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Health centers take on opioid addiction Paul Dragu pdragu@havredailynews.com

Community health centers in north-central Montana have received $350,000 in federal grants to use in the regional battle against rampant opioid abuse and to help treat people with mental health issues.

Bullhook Community Health Center in Havre and Sweet Medical Center in Chinook each received $175,000. The grants are part of $2.8 million in grants to 17 health centers in Montana and $200 million nationwide from the U.S. Department of Health and Human Services’ Health Resource and Services Administration.

The opioid epidemic has been federally recognized as a national crisis, and the Hi-Line, despite its geographical isolation or its national inconspicuousness, has not been spared from its ravaging effects. The need for care in the region, Bullhook CEO Cindy Smith said, is as great as it is anywhere.

“When these guys,” Smith said, referring to Licensed Clinical Professional Counselor and Licensed Addictions Counselor Misty Geer, Addictions Case Manager Sandy Derry and Nurse Practitioner Katie Olson — who is training to be psychiatric nurse practitioner as well — “don’t have enough slots to schedule the patients that are being referred, you know we have a big problem.”

The clinic’s backlog is an indication of two regional problems, Smith said. Geer is backed

Havre Daily News/Floyd Brandt Bullhook Community Health Center CEO CIndy Smith listens during a discussion of treating opioid abuse. up two weeks before she can see anybody.

That’s how bad care is needed and it is also a reminder of the continuing provider shortage in the region. Montana has, and continues

to have, problems getting and hiring qualified employees in the mental health field, Smith said.

Despite statewide personnel issues, community health centers have been effective, and for that reason, Smith said, the government saw fit to arm them with more resources.

“They realize the impact and have seen data and outcomes from community health centers. So that’s why they give to community health centers,” she said.

Smith said Bullhook sees about 5,000 patients a year for about 15,000 visits.

Sweet Community CEO Dana Pyette said about 2,000 patients a year come through their

health center at its Chinook and Harlem clinics.

Part of the grant money, Smith said, will be used to add staff so more people can get treatment faster. And although the backlog stretches for weeks, they still try to get patients seen by someone quickly.

“We try to get them in right away to see a case manager so at least somebody gets in touch with them and let them know we’re going to start working on this for them,” Smith said. “We want them to have access the minute they say they want help so we at least get them hooked up with somebody to talk to.”

A psychologist has already been hired and she will began work this month, Smith said.

She will be the only psychologist at the clinic.

Someone who is already working the health center in one capacity is being trained to be the second psychiatric nurse. And since an electronic medical records system has been implemented — all departments have access to patient records — a trainer is being brought in to teach employees how to best utilize the system. The goal is to insert patient information so it is accessible, as well capturable in the sense of being able to accurately determine the effectiveness, or lack, of treatment.

The grant money, Smith said, is to be evenly split between mental health and ubstance addiction counseling.

Pyette said the requirements for splitting the money between the two types of care apply to the Chinook health center as well.

Sweet Community will use some of the money to hire a licensed social worker and community health worker, Pyette said. In addition, the grant will also fund anti-stigma education and community education to raise awareness to the services provided by the health center.

The U.S. Department of Health and Human Services reports the majority of drug overdose deaths, more than six out of 10, involve opioids.

Since 1999, the number of overdose deaths involving opioids — including prescription opi-

Havre Daily News/Floyd Brandt Sweet Medical Center CEO Dana Pyette works in her office.

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Gene therapy helps boys with “Lorenzo’s Oil” disease

By MARILYNN MARCHIONE AP Chief Medical Writer The fledgling field of gene therapy has scored another win: A n ex p e r i m e n ta l t re a t m e n t seemed to help boys with the inherited nerve disease featured in the movie “Lorenzo’s Oil.” Fifteen of the 17 boys treated in a study had no major disability two years later — remarkable for a disease that often causes swift decline and kills within a decade.

“This appears to be a terrific new therapy” for many kids who had little hope before, said one s t u d y l e a d e r, D r. D av i d A .

Williams of Boston Childrens Hospital.

The news is bittersweet for Paul and Liliana Rojas, a couple from Dover Plains, New York, with two sons who have the disease. Brian, 7, received the treatment; Brandon, 10, didn’t.

