Change Health Magazine

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specializing in addiction recovery

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CONTENTS To send a comment or question, write to: Change Health Systems 2401 Liberty Heights Avenue Suite 4670, Baltimore MD 21215 (410) 233-1088 Change Health Systems Magazine is published by theinfluence.org Copyright 2018 by TheInfluence.org. No part of this publication may be reproduced in any form or by any means without the prior written permission of the publisher, excepting brief quotations in connection with reviews written specifically for inclusions in magazines or newspapers, or limited excerpts strictly for personal use. Printed in the United States of America. All rights reserved. 6830 West Villard Ave Milwaukee, WI 53218

FEATURES 06 CHANGE HEALTH ANDTHE COMMUNITY GROWINGTOGETHER CHS adds services to become a one-stop shop 10 LOOKING ATTHEWHOLE PICTURE Chief clinical officer’s roots are in West Virginia 26 GETTINGTHE POINT ACROSS Sonnie Price, the program administrator at Change Health, joined the staff earlier this year 30 GETTINGTOTHE ROOTS OF ADDICTION Dual diagnoses pose challenges 54 WORKINGTOWARD A POSITIVE COMMUNITY

Working at Change Health leads to career change 58 WORKINGTOWARD A POSITIVE COMMUNITY Working at Change Health leads to career change IN THE NEWS 14 CVS PHARMACY CVS Health has installed safe medication disposal units in 19 of its pharmacies across Maryland 18 SAVING LIVES It’s time for everyone to carry naloxone 22 DANGEROUS MIX In treating overdose patients, emergency rooms face challenges in detecting mix of drugs 34 UNDERSTANDING ADDICTION Addicton is not simply a weakness 38 GIVING ADDICTS A “REST” Developers working on a first digital therapy for addiction

42 THE OPPOSITE OF ADDICTION IS NOT SOBRIETY Connection with other addicts prove crucial factor 46 COPINGWITH DISCRIMINATION Discrimination remains largerly ignored as a cause of substance abuse 48 HIDDENDANGER New synthetic drug strains are making it difficult to diagnose overdose

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Bring your self to life.

It’s time to discover a new form of yourself a new

path for yourself one that reaches well past the

impulse of the moment. It’s time to wake up in a

world of self-made character of self-determination.

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Psychiatry Urgent Care This service provides emergency appointments and walk-ins for clients. Some of our psychiatry urgent care services includes: • Comprehensive Psycho-social Assessment • Medication Management • Psychiatric Evaluation • Tele-psychiatry

Respite Services CHS provides short-term respite services to families caring for children with serious emotional disturbances or adults with serious and persistent mental illness. These services give

caregivers a break from the rigors of their care-giving duties and support the clients in remaining in their homes. In- home Respite services may be provided at the client’s home, school or any other. Therapeutic Behavioral Services These therapeutic services are geared towards individuals displaying maladaptive, inappropriate, disruptive or dangerous behavior that is determined to be harmful to self and others. Some of our services include: • Screening Assessment • Evaluation •Preliminary planning

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Our Psychiatric rehabilitation program which is known as our “Pathway to Wellness” program. Our Pathway to Wellness program caters primarily for adults facing continuous developmental and behavioral health issues. We also serve individuals with emotional and/or behavioral challenges. Our Pathway to Wellness Program provides organized activities to assist clients in recovery from behavioral health disorders to develop the emotional, social and intellectual skills needed to live, learn and work in the community with the least amount of support. These activities are provided both offsite and on-site. Some of our Pathway to Wellness services and group topics include: -Wellness Support- -Preparation for employment-

-Coping with Bereavement and Grief- -Money and financial management- -Stress Recognition and management- -Yoga and Medication- -Dance, recreation and exercise-

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By Morgan Eichensehr – Reporter, Baltimore Business Journal Jul 12, 2018, 7:00am CVS Health has installed safe medication disposal units in 19 of its pharmacies across Maryland, in an effort to help prevent opioid abuse and misuse.

