Memorial Hospital's Bridge Program & the Treatment of Opioid Addiction
Dr. Kian Azimian shares information about how Memorial Hospital's Bridge Program provides treatment for patients suffering form opioid addiction.
Featured Speaker:
Kian Azimian, MD
Dr. Kian Azimian, MD, is a board-certified emergency medicine physician and is the Assistant Medical Director with Bakersfield Memorial Hospital. He received his medical degree from Keck School of Medicine at the University of Southern California and has been practicing medicine for over 17 years. Dr. Azimian leads by example to provide exceptional care to his patients. Believing in the importance of reducing stigma, treating all patients with dignity and compassion, and living a quality life, Dr. Azimian became the BMH Co-Director for the CA Bridge Program in Kern County. With the CA Bridge Program, Dr. Azimian and his ED team provide low-barrier treatment options for those with opioid use disorder right from the emergency department. Transcription:
Memorial Hospital's Bridge Program & the Treatment of Opioid Addiction
Bill Klaproth (Host): There’s a new program to provide medication and training in the fight against the opioid epidemic with the Bridge Grant Program. So, let’s talk about the treatment of opioid addiction and Memorial Hospital’s Bridge Grant Program with Dr. Kian Azimian, Emergency Medicine Physician and the Assistant Medical Director with Bakersfield Memorial Hospital. Dr. Azimian, thank you for your time. So, tell us, what is the Bridge Grant Program?
Kian Azimian, MD (Guest): So, the money from the State of California is used for educating providers that are going to care for the patients with opioid use disorder.
Host: Now I know the money is divided up and a portion of the money goes to the Substance Abuse Navigator that is used for counseling and education and getting people into the program. What else?
Dr. Azimian: The other portions of it are really focused on getting the education for the providers and also education for patients, getting posters up, letting people know that we have this program available. And then on top of that, we start people that have opioid use disorder on these medications called buprenorphine and then on an outpatient basis, they are started on suboxone.
Host: So, then how does this work? I imagine a patient would present in the Emergency Department. What is the process after that then?
Dr. Azimian: So, once the patient arrives in the Emergency Department that has opioid use disorder; we talk to them and try to get them onto medications that will treat their illness. So, that can happen in a couple of different ways. One way is a patient overdoses, paramedics or police department will give him Narcan or her Narcan, the patient comes to the Emergency Department and that’s our opportunity to talk to them to get them educated in regards to buprenorphine and suboxone and get them onto this program.
Another way is patients come into the Emergency Department for unrelated things, they are coming in for an abscess, they are coming in for a cold or what have you and we identify them as having opioid use disorder from either pills of heroine or whatever and then we can talk to them about what we have available through this program. And then ultimately, now that our program is up and running; we actually have patients that come in that have talked to other folks that have opioid use disorder and they basically learned that we are a resource for them, so they come in and we’re able to get them into the program.
Host: So, how do these other medications work and how are they different than Narcan?
Dr. Azimian: So, Narcan is the medication that basically reverses the opioids. So, if you can imagine any opioid like heroine, fentanyl, morphine, dilaudid is kind of like the gas pedal for narcotics. So, it makes your pain go away but at the same time, it gives you constipation, decreases your respiratory rate, makes your pupils small, et cetera. That’s what the narcotic does. What the Narcan does is it reverses it. It’s kind of like the brake and the way that it actually works in the body is that it pushes off the narcotic off of the receptor on the cells of the body that make you have that sensation that the narcotics give you.
So, the Narcan reverses that. But the way the buprenorphine works is it is kind of in between. It sits on that receptor, but it doesn’t kind of push the receptor or sit on the receptor so hard that I makes you have that decrease in respiratory rates and stop breathing et cetera.
Host: So, can you talk about the benefit of this type of medication that you’ve been talking about that comes with the Bridge Grant Program? What is the benefit to the patient? And then what is the benefit to the hospital?
Dr. Azimian: Unfortunately, the patients that are using the other opioids like the pills or the fentanyl patches or they are going on the street and purchasing heroine, of course all of the other opioid pills and patches et cetera, they predominantly are buying it from the street or getting it from other patients that are getting it from physicians et cetera; all of those have a very, very high likelihood of overdoses so patients can die from the overdose. Unfortunately if you are sharing needles, you have a very high chance of transmitting illnesses from person to person. The folks that are very desperate and have opioid use disorder are at much higher risk of both being victims of violence and being violent or going into criminal activity in order to have the money for these drugs.
So, once you provide the buprenorphine, you are basically eliminating the risk of infections, you are eliminating that huge risk of overdose and also eliminating the risk of them physically being harmed or harming others. And once patients are on these treatments; the overall risk reduction for mortality is a 15 time reduction in likelihood of death which is – and that’s all causes of death from opioid use disorder. So, this is an extremely, extremely impressive reduction of harm for the patient. That helps not only the patient that’s in front of you that could be a family member, a friend or just a community member but it also helps everybody else in the community.