Brandon was too far along in his disease to qualify for the study, his father said, adding, “ B r i a n wa s n o t . T h a n k s t o B ra n d o n h e wa s d i a g n o s e d early,” in time to be helped.

Study results were published O c t . 4 by t h e N ew E n g l a n d Journal of Medicine and discussed at a medical conference i n K a n s a s C i t y, M i s s o u r i .

Government grants and the therapy’s maker — Bluebird Bio Inc. of Cambridge, Massachusetts — paid for the study, and some researchers work or consult for the company.

Only one gene therapy is sold in the United States, a leukemia treatment approved in August.

Only a few are sold elsewhere.

Researchers increasingly are trying these approaches for diseases caused by a single gene, as this one is.

Called adrenoleukodystrophy, it almost exclusively strikes boys, who have only one copy of the X chromosome, where the gene that causes the disease lies. It affects a b o u t 1 i n eve r y 2 0 , 0 0 0 b oys worldwide.

They are unable to make a protein that helps break down certain fatty acids, causing the acids to build up and damage nerves, muscles and the brain.

Their plight became better known after the 1992 movie about a couple who, desperate for a cure for their son, developed a treatment from olive and rapeseed oils that seemed to help him. The real life Lorenzo died in 2008 at age 30, having lived two decades longer than doctors predicted.

Katherine C. Cohen/Boston Children’s Hospital via AP Paul and Liliana Rojas speak to their sons, Brian, second from left, and Brandon, Aug. 29 at Boston Children's Hospital. The young boys suffer from adrenoleukodystrophy, an inherited nerve disease featured in the movie "Lorenzo's Oil." Brian was able to benefit from an experimental treatment while the disease had progressed too far in Brandon to qualify for the gene therapy study. Study results were published Oct. 4 by the New England Journal of Medicine and discussed at the Child Neurology Society conference in Kansas City.

Lorenzo’s oil did not turn out to be a cure. The only effective treatment is a stem cell transplant from a matched sibling, but only about 1 in 5 boys with the disease have such a donor.

The gene therapy tested a way for boys to serve as their own cell donors.

Doctors remove some of the patient’s blood stem cells, modify them in the lab to carry the healthy gene and give them back intravenously.

Before the modified cells are returned, patients take strong medicines to destroy much of their native bone marrow. That helps the genetically modified cells take hold and multiply, so they can supply the protein that the boys lack.

The study tested this treatment in 17 boys ages 4 to 13 with

the most severe form of the disease that affects the brain. Two years after treatment, 15 were neurologically stable. The other two died, one from worsening disease and the other from complications of a donor transplant a t t e m p t e d a f t e r h e w i t h d rew from the study.

The results suggest this therapy is at least as good as stem cell transplants given to boys who have suitable donors “and it i s p o s s i b l y s a f e r, ” D r. M a rc Engelen of Emma Children’s Hospital in Amsterdam wrote in a commentary in the medical journal.

The main questions are how long the benefits will last, how much the treatment will cost if it wins approval, and whether it will replace stem cell transplants from donors, he wrote.

T h e U . S . Fo o d a n d D r u g Administration requires gene therapy participants to be monito re d fo r 1 5 ye a rs, s o t h e s e patients will continue to be studied, Williams said. Eight more patients are being added to the study as part of Bluebird’s plans to seek approval of the therapy in the U.S. and Europe.

Brandon Rojas now needs a wheelchair and feeding tube. He had been a healthy, normal child until suddenly starting to drool and have learning problems in school about the time he turned 7. He was diagnosed three years ago and doctors advised the couple to have Brian tested too.

They were on a Make-A-Wish Foundation trip when the results came.

“We were driving to one of the Disney parks and had to pull

over to get the call,” Paul Rojas said. “Once we got off the phone, we both looked at each other and said we need to move forward now and save our younger son any way we can.”

The couple has joined an e f fo r t to i n c re a s e n ew b o r n screening for the disease, especially now that a therapy may soon be available to help — if it’s tried soon enough.

—— Marilynn Marchione can be followed at http://twitter.com/ MMarchioneAP —— This Associated Press series was produced in partnership with t h e H owa rd H u g h e s M e d i c a l Institute’s Department of Science Education. The AP is solely responsible for all content.