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w “This is for those medications that are sitting in your home that are no longer needed,” Davis said. “So maybe a patient had a broken leg and needed opioids for the pain, but has some pills left over — those drugs can be easily diverted for abuse by anyone who has access, and we want to help prevent that.” In addition to the medication disposal effort, the CVS Health Foundation is helping to fund opioid-related efforts at the local level, by awarding up to $2 million in grants to community health centers dedicated to supporting opioid addiction recovery. In Baltimore, a $85,000 grant is going to Total Health Care. The funding will be used to develop and implement care models to increase participation in Total Health Care’s substance abuse treatment program. Davis said taking part in combating the opioid crisis is in line with CVS’s mission as a health care company. “Our pharmacists are uniquely positioned as part of the local health care systems to play an important role in educating and also intervening on this issue,” Davis said. “Our mission is about helping people on their path to better health, and one of the ways we can do that is through heightened safety around prominent public health issues.” Maryland is among states across the U.S. that have been ravaged by the deadly ongoing opioid epidemic. Tom Davis, vice president of professional services for CVS Health (NYSE: CVS), said CVS is seeking to support communities that have been affected by the crisis with its medication disposal kiosks. The units will allow patients to drop off unused or excess pills from old prescriptions, so they can be handed over to police and safely disposed of.

CVS looks to prevent

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I recently returned to Buffalo after living five years in Maryland where, in the first nine months of 2017, overdose deaths related to heroin, fentanyl and other opioids reached a new high of 1,501. In response to a mandate from Gov. Larry Hogan, my colleagues and I developed an opioid awareness program for all newly admitted students at Johns Hopkins University. The recent move by the Town of Tonawanda to equip its police officers with naloxone moves that department from being aware to taking action to save lives. Amid the nation’s opioid crisis, why are communities slow to adopt the lifesaving antidote naloxone? On April 5, U.S. Surgeon General Dr. Jerome Adams issued an advisory recommending that more Americans carry naloxone – not just emergency responders and law enforcement personnel, but average citizens. Recent reports from the Centers for Disease Control and Prevention suggest that more than half of opioid overdose deaths are caused by synthetic drugs, including fentanyl. While heroin overdoses evolve in minutes to hours, fentanyl is faster acting and more potent, evidenced by that overdose evolving in seconds to minutes. In his study, “Characteristics of fentanyl overdoses – Massachusetts, 2014-2016,” Dr. Alexander Walley reported that among people who witnessed naloxone being administered, 83 percent said that two or more naloxone doses were used before the person responded. Of those who died from fentanyl overdoses, 90 percent had no pulse by the time emergency medical services arrived. [in Maryland] overdose deaths related to heroin, fentanyl and other opioids reached a new high of 1,501

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Patients who wind up in emergency rooms because of drug use have far more types of drugs in their systems than the standard screening test used by hospitals is catching, a new study has found. -22-

While the drug epidemic has focused on opioid use, two-thirds of patients who ended up at two University of Maryland Medical System emergency rooms in 2016 had multiple drugs in their systems — up to six were found in some urine samples. Emergency rooms tend to use a basic urine test that, like a pregnancy test, turns colors when it detects certain chemicals in drugs. The test is quick and inexpensive, but detects fewer than a dozen drugs, including opioids. The tests don’t detect drugs such as fentanyl and oxycodone, both of which have contributed to record overdoses across the country. Knowing what drugs a patients has taken can help doctors better decide a course of immediate treatment, as well as follow- up treatment such as rehabilitation, said doctors from the two emergency rooms and researchers from the Center for Substance Abuse Research at the University of Maryland, College Park. “We need to know the drug trends to know how to help people,” said Dr. Zachary D.W. Dezman, an attending physician in the emergency room at Midtown. Urine samples were tested from 106 patients at Prince George’s and 69 from the Midtown campus. Patients in Baltimore tested positive mostly for marijuana and fentanyl, a highly potent synthetic often added to heroin without users knowing.

