Suffolk County has a high rate of opioid and other substance use problems, and the highest number of opioid overdose fatalities of any county in New York State. As Suffolk County’s only academic medical center, Stony Brook Medicine is using its clinical, research and educational expertise to help lead the fight against opioid and other substance use problems.
Below are some of the ways Stony Brook is effecting positive change:
SBIRT: Conversation starters that can lead to better health
Patients who come into the hospital are often guarded about their personal habits, and broaching the topic of substance use has historically been difficult for both physicians and patients. Everyone has their own personal biases, and no one wants to be judged. Yet having those conversations can signal the beginning of a conversation about health and wellness.
To address this, a Stony Brook team led by Kristie Golden, PhD, Associate Director of Operations, launched a Screening, Brief Intervention and Referral to Treatment (SBIRT) program in 2016 as a routine part of Emergency Department visits, physicals and well visits for patients entering those settings.
SBIRT is an approach to population health that helps physicians start a conversation with a patient in such a way that they can objectively assess a patient’s habits. It also enables clinicians to educate patients about how alcohol or drug use may be impacting their overall well-being and helps to ensure that patients with substance use difficulties are connected to the appropriate community resources at the time of discharge, beyond simply providing information about where they can seek services.
Addiction Psychiatry Services and physician training
Once the SBIRT program was established, it helped lay the groundwork for the launch of Stony Brook Medicine’s Addiction Psychiatry Division in 2017.
The division, within the Department of Psychiatry, is led by addiction and policy expert Richard N. Rosenthal, MD. Its team of specialists evaluate, diagnose and treat people who have one or more disorders related to addiction. The team also conducts research into the causes of and effective interventions for addiction and trains Stony Brook healthcare professionals in how to better identify and treat addiction.
Training includes the Psychiatry Residency program at Stony Brook Eastern Long Island Hospital, which began last summer, under the direction of Eduardo Constantino, MD, through the Renaissance School of Medicine at Stony Brook University. Its purpose is to train community psychiatrists who will then remain in the area to work with those individuals who have mental health needs including substance use disorders.
Another strategy for training involves the use of telehealth. Using a module developed by a team led by Rachel Wong, MD, MPH, MBA, Assistant Professor of Internal Medicine, the Renaissance School of Medicine is training future generations of internal medicine residents on how to use telehealth to respond to opioid and chronic pain issues.
The training module is the first of its kind nationally. Internal medicine residents learn to conduct video visits directly with patients, as well as learn clinical management using other digital tools, such as electronic messaging and virtual meetings with specialists in a group video visit format. This comprehensive training helps doctors overcome geographic distances and teaches residents how to optimize time using electronic means, when the doctor and patient are not available at the same time.
Quannacut: Newly expanded state-of-the-art facility in Riverhead
Since the 1980s, Stony Brook Eastern Long Island Hospital has continuously demonstrated a strong commitment to its at-risk community by providing high-quality addiction treatment to patients with a wide range of diagnoses and demographics.
Nearly 35 years ago, the inpatient component of the program began with 18 beds at the hospital’s Greenport location. Today, it features a 23-bed Psychiatric Unit, a 20-bed Quannacut Rehabilitation Unit, and a 10-bed Quannacut Detoxification Unit.
As inpatient services grew to serve Eastern Long Island’s at-risk populations, so did the need for more outpatient services.
Today, in its expanded 14,000-square-foot, state-of-the-art outpatient location at 905 East Main Street in Riverhead, the Quannacut program supports a transformational change within Stony Brook Medicine and increases access to comprehensive addiction treatment on the North Fork, South Fork and throughout Eastern Long Island.
“Quannacut,” the Native American word for “hope” or “rainbow,” defines the facility’s culture and mission in addressing addiction as a treatable disease.
David Cohen, Director of Outpatient Services at Quannacut, and Jarid Pachter, DO, Medical Director at Quannacut, are keenly aware that while medication can be the most vital and lifesaving component of treatment for some patients, full recovery and health cannot be accomplished unless all areas of one’s physical and mental health are addressed.
The program uses a medical psychotherapeutic approach and highly individualized programs for adults with diverse needs across a variety of treatment disciplines — including psychiatric, cultural, physical health and criminal justice. The impact of a patient’s immediate substance use issues on their support system, family members and significant others are also evaluated.
For signs of opiate addiction in the ER
A Stony Brook team is also working with the Greater New York Hospital Association (GNYHA), New York State Department of Health, and the Office of Addiction Services and Support (OASAS) as a learning collaborative in which all hospitals on Long Island are pilot sites for the protocol of prescribing buprenorphine/naloxone for those who show signs of opiate addiction in hospital emergency departments.
Led by Susan Wilner, LCSW, Assistant Director of Behavioral Health Services Operations, and Eric Morley, MD, Clinical Director of Emergency Medicine, the effort employs a medication for addiction treatment (MAT) approach in ERs, which offers an opportunity for patients to begin treatment for opiate addiction immediately, with follow-up treatment on an outpatient basis.
Other clinical services
Stony Brook’s Maternal Opioid Management Service (MOMS) and outpatient program — the first and only in the county, provides office-based buprenorphine treatment, behavioral health counseling, social services, and prenatal as well as postpartum care to women with opioid use disorder.
Established by David Garry, MD, a high-risk pregnancy specialist and Division Director of Maternal Fetal Medicine at Stony Brook Medicine, and Lisa Clark, DNP, CPNP-AC, PC, a pediatric nurse practitioner, the goal is to prevent withdrawal and cravings for drugs and provide access to treatment that will lead to better health for the mom. During the postpartum phase, each new mom in the program is connected with community providers to continue medicine assisted treatment. And babies born to moms enrolled in the program remain with their moms whenever possible.
The role of research
Many faculty at Stony Brook Medicine have dedicated their careers to substance use disorders.
For example, Helen Fox, PhD, in the Department of Psychiatry and Behavioral Health, recently received a multi-site federal grant of $2.4 million to study whether a medication called guanfacine can improve outcomes for women with substance use issues, by reducing drug cravings during stress. And James Swain, MD, PhD, of the Department of Psychiatry and Behavioral Health and the Department of Psychology, received a federal grant of $3.5 million to study the effects of opioids on brain and caregiving behaviors of new moms. Opioid use disorder and related problems like postpartum depression are linked to higher risks of parenting problems, child abuse (physical and emotional) and the costly use of foster care.
By continuously applying Stony Brook’s clinical research and education expertise where it can make a difference – and by working with communities, local, state and national governments, policy makers and other academic institutions – Stony Brook Medicine continues to fight to end the opioid epidemic to benefit our children and future generations.