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Studying 1 million people to end cookie-cutter health care

By LAURAN NEERGAARD AP Medical Writer WASHINGTON — In a quest to end cookie-cutter health care, U.S. researchers are getting ready to recruit more than 1 million people for an unprecedented study to learn how our genes, environments and lifestyles interact — and to finally customize ways to prevent and treat disease.

Why does one sibling get sick but not another? Why does a drug cure one patient but only cause nasty side effects in the next?

Finding out is a tall order. Today, diseases typically are treated based on what worked best in short studies of a few hundred or thousand patients.

“We depend on the average, the onesize-fits-all approach because it’s the best we’ve got,” said Dr. Francis Collins, director of the National Institutes of Health.

That’s changing: The NIH’s massive “All Of Us” project will push what’s called precision medicine, using traits that make us unique in learning to forecast health and treat disease. Partly it’s genetics. What genes do you harbor that raise your risk of, say, heart disease or Type 2 diabetes or various cancers?

But other factors affect that genetic risk: what you eat, how you sleep, if you grew up in smog or fresh air, if you sit at a desk all day or bike around town, if your blood pressure is fine at a check-up but soars on the job, what medications you take.

Not to mention differences based on age, gender, race and ethnicity, and socioeconomics.

Laye r i n g a l l t h a t i n fo r m a t i o n i n what’s expected to be the largest database of its kind could help scientists spot patterns, combinations of factors that drive or prevent certain diseases — and eventually, researchers hope, lead to better care.

“The DNA is almost the easiest part,” Collins said. “It’s challenging to figure out how to put all that together to allow somebody to have a more precise sense

of future risk of illness and what they might do about it.”

Pilot testing is under way, with more than 2,500 people who already have enrolled and given blood samples. More than 50 sites around the country — large medical centers, community health centers and other providers like the San Diego Blood Bank and, soon, select Walgreens pharmacies — are enrolling patients or customers in this invitationonly pilot phase.

If the pilot goes well, NIH plans to open the study next spring to just about any U.S. adult who’s interested, with sign-up as easy as going online.

It’s a commitment. The study aims to run for at least 10 years.

The goal is to enroll a highly diverse population, people from all walks of life — specifically recruiting minorities who have been under-represented in scientific research.

A n d u n u s u a l fo r o b s e r va t i o n a l research, volunteers will get receive results of their genetic and other tests, information they can share with their own doctors.

“Anything to get more information I can pass on to my children, I’m all for it,” said Erricka Hager, 29, as she signed up last month at the University of Pittsburgh, the project’s first pilot site.

A usually healthy mother of two, she said she hopes the study can reveal why she experienced high blood pressure and gestational diabetes during pregnancy.

Heading the giant All Of Us project is a former Intel Corp. executive who brings a special passion: How to widen access to the precision medicine that saved his life.

In college, Eric Dishman developed a form of kidney cancer so rare that doctors had no idea how to treat him, and predicted he had months to live. Only two studies of that particular cancer had ever been done, on people in their 70s and 80s.

“They didn’t know anything about me because they’d never seen a 19-year-old with this disease,” said Dishman.

Yet he survived for two decades, trying one treatment after another. Then, as he was running out of options, a chance encounter with a genetics researcher led to mapping Dishman’s DNA — and the stunning discovery that his kidney cancer was genetically more like pancreatic cancer. A pancreatic cancer drug attacked his tumors so he could get a kidney transplant.

“I’m healthier now at 49 than I was at 19,” said Dishman. “I was lucky twice over really,” to be offered an uncommon kind of testing and that it found something treatable.

Precision medicine is used most widely in cancer, as more drugs are developed that target tumors with specific molecular characteristics. Beyond cancer, one of the University of Pittsburgh’s hospitals tests every patient receiving a heart stent — looking for a genetic variant that tells if they’ll respond well to a particular blood thinner or will need an alternative.

The aim is to expand precision medicine.

“Why me?” is the question cancer patients always ask — why they got sick and not someone else with similar health risks, said Dr. Mounzer Agha, an oncologist at the University of Pittsburgh Medical Center.

“Unfortunately I don’t have answers for them today,” said Agha, who said it will take the million-person study to finally get some answers. “It’s going to help them understand what are the factors that led to their disease, and it’s going to help us understand how to treat it better.”