The results highlight the complexities that exist in the current epidemic, said principal investigator Eric Wish, director of the Center for Substance Abuse Research. In some cases, dealers are mixing drugs without the knowledge of users. Many of the patients whose urine was tested misinformed doctors about what they had taken. “It used to be [drug users] didn’t want to admit what they were taking,” Wish said. “In this age they don’t know what they are taking.” Maryland’s drug-related deaths increase for seventh straight year, reach all-time high in 2017. “People are like walking drug stores now, there are so many drugs in their system,” Wish said. “A lot of the treatment now is focused on opioids. The important thing for the medical and treatment community to know is they are using far more than opioids.” Lawmakers and public health officials need to know the extent of fentanyl use to help reduce it, he said. “The emergency room is a place from which you can launch those public health efforts,” he said.

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THERE IS LIFE AFTER ADDICTION

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2401 Liberty Heights Avenue Suite 4670 Baltimore, MD 21215 410-233-1088

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GETTING THE POINT ACROSS

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COMMUNITY BEHAVIORAL HEALTH SERVICES -28-

Board eligible or certified Psychiatrists are available for diagnostic assessment as well as medication monitoring and evaluation.

Our services include: • Comprehensive Psycho-Social Assessment • Family, Group and individual psychotherapy • Medication Management

• Psychiatric Evaluation • Tele-Psychotherapy • Systems Therapy • Behavior Therapy • Cognitive Therapy

• Solution-Focused Therapy • Rational Emotive Therapy • Reality Based Therapy • Interpersonal Psychotherapy • Play Therapy • Group Therapy

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To empower individuals and promote self- awareness through supportive educational and therapeutic interventions. Mission: Vision: Philosophy: To be a partner in facilitating and sustaining positive community development where all individuals can attain their full potentials. We Believe “Treatment works,” “Change Begins with me,” and “It’s all personalized.”

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2401 Liberty Heights Avenue Suite 4670 Baltimore MD 21215

Addiction is not simply a weakness. People from all backgrounds, rich or poor, can develop an addiction. Addiction can happen at any age. -34-

Addiction is a brain disease. • Drugs change how the brain works. • These brain changes can last for a long time. • They can cause problems like mood swings, memory loss, even trouble thinking and making decisions. • Addiction is a disease, just as diabetes and cancer are diseases. There is hope... and we’re here to help. We can help you manage your addiction... through medication based treatment and counseling.

What is addiction and why do scientists believe it is a treatable disease? According to the National Institute on Drug Abuse, when a person can’t stop taking a drug or drinking alcohol even if he/she wants to, it’s called addiction. The urge is too strong to control, even if he/she know the drug is causing harm. When people start using drugs or drinking alcohol, they don’t plan to get addicted. They like how the drug/alcohol makes them feel. They believe they can control how much and how often they take the drug or drink. However, drugs/alcohol change the brain. People start to need the drug/alcohol just to feel normal. That is addiction, and it can quickly take over a person’s life. Drugs/alcohol can become more important than the need to eat or sleep. The urge to get and use the drug or to drink can fill every moment of a person’s life. The addiction may replace all the things the person used to enjoy. A person who is addicted might do almost anything—even lying, stealing, or hurting people—to keep taking the drug or drinking alcohol.