At this point, deaths from opioid use disorder from having overdoses is the fifth cause of death in the United States. And that’s very impressive. That’s behind heart disease, cancer, chronic lung disease like COPD et cetera, suicide and the next one is overdoses. So, it’s very, very impressive. I mean just a couple of years back it was over 70,000 per year in 2018.
Host: So, you said 15 times, 15 times risk reduction and mortality. That’s unbelievable.
Dr. Azimian: Let me put it to you this way. If we give an aspirin to somebody to avoid having them have their next heart attack; if I recall the numbers, it’s a – the number needed to treat is seven people you need to treat in order to actually help one person. This is so impressive as far as how much it helps, it’s 15 times stronger. So, for every person that you are treating; you are reducing their risk by 15 times of dying. Very impressive how well it works as far as getting the risk of death to decrease.
Host: So, it’s easy to see the clear benefits of the Bridge Grant Program. So, is there anything else that can be done to care for people struggling with opioid addiction?
Dr. Azimian: You know for sure. I think taking away some of the stigma is very, very important. Instead of calling somebody an opiate addict or a narcotic addict, using the word opioid use disorder and realizing that they truly have an illness and also understanding that that illness can be treated; I think that is a very important step. Getting the education out there to let people know that there are centers that are eager to take care of them and help them on the road to recovery and really provide hope. I mean the sad thing about all of these people that are dying is that most of them are very young. You are talking about people between 25 and 45 years of age. These are people that should be productive members of our society. Instead they are dying. And that’s just – that’s not good for us in the long run.
And this is from all swaths of socioeconomic status. I mean this isn’t just some person that’s be homeless their whole life. This is from poor, middle class, rich, I mean everybody is in there. The other thing is Narcan. I mean we really need to get Narcan out there and let people know that Narcan is available for them. It’s a very simple little spray that you can spray into the patient’s nose if they’ve overdosed. And getting that out very readily available is very helpful because – instead of waiting for a police officer or a paramedic to come over and shoot the medications, just spray it into somebody’s nose or give them an injection of the Narcan. If people have this available to them, they can just spray in the nose of somebody that’s overdosed and save their life.
Host: It really is a life saving drug. So, and overall, the whole Bridge Grant Program, it’s easy to see how this has such a positive impact and effect not only for the person struggling with opioids, but for the community and the hospital as well. This truly is a great program.
Dr. Azimian: Very true. The impressive thing is, we haven’t been doing this for very long, but we already have people that have been clear from using heroine for six to nine months and they gotten their lives back together. They are back with their families; they are not homeless. A couple of the people we have talked to have gone back to work and they are taking buprenorphine, but they are working. I mean how impressive is that to take somebody off the streets, back home, taking care of their family and working.
Host: Which is key to helping people get back on their feet. Well Dr. Azimian, thank you so much for your time today and talking to us about the Bridge Grant Program.
Dr. Azimian: I appreciate it. Thank you so much.
Host: That’s Dr. Kian Azimian and for more information please visit www.dignityhealth.org/bakersfield. And if you like what you’ve heard, please share this podcast on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.
Memorial Hospital's Bridge Program & the Treatment of Opioid Addiction
Bill Klaproth (Host): There’s a new program to provide medication and training in the fight against the opioid epidemic with the Bridge Grant Program. So, let’s talk about the treatment of opioid addiction and Memorial Hospital’s Bridge Grant Program with Dr. Kian Azimian, Emergency Medicine Physician and the Assistant Medical Director with Bakersfield Memorial Hospital. Dr. Azimian, thank you for your time. So, tell us, what is the Bridge Grant Program?
Kian Azimian, MD (Guest): So, the money from the State of California is used for educating providers that are going to care for the patients with opioid use disorder.
Host: Now I know the money is divided up and a portion of the money goes to the Substance Abuse Navigator that is used for counseling and education and getting people into the program. What else?
Dr. Azimian: The other portions of it are really focused on getting the education for the providers and also education for patients, getting posters up, letting people know that we have this program available. And then on top of that, we start people that have opioid use disorder on these medications called buprenorphine and then on an outpatient basis, they are started on suboxone.
Host: So, then how does this work? I imagine a patient would present in the Emergency Department. What is the process after that then?
Dr. Azimian: So, once the patient arrives in the Emergency Department that has opioid use disorder; we talk to them and try to get them onto medications that will treat their illness. So, that can happen in a couple of different ways. One way is a patient overdoses, paramedics or police department will give him Narcan or her Narcan, the patient comes to the Emergency Department and that’s our opportunity to talk to them to get them educated in regards to buprenorphine and suboxone and get them onto this program.
Another way is patients come into the Emergency Department for unrelated things, they are coming in for an abscess, they are coming in for a cold or what have you and we identify them as having opioid use disorder from either pills of heroine or whatever and then we can talk to them about what we have available through this program. And then ultimately, now that our program is up and running; we actually have patients that come in that have talked to other folks that have opioid use disorder and they basically learned that we are a resource for them, so they come in and we’re able to get them into the program.
Host: So, how do these other medications work and how are they different than Narcan?