And NIH’s Collins expects surprises.

Maybe, he speculates, Type 2 diabetes will turn out to be a collection of genetic subtypes that require varied treatments.

“This looks at individual responses to treatment in a way we couldn’t do previously with smaller studies,” he said.

The study starts simply: Volunteers get some standard health checks — weight, blood pressure and heart rate.

They answer periodic questionnaires

about their health, background and habits, and turn over electronic health records. They give a blood sample that, if they agree, will undergo DNA testing sometime next year.

Eventually, researchers will ask some participants to wear sensors that may go beyond today’s Fitbit-style health trackers, such as devices that measure blood pressure while people move around all day, or measure environmental exposures, Collins said.

I n P i t t s b u r g h , t h e R e v. P a u l Abernathy made a health change after signing up for the pilot study. Surprised to learn his BMI was too high despite regular weight-lifting, he began running.

“I’m praying I have the discipline to continue that, certainly in midst of a busy schedule,” said Abernathy, who directs the nonprofit Focus Pittsburgh that aids the poor and trauma victims.

“We have a chance really to influence history, to influence the future of our children and our children’s children,” added Abernathy, who said he hopes the study will help explain racial disparities such as lower life expectancies between African-Americans and whites who live in the same areas.

At NIH, Collins said he plans to enroll, too. He’s had his DNA mapped before but can’t pass up what he’s calling a one-in-a-million experience to be part of a monumental study rather than the scientist on the other side.

“I’m curious about what this might t e a c h m e a b o u t mys e l f . I ’ m p re t t y healthy right now. I’d like to stay that way.”

—— This Associated Press series was produced in partnership with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Help: Provides script, list of question and explanations of importance of questions ■ Continued from page 9 ability or accessibility. Insurance coverage varies, and some parts of the country have shortages of providers that may leave patients traveling or turning to telemedicine, Rosenberg said.

The Navigator offers a step-by-step guide to assessing additional options beyond the well-known AA and detox.

First, it links to existing directories of thousands of board-certified addiction doctors or psychiatrists, accredited alcohol treatment centers and licensed therapists, searchable by ZIP code.

Licensing and accreditation information

mark an initial filter.

Next, the NIH defined five signs of quality to check: • Credentials. For example, look for a therapist who holds at least a master’s degree and has specialized training in addiction treatment, the tool advises.

• A comprehensive assessment.

Providers can use a battery of tests to determine the type and severity of alcohol disorders.

• Customized treatment. There is no one-size-fits-all approach, Koob stressed.

• Evidence-based practices. NIH

wants patients to consider scientifically proven options, including behavioral therapies and three FDA-approved medications.

• Continuing recovery support. “It’s not just an acute disorder,” said Lori Ducharme, a NIAAA specialist who led the Navigator’s development. “You want someone who will stick with you for the long-term.”

How do you know if a potential provider meets those quality indicators?

“You need to call them and ask them questions to see if they’ll be the right fit

for you,” Ducharme said.

The Navigator provides a script, lists of questions targeted to each type of provider plus an explanation of why each question is important and what answer to listen for.

For example, addiction is a disease, not a weakness, so watch out for providers who use stigmatizing language such as “drunk,” the tool advises. And if a provider automatically dismisses medication, that’s a warning sign about not practicing evidence-based care.

Havre Daily News/Floyd Brandt Sweet Medical Center stands on Pennsylvania Street in Chinook. oids and heroin — quadrupled. Overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. The amount of prescription opioids sold to pharmacies, hospitals, and doctors’ offices nearly quadrupled from 1999 to 2010, yet there had not been an overall change in the amount of pain that Americans reported, the U.S. Department of Pulbic Health and Human Services reports. Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999.

Montana Department of Public Health and Human Service says 693 deaths in the state were attributed to prescription opioid poisoning between 2000 and 2015. From 2000 to 2012, the opioid-related death rate in the state, a chart on its website shows, exceeded the national average, with the 2008-2009 period showing the largest discrepancy. During that period, there were nearly eight deaths per 100,000 people in Montana related to opioids, whereas the national average was slightly over four.

The grant money shows faith on the part of the government that community health centers are effective, Smith said.

One of the changes in addiction treatment is changing the stigma attached to those who have a problem with drug abuse. Changing perception includes taking out words the word addiction. The word addiction is no longer to be used, the staff at Bullhook said.