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Giving addicts a “reset ” Developers working on first digital therapy app for addiction One reason the opioid addiction epidemic has taken hold in many rural areas is that many Americans with substance use disorder live long distances from the nearest treatment providers. But a new tool may provide hope.The U.S Food and Drug Administration (FDA) is currently reviewing a new tool that may help remedy that geographical problem: the first prescription digital therapy designed to treat SUD. Boston and San Francisco-based Pear Therapeutics developed reSET, a mobile app used as a treatment tool concurrently with outpatient therapy centered on SUDs.The project has demonstrated better abstinence and treatment retention when applied alongside face-to-face therapy focused on SUD-related treatments for alcohol, marijuana, cocaine and stimulants.The therapy also includes a web-based program for healthcare providers. An app to help opiate addicts Pear is also developing reSET-0, an app specifically designed to help opiate addicts. Both apps consist of a patient-facing smartphone application and a clinician-facing web interface. The company raised $20 million last year with the aid of various venture companies including Arboretum Ventures, an Ann Arbor, Mich.-based venture capital firm. “(reSET) will give patients and clinicians a new tool to improve therapy specifically in an area right now that is a true health epidemic in the U.S,” Dr.Thomas Shehab, managing director at Arboretum Ventures, told DrugAddictionNow.com. “It’s an extremely novel approach to central nervous system and behavioral health diseases that we didn’t see anyone else addressing in that way.”

Pear submitted reSET for review by the FDA during the first half of 2016 and says it is expected to be approved this year. Dr. Shehab said his firm is “particularly intrigued by their approach because it’s a combination of a very well-studied digital therapy being used in conjunction with other therapies.” He says, “We thought the unique makeup of the Pear team and their unique approach to digital therapies really made us feel it had the highest likelihood of success in really helping address these issues.”

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According to data provided by Pear Therapeutics, 507 people with SUD from 10 treatment centers nationally received either face-to-face therapy or reduced volume of face-to-face therapy with reSET.They were given 12 weeks of outpatient therapy with or without using the app; if without, a portion of the digital therapy was replaced with face-to-face therapy. Abstinence was calculated two times weekly through a breathalyzer, urine samples and self-reports. Of the participants dependent on alcohol, marijuana, cocaine and stimulants, 58.1 percent of them receiving treatment with reSET were abstinent during weeks nine through 12, versus 29.8 percent of participants receiving only face-to-face therapy. Of the participants who started the study with a positive drug test, 26.7 percent of them who received reSET were abstinent during weeks nine through 12 of the study; only 3.2 percent of those that received traditional face-to-face therapy reported abstinence during the same time period. Participants using reSET presented statistically significant advancement in retention rates compared to those not using the app. After 12 weeks, 59 percent of participants that received face-to-face therapy retained sobriety in comparison to the 67 percent of those that used reSET.The reSET-O app has shown promising results in According to data provided by Pear Therapeutics, 507 people with SUD from 10 treatment centers nationally received either face-to-face therapy or reduced volume of face-to-face therapy with reSET.They were given 12 weeks of outpatient therapy with or without using the app; if without, a portion of the digital therapy was replaced with face-to-face therapy. Abstinence was calculated two times weekly through a breathalyzer, urine samples and self-reports. Of the participants dependent o alcohol, marijuana, cocaine a d stimulants, 58.1 percent of them receiving treatment with reSET were abstinent during weeks nine through 12, versus 29.8 percent of participants receiving o ly face-to-face therapy. Of the participants who started the study with a positive drug test, 26.7 percent of them who received reSET were abstinent during weeks nine through 12 of the study; only 3.2 percent of those that received traditional face-to-face therapy reported abstinence during the same time period. Participants using reSET presented statistically significant advancement in retentio rates compared to th se not using the app. After 12 weeks, 59 percent of participants that received face-to-face therapy retained sobriety in comparison t the 67 percent of those that used reSET.The reSET-O app has shown promising results in

