The American healthcare system has failed to address the needs of vulnerable patients with multiple, chronic, co-morbid conditions. We focus our attention on the opioid epidemic as it kills Americans by the tens of thousands and is currently the greatest threat to health. Decreased cost and improvements in treatment outcomes for complex patients demand that providers learn a new set of clinical skills. These skills are not given enough focus in current medical school curricula or post-graduate psychology training programs. This has never been more important than now, a time where the iatrogenic opioid epidemic has occurred along with the widening illicit use of fentanyl and fentanyl opioid derivatives. We have published a textbook on this subject entitled, Integrative Medicine for Vulnerable Populations: A Clinical Guide to Working with Chronic and Comorbid Medical Disease, Mental Illness, and Addiction. Our model of Integrative Medicine provides a methodology and a skill set that has been successful at treating individuals with co-existing chronic physical and mental health conditions including substance use, severe mental illness, chronic pain, trauma, infectious disease, and other chronic conditions that are comorbid and syndemic, difficult or impossible to treat in isolation and occur more commonly in impoverished communities and people of color. We are currently focusing our attention in Kensington and North Philadelphia, areas of Philadelphia that have been most hard hit by the syndemic with high rates of overdose death, new HIV infection, and epidemic Hepatitis A. Our model focuses on comprehensive evaluation, an integrated formulation that adequately addresses all of the problems, and a rehabilitative holistic treatment plan that targets both physical and mental health conditions provided by a highly coordinated interdisciplinary team of providers. This practice requires that the team understands each discipline’s role and that team communication is built into practice. At a time when “burnout”threatens the integrity of our field, this model improves outcomes, decreases costs, and improves staff and patient retention. We will describe the kind of patients who require this high intensity service, the essential elements of the method, empiric outcomes data, barriers and facilitators to effectiveness, the implications of the structure of the team, and the financial model that we have developed for our work. Finally, we will focus on an extended case study of a patient our team has treated for more than 10 years.
- Describe the syndemic of opioid use disorder, infectious disease, and severe mental illness that more frequently leads to poor health outcomes in impoverished communities and people of color
- Summarize the essential elements of a methodology that can be used to improve treatment outcomes in complex patients with opioid use disorder
- Apply integrative methodology for treatment of opioid use disorder and discuss the utility of an integrated whole-person and rehabilitative treatment plan with complex patients