The Echo Institute says the key to success is a team-based approach in which the addiction is identified as a disease and not a character flaw.

Addiction is the wrong word, Smith said.

“Substance use disorders are a chemical thing that happens in your brain. It changes your brain function. The old myth that you just have to be strong isn’t so effective,” Smith said. “The addiction is the disorder.”

“I think changing the stigma of the wording makes it more acceptable for people to understand,” Geer said. “This isn’t a choice, it’s more of a disease. The model before said it is a choice — ‘it’s all about willpower, you can make that change.’

“But people can’t do it on their own. They need support. They need help,” Geer said.

Labeling it a disorder, is not an excuse to forego effort or dismiss personal responsibility, the group said.

“I think there is self-responsibility in every disease process, whether it’s diabetes or addiction. You have to be responsible and willing to get better,” Olson said.

“They don’t choose to be diabetic, but they can make changes,” Geer added. “It’s about choices, too. So, if you’re aware that you have

Havre Daily News/Floyd Brandt Bullhook Community Health Center stands on Fifth Avenue in Havre. this and you’re still making counterproductive decisions, you’re not going to be successful, or get anywhere.”

Motivation plays a role, Geer said, and for that “there’s all different kinds of skill building that we can do to help people understand what they are suffering from.”

The damage some poeple have incurred from the abuse is irreversible, Derry said.

Some have developed cognitive delays or de-

mentia.

“You can rebuild pathways and learn different skills and tools, but it’s always going to be some degree of damage,” Geer said.

Getting to the root of the problem, the reasons why someone turned to drugs is also part of treatment.

Reasons for abuse are many and when

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treating, it’s important find out what caused someone to develop drug problems. Sometimes, the women said, the drugs throw them into mental health. Other times family history can be a contributor — the environment

in which they were raised. And then there’s trauma.

“Trauma as a child is huge,” Derry said.

One of the major changes in treating mental health and substance abuse issues has been

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Trying to get sober? NIH offers tool to help find good care

Opioids: Derry: ‘Trauma as a child is huge’

Havre Daily News/Floyd Brandt Addictions Case Manager Sandy Derry works in her office in Bullhook Community Health Center.

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Havre Daily News/Floyd Brandt Nurse Practitioner Laura Shellman talks in Sweet Medical Center in Chinook. the implementation of the collaborative care model, or, as the Bullhook staff call it, “wraparound treatment.”

“Before, you had medical here, behavioral here, mental health here, substance counseling over here,” Smith said. “Now … everyone is starting to talk together.”

In 2009 the National Council for Community Behavioral Healthcare issued “Behavioral Health/Primary Care Integration and the Person-Centered Health Care Home,” a report that summarized a collaborative care model to delivering mental health and substance use services in primary care service and primary care service in mental health and substance use settings. The Echo Institute says that more than 40 percent of patients with substance use disorder seeking treatment also have a mood disorder.

An example of how the care model would is implemented is provided in a mock report written by the American Psychiatric Association Academy of Psychosomatic Medicine:

John is a 48-year-old man visiting his primary care physician for a follow-up to manage hypertension. During the visit, John’s depression test is in the moderate range for major

depression. John was treated by Dr. Stevens months ago for depression and is on a daily dose of 20 milligrams of fluoxetine. This is John’s first visit since the collaborative model has been implemented.

Dr. Stevens talks to John during their appointment before introducing him to Ms. Cook, a behavioral health specialist, who is available in the clinic to meet patients as they go from appointments at the request of any clinic staff.

Ms. Cook discovers that John has recently moved out of his house and is separating from his wife. He is staying with a friend and has had a difficult time making it on time to work.

He often goes to bed late and sleeps in, missing his alarm and calling in sick. Ms. Cook shares some of that information about John with Dr. Stevens, who then increases John’s fluoxetine to 40 mg a day. She also engages him in behavioral activation strategy to improve his mood.

Five weeks later, the consulting psychiatrist, Dr. Brown, notices that John’s depression score hasn’t changed. Ms. Cook tells Dr. Brown that John stopped taking the fluoxetine the week before because it was making him

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AP Photo/Lauran Neergaard Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health, looks Sept. 19 in his office in Rockville, Md., at a new resource his institute is offering. Koob’s agency has released a novel online tool to help people get a better shot at high-quality care for alcohol problems — directories of treatment providers paired with the questions to ask before signing up.