three independent and randomized clinical trials, the company says. A study of 465 participants that completed outpatient methadone or buprenorphine treatment for opioid addiction was conducted, in which the participants were given standardized face-to-face therapy or shortened standardized treatment with reSET-O.Their abstinence was determined by self-reporting and urine tests. The developers plan to submit reSET-O to the FDA for approval, pending approval of reSET. “With all that’s going on, this is a very exciting company that we’re very enthusiastic about because it benefits a group of patients in great need,” Dr. Shehab said. “We think that reSET has a lot of potential.” three independent a d randomized clinical trials, the company says. A study of 465 participants that completed outpatient methadone or buprenorphine treatment for opioid ad iction was conducted, in which the participants were given standardize face-to-face therapy or shortened standardize treatment with reSET-O.Their abstinence was determined by self-reporting a d urine tests. The developers plan to submit reSET-O to the FDA for approval, pending approval of reSET. “With all that’s going o , this is a very exciting company that we’re very enthusiastic about because it benefits a group f patients i great need,” Dr. Shehab said. “We think that reSET has a lot of p tential.”

Maker receives NIDA grant In July, Pear announced it

Maker receiv s NIDA grant In July, Pear annou ced it

has received a Small Business Innovation Research (SBIR) Fast-Track award funded by the National Institute on Drug Abuse (NIDA). PEAR will collaborate with CleanSlate Research and Education Foundation and Columbia University Medical Center Department of Psychiatry’s Division on Substance Use Disorders on the project. The grant will support the application of “enhanced engagement and gamification mechanisms” to reSET and reSET-O, the company says.

has received a Small Business Innovation Research (SBIR) Fast-Track award funded by the National Institute on Drug Abuse (NIDA). PEAR will collaborate with CleanSlate Research and Education Foundation and Columbia University Medical Center Department of Psychiatry’s Division on Substance Use Disorders on the project. The grant will support the application of “enhanced engagement a d gamification mechanisms” to reSET and reSET-O, the company says.

“It benefits a group of patients in great need.” - Dr.Thomas Shehab, Arboretum Ventures “It benefits a group of patients in great ne d.” - Dr.Thomas She ab, Arboretum Ventures

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These therapeutic services are geared towards individuals displaying maladaptive, inappropriate, disruptive or dangerous behavior that is determined to be harmful to self and others.

Some of our services include: • Screening Assessment • Evaluation • Preliminary planning

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Connection with other addicts prove crucial factor

“If drugs are not the cause of addiction, what is?” - Bruce K. Alexander, psychologist

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PSYCHIATRY URGENT CARE

This service provides emergency appointments and walk-ins for clients.

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WE’RE JUST A PHONE CALL AWAY (410) 233-1088

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Hidden Danger New synthetic drug strains are making it difficult to diagnose overdose

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Over the course of two days in mid-August, more than 95 people in New Haven, Connecticut, overdosed.

Their drug, however, wasn’t heroin. It was synthetic cannabinoids, commonly sold as K2, Spice, or potpourri. The fallout from the incident was so widespread that experts have referred to it as a “mass casualty incident.” In nearby Baltimore, a new study by the University of Maryland’s Center for Substance Abuse Research (CESAR) published this month articulates many of the problems with identifying and treating synthetic cannabinoid overdoses.

Researchers studied urine samples of patients with suspected synthetic cannabinoid overdose at two different hospitals, the University of Maryland Medical Center Midtown Campus in Baltimore and the University of Maryland Prince George’s Hospital Center in Cheverly, a suburb of Washington, D.C.

They almost immediately hit a snag with their study.

If the patients had been using Spice, why wasn’t it showing up in their urine?

“When we got the results back, it was just kind of amazing because we expected to find a large percentage testing positive for the synthetic cannabinoids metabolites we were testing for, and what we found was that in the first go around only I think one specimen testing positive for it,” said principal investigator Eric Wish, PhD, a principal study investigator and director of CESAR at the University of Maryland, College Park, College of Behavioral & Social Sciences.

Despite testing the urine for 169 different drugs, including 26 metabolites of synthetic cannabinoids, it simply wasn’t there. The issue, say experts, highlights an urgent need for improved testing for so-called new psychoactive substances, including Spice and synthetic cathinones, also known as bath salts. These new drugs don’t show up on standard drug tests, making it difficult to form a clear diagnosis. Designer drugs continually manage to dodge legislation because whenever a certain variety is outlawed based on its chemical structure, a new similar chemical is manufactured and sold legally.>>>

“People want to know what they’ve been exposed to.”