Dr. Azimian: So, Narcan is the medication that basically reverses the opioids. So, if you can imagine any opioid like heroine, fentanyl, morphine, dilaudid is kind of like the gas pedal for narcotics. So, it makes your pain go away but at the same time, it gives you constipation, decreases your respiratory rate, makes your pupils small, et cetera. That’s what the narcotic does. What the Narcan does is it reverses it. It’s kind of like the brake and the way that it actually works in the body is that it pushes off the narcotic off of the receptor on the cells of the body that make you have that sensation that the narcotics give you.
So, the Narcan reverses that. But the way the buprenorphine works is it is kind of in between. It sits on that receptor, but it doesn’t kind of push the receptor or sit on the receptor so hard that I makes you have that decrease in respiratory rates and stop breathing et cetera.
Host: So, can you talk about the benefit of this type of medication that you’ve been talking about that comes with the Bridge Grant Program? What is the benefit to the patient? And then what is the benefit to the hospital?
Dr. Azimian: Unfortunately, the patients that are using the other opioids like the pills or the fentanyl patches or they are going on the street and purchasing heroine, of course all of the other opioid pills and patches et cetera, they predominantly are buying it from the street or getting it from other patients that are getting it from physicians et cetera; all of those have a very, very high likelihood of overdoses so patients can die from the overdose. Unfortunately if you are sharing needles, you have a very high chance of transmitting illnesses from person to person. The folks that are very desperate and have opioid use disorder are at much higher risk of both being victims of violence and being violent or going into criminal activity in order to have the money for these drugs.
So, once you provide the buprenorphine, you are basically eliminating the risk of infections, you are eliminating that huge risk of overdose and also eliminating the risk of them physically being harmed or harming others. And once patients are on these treatments; the overall risk reduction for mortality is a 15 time reduction in likelihood of death which is – and that’s all causes of death from opioid use disorder. So, this is an extremely, extremely impressive reduction of harm for the patient. That helps not only the patient that’s in front of you that could be a family member, a friend or just a community member but it also helps everybody else in the community.
At this point, deaths from opioid use disorder from having overdoses is the fifth cause of death in the United States. And that’s very impressive. That’s behind heart disease, cancer, chronic lung disease like COPD et cetera, suicide and the next one is overdoses. So, it’s very, very impressive. I mean just a couple of years back it was over 70,000 per year in 2018.
Host: So, you said 15 times, 15 times risk reduction and mortality. That’s unbelievable.
Dr. Azimian: Let me put it to you this way. If we give an aspirin to somebody to avoid having them have their next heart attack; if I recall the numbers, it’s a – the number needed to treat is seven people you need to treat in order to actually help one person. This is so impressive as far as how much it helps, it’s 15 times stronger. So, for every person that you are treating; you are reducing their risk by 15 times of dying. Very impressive how well it works as far as getting the risk of death to decrease.
Host: So, it’s easy to see the clear benefits of the Bridge Grant Program. So, is there anything else that can be done to care for people struggling with opioid addiction?
Dr. Azimian: You know for sure. I think taking away some of the stigma is very, very important. Instead of calling somebody an opiate addict or a narcotic addict, using the word opioid use disorder and realizing that they truly have an illness and also understanding that that illness can be treated; I think that is a very important step. Getting the education out there to let people know that there are centers that are eager to take care of them and help them on the road to recovery and really provide hope. I mean the sad thing about all of these people that are dying is that most of them are very young. You are talking about people between 25 and 45 years of age. These are people that should be productive members of our society. Instead they are dying. And that’s just – that’s not good for us in the long run.
And this is from all swaths of socioeconomic status. I mean this isn’t just some person that’s be homeless their whole life. This is from poor, middle class, rich, I mean everybody is in there. The other thing is Narcan. I mean we really need to get Narcan out there and let people know that Narcan is available for them. It’s a very simple little spray that you can spray into the patient’s nose if they’ve overdosed. And getting that out very readily available is very helpful because – instead of waiting for a police officer or a paramedic to come over and shoot the medications, just spray it into somebody’s nose or give them an injection of the Narcan. If people have this available to them, they can just spray in the nose of somebody that’s overdosed and save their life.
Host: It really is a life saving drug. So, and overall, the whole Bridge Grant Program, it’s easy to see how this has such a positive impact and effect not only for the person struggling with opioids, but for the community and the hospital as well. This truly is a great program.
Dr. Azimian: Very true. The impressive thing is, we haven’t been doing this for very long, but we already have people that have been clear from using heroine for six to nine months and they gotten their lives back together. They are back with their families; they are not homeless. A couple of the people we have talked to have gone back to work and they are taking buprenorphine, but they are working. I mean how impressive is that to take somebody off the streets, back home, taking care of their family and working.
Host: Which is key to helping people get back on their feet. Well Dr. Azimian, thank you so much for your time today and talking to us about the Bridge Grant Program.
Dr. Azimian: I appreciate it. Thank you so much.
Host: That’s Dr. Kian Azimian and for more information please visit www.dignityhealth.org/bakersfield. And if you like what you’ve heard, please share this podcast on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.