By LAURAN NEERGAARD AP Medical Writer WASHINGTON — The phone calls come — from fellow scientists and desperate strangers — with a single question for the alcohol chief at the National Institutes of Health: Where can my loved one find good care to get sober?

Oct. 3, the government released a novel online tool to help — directories of

alcohol treatment providers paired with key questions patients should ask for a better shot at high-quality care.

“Most people think treatment is detox for 28 days or Alcoholics Anonymous.

There’s a vast in-between,” said George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism.

More than 15 million adults in the

U.S. have what’s called alcohol use disorder, meaning they either misuse or are addicted to alcohol, and fewer than 10 percent get treatment, according to federal estimates.

Many who do get treated don’t receive quality care that best fits their needs, Koob said. He ordered development of the Alcohol Treatment Navigator after realizing if medical professionals were

confused, families must be lost.

“It’s the hardest thing, navigating how do you find treatment,” said Linda Rosenberg, president of the nonprofit National Council for Behavioral Health.

She was not involved with the tool but praised NIAAA for developing it. “It’s desperately needed.”

The tool can’t solve issues of afford-

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Havre Daily News/Floyd Brandt Area Manager Briayan Flores of Youth Dynamics works in his office in the Atrium Mall. horses.

Andreya Taylor, therapist at the Havre office, said equine therapy can help children with a myriad of different conditions

such as depression, anxiety, anger.

Independent living skills is another option Youth Dynamics offers its clientele.

Either in a residential home or through a mentor, children ages 14 to 17 can learn about simple tasks and responsibilities that will help them make the leap into adulthood such as laundry, money management and other chores.

Griebel said independent living skills are a way to teach teenagers “kind of be an adult.”

Foster parents and parents of children in Youth Dynamics also receive 48 hours of respite care a year.

Respire care, Griebel said, provides parents and foster parents with a break either to do chores or just have “some me time.” Youth Dynamics can arrange for children to stay with another licensed foster home during that time.

Youth Dynamics will soon offer common-sense parenting classes to the public.

A handout provided by Youth Dynamics says common sense parenting is a “high qualify evidence based parenting class that helps parents have consistent, accountable, interactions with their children.”

Basic and easy- to-use parenting techniques are taught, the handout says. People who take part in the program, the handout says, report better family management practices, less substance use and a significant decrease in the risk of child abuse taking place.

Flores said the classes will be offered online or at the Youth Dynamics office.

Participants can opt to either take one eight-hour class or two four-hour classes over two days.

The classes are free of charge, Flores said, and will be taught by someone who has been working with Youth Dynamics for 14 years.

No date has yet been set for the classes.

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Youth Dynamics expands to meet an expanding need for youth services

Youth: Will be offering common-sense parenting classes keep things going.”

Families, he said, might sometimes need a mentor for their children.

Services Youth Dynamics provides, he said, include therapy, classes and support for the children and their families, foster and respire, parent education and support, educating parents about the mental health system, therapeutic group homes, substance abuse treatment, youth mentors and independent living skills and treatment for overly sexualized youth or youth with substance abuse issues.

Youth Dynamics operates ten specialized therapeutic homes where children can stay throughout the state, said Janice Griebel, a case manager with the Havre office. For example, a home in Helena serves children ages 6 to 13 while others serve children ages 14 to 18.

Some homes are only for males, others only for females and some are for both genders. Youth Dynamics has therapeutic homes tailored to children with certain needs.

Griebel said some therapeutic homes are tailored to children with a specific disorder. One home in Billings., she said, is meant for children with substance abuse problems. Another, in Boulder, is designated for highly sexualized youth.

One therapeutic home practices equine therapy, where children ride and care for

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Youth Dynamics is also looking to increase its partnerships with primary care providers to make sure children are receiving medical care.

“Some of our kids are on medication too, so that just helps us coordinate between the therapy and other care aspects of it with … the medical side of it,” Taylor said.

In addition to the parents of children, Youth Dynamics also works with area school districts. Family support assistants sometimes go to meet with the children, speak with their teachers or have lunch with the child, sharing a meal with someone and interacting with their FSA or other Youth Dynamics personnel.