“While the press and the media talk about Spice and K2 like it’s a single type of phenomenon, the truth can’t be further from that,” Wish told Healthline. “Basically what you have is some chemist in another country, oftentimes the DEA says it’s China, who waits and they see what has been put on the prohibited list by the government. And then they go ahead and they tweak the molecule a little so it’s no longer on the prohibited list and then they make it available.” New diagnostic measures One year later, researchers implemented an updated drug-test panel that increased the number of synthetic cannabinoids from 26 to 46. Even with this improved panel, only about one-quarter of the samples tested positive. The study also highlights several other findings that could potentially help improve immediate care for individuals overdosing on newer drugs at emergency departments as well as future public health initiatives. For instance, where a patient lives can foretell what drugs may be in their bloodstream. Researchers saw that in patients at Prince George’s County. Nearly half of them also tested positive for the hallucinogen PCP. Those at the Midtown Campus hospital were far more likely to have cocaine and fentanyl in their bloodstream. “The study provides public health officials, provides patients themselves, an understanding of the risks that they are exposed to,” said Dr. Zachary D.W. Dezman, an assistant professor of emergency medicine at the University of Maryland School of Medicine.

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The fentanyl factor Fentanyl, a powerful synthetic opioid, is increasingly showing up across the United States with deadly results. In this study, researchers found that among all substances, fentanyl was the most likely to be found in combination with multiple other drugs. In some specimens, it was detected with as many as 12 others — indicating that users either aren’t aware what is in their drugs or that users of fentanyl are regularly using many different drugs simultaneously. “I’ve had a number of patients who once they were told they were fentanyl positive… started to seek treatment,” he added. Currently, fentanyl doesn’t show up on common “dip tests” used in hospitals, but Dezman hopes that will soon change. Synthetic cannabinoids, fentanyl, and synthetic cathinones represent a new challenge for members in the healthcare community to identify and treat, but by understanding which drugs are being used in which communities, better education and treatment options can be developed. “We can track people down to a particular area code, and that allows us to do things like create, potentially, a mobile van for education efforts to educate the neighborhood on the dangers they are being exposed to, signs to look out for an opioid overdose, distribute naloxone, and potentially also start a mobile opioid maintenance therapy van [to provide] methadone or Suboxone,” said Dezman. People “want to know what they’ve been exposed to,” said Dezman.

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OPIATE + OPIOID ADDICITON What is the difference between Opiates and Opioids?

OPIATES

OPIOIDS

A Natural Pain RemedIES

SYNTHETIC PAIN MEDICATIONS

VS.

Opium

Oxycodone

Thebaine

Hydrocodone

Morphine

Oxymorphone

Codeine

Hydromorphone

Heroin

What Medications Treat Opiate & Opioid Addiction?

Naltrexone

These medications act directly upon the opioid receptors; more specically the mu receptors. Because the effects of these medications vary at the receptor level, there can be different clinical effects during treatment.

ReVia | Depade | Vivitrol

Methadone Dolophine

Buprenorphine Suboxone | Subutex

A FULL AGONIST binds to the receptor and activates it by changing its shape - inducing a full receptor response.

A PARTIAL AGONIST binds to the receptor and activates it with a smaller shape change in the receptor that includes a partial receptor response.

We provide real treatment that produce real results.

CALL US! (410) 233-1088 2401 Liberty Heights Ave. Suite 4670, Baltimore MD 21215

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DON’T

TAKE CONTROL

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Embrace Change

2401 Liberty Heights Ave, Suite 4670 Baltimore, MD 21215

44 N. Potomac St, Suite 101 Hagerstown MD 21740

410.233.1088

240.420.1850

CHANGE-HEALTH.COM

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