Anti-overdose project will propel existing Brien Center work

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PITTSFIELD — In the coming weeks, leaders of an $89 million federal project, joined by new allies in Berkshire County, will map logistics for a four-year study on the best ways to treat opioid use disorder.

But in Pittsfield, health experts who for years have fought this form of addiction aren't looking for new approaches. They're simply eager to scale up efforts they know to be effective in helping people get back their lives.

"It will help us do more of what we do," said Dr. Jennifer Michaels, medical director of the Brien Center. "We have a tradition of helping people get back on their feet."

"The intention is to have a far greater reach than we do now," said Christine Macbeth, the center's president and CEO.

The Brien Center will serve as the county's anchor institution in a project led by Boston Medical Center that seeks to reduce opioid overdose deaths by 40 percent when the study concludes. The effort, announced last week, is part of a four-state project and will enlist as partners 16 Massachusetts communities hard hit by the opioid epidemic. Pittsfield and North Adams are participating.

While the Brien Center is the overall agency for the county, it will join with local partners, including the Northern Berkshire Community Coalition.

The study, funded by the National Institute on Drug Abuse, will examine the relative benefits of what's known as Office-Based Addiction Treatment and the use of that approach joined by other, wider interventions in a patient's social life.

In Berkshire County, leaders of the Brien Center say the influx of money and the ability to expand staff should enable them to reach more people — and, hopefully, save more lives.

The treatment involves use of buprenorphine, the generic name for the drug Suboxone. Even on its own, a project that seeks to widen use of that medication can do good, according to Michaels, because the drug continues to carry a stigma more than a decade after it was introduced.

As many as one-third of addiction programs in the United States do not provide for medication-assisted treatment, as the approach is called. Buprenorphine eliminates drug cravings and symptoms of withdrawal, while helping patients regain everyday functions without any sense of intoxication, Michaels said.

"That, to me, is a disgrace. There is a lot of resistance, and it's unfortunate," she said of opposition to the medication. "People live in fear that they will be `outed.' I do believe that stigma kills."

Even though the Brien Center charts good results from use of medication-assisted treatment, its leaders say they continue to encounter stigma and resistance. Macbeth and Michaels say they hope the new study will help counter remaining stigma, as more and more people see the results achieved.

"We're getting that message across loud and clear," Macbeth said of the center's treatment methods, which it prefers to call Office-Based Opioid Treatment, zeroing in on the specific nature of an addiction.

"We can tell you — it works," Macbeth said.

In 2018, the number of fatal overdoses in Massachusetts fell 4 percent, to 1,974. Figures for deaths in Berkshire County in 2018 are not yet available. From 2000 to 2017, 221 people in Berkshire County died as a result of opioid overdoses, according to the state Department of Public Health.

Twenty-seven people died of overdoses in the county in 2017, compared with 36 in 2016, 33 in 2015 and 29 in 2014.

Study goals

The federal study, which also will roll out in Kentucky, Ohio and New York, seeks to shape a new national model for combating opioid use disorder.

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But in many ways, the approaches it will explore already are in play in Berkshire County — both the use of buprenorphine and the layering on of outreach to patients designed to help them return to normal lives.

For instance, the nurses who manage care under the Brien Center's programs work to identify trouble spots in patients' lives that get in the way of recovery from opioid use. Those could be family issues, or problems with other unaddressed medical concerns.

"We do treat the whole person and have been doing that for years," Macbeth said.

Word of the new study comes weeks after Berkshire Medical Center launched a "bridge program" with the Brien Center in response to a new state law. The 2018 law requires hospital emergency departments to be able to provide initial doses of medication-assisted treatment for patients who want to begin that. The program then refers patients from the hospital to the center, where they can obtain additional doses of medication, as well as other health services.

"The community is really poised to take the next step," Michaels said of medication-assisted treatment.

The Brien Center plans to use resources from the federal grant to step up its outreach efforts to jails and homeless shelters, as well as other settings. The grant provides for one new full-time nurse care manager and a half-time administrator for each partner agency.

"The intent is to have a far greater reach than we do now," Macbeth said.

David Kibbe, a spokesman for Boston Medical Center, said that while details are being worked out, the study does intend to increase patient access from the outset.

"Expansion of access to care is a key goal of the study," he said.

The 40 percent goal on reduced fatal overdoses and the dollar value of the grant were set by the funding agencies, Kibbe said.

Michaels and Macbeth note that because of the high percentage of Massachusetts residents with health insurance, lack of coverage is not often a barrier. It isn't yet known whether money from the grant will be available to cover any out-of-pocket costs for prospective patients.

"It's too early to say what types of care and how insurance coverage would factor into that," Kibbe said.

Gaps in public or private transportation remain a stumbling block in Berkshire County for some people who could benefit from treatment.

The goal now and in coming years, Macbeth said, will be to get help to people who stand ready to overcome opioid use disorder.

"Just help them make the connections, and get their needs met," Macbeth said.

For Michaels, success comes not only through helping patients beat opioid use disorder, but by enabling them to reclaim their lives as residents no longer derailed by addiction's incessant and destructive demands.

"We get to see that every day in the people we serve," Michaels said.

Larry Parnass can be reached at lparnass@berkshireeagle.com, at @larryparnass on Twitter and 413-496-6214.


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