of time with these people so that they really do truly recover.”

Stern has made a similar proposal, which would work in conjunction with the state proposal, to the Shelby County Commission.

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