“They love it,” Griebel said.

Youth Dynamics gets the bulk of its funding from a mix of grants, donations and money from Medicaid.

Tammy Jungers, a care manager, said Medicaid covers all of the services Youth Dynamics provides as does private insurance. It uses a sliding fee scale based on income.

As an office in a frontier area, the Havre office has to cope with obstacles that it’s counter parts in cities and more populated areas of Montana do not have, such as the distance clients have to travel for the services Youth Dynamics matches them clients up with.

In places like Bozeman, Griebel said, someone can maybe walk to a hospital or to see a specialist. Given the distance from Havre to larger cities, a lot more travel is involved.

Youth Dynamics also helps to resolve the issue by helping clients find transportation.

Finding enough people to fill openings can also be a challenge.

“You can’t compete the resources here to like Billings or anything like that.”

Flores said.

He added that finding enough people to serve as FSAs can also be difficult.

Though their office is now fully staffed, Flores said they are in “dire need” of more FSAs. Candidates interested in a working as an FSA need to be 18 years older, have an insured vehicle and undergo a background check.

The Havre office also does the best it can to make itself known in the community.

Griebel said Youth Dynamics will take part in medical health fair at Sweet Medical Center at the end of October. The office will host a Halloween party Oct 31 at 3 p.m . Griebel said it will give people a chance to ask about the services the office provides.

Staff and people will be encouraged to dress up and is free of charge.

People interested in the services Youth Dynamics can find out more can call the Havre office at 265-3226 or visit the Youth Dynamics website http://www. youthdynamics.org.

Alex Ross aeross@havredailynews.com Youth Dynamics in Havre has experienced such an influx in demand for its services that they recently had to enlarge their staff.

“It just seems like these past couple of weeks, it has been busier and busier,” said Briayan Flores, area manager of the Havre office.

The Havre office, on the upper floor of the Atrium Mall, has in recent months gone from having an in office staff that fluctuated between one and four and sharing an area manager with their Shelby office, to now having five employees including their own area manager and an onsite therapist. A case manager and two care providers round out the staff.

Four family support assistants, or FSAs, are also employed by the office, and spend the bulk of their time working with clients outside the office.

Grants and donations and some money from Medicaid provide “We support them in the home, at school and in the community wherever they may need that support,’ Jordan O’Meara, a case manager at the Havre office said.

The office serves children ages 2 to 18.

Its services communities as far east as the Fort Belknap Indian Reservation, west as

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Havre Daily News/Floyd Brandt Care Manager Jordan O'Meara, left, and Youth Care Manager Janice Griebel discuss the days activities at Youth Dynamics office in the Atrium.

Opiods: Way prescribed is changing ■ Continued from page 4 jittery. The psychiatrist recommends switching John to another medication, sertraline.

Ms. Cook passes the information on to John’s primary care physician, Dr. Stevens, through the electronic health record. Dr. Stevens then writes a prescription for the sertraline the next day and John agrees to try it. Ms. Cook goes over the side effects with John and then gives him her’s and the psychiatrists’ contact information in case he has any problems.

“By constant communication and sharing of tasks, the collaborative care team can work at their optimum level of efficiency and competence and share in the management of patients in a coordinated fashion,” the report says.

The Bullhook staff talked about reasons why opioid abuse has gotten out of control.

Olson said opioids became a huge issue when pain became one of the vital signs.

“It started with doctors who said ‘If you are in pain, you shouldn’t ever be in pain — let’s treat it so you shouldn’t ever have pain,’” Derry said.

“We put it in the forefront of our treatment and people are under the impression they shouldn’t have any pain — and that’s just not realistic,” Olson said.

But the shift, she said, has begun.

“We want to better control your pain so you can function. The different scales we use are not 0 out of 10 pain. It’s more, ‘Can you go spend time with your kids and see your family and feel better and function?’”

Different ways of managing the pain is an-

other aspect of trying to curb opioid prescription, ways which can include physical therapy, meditation, acupuncture and yoga.

Other ways to curb use may include prescribing less.

“Instead of getting prescription for 30 days, maybe you only get it for a week,” Derry said.

It’s important, the group said, that when reducing the amount of drugs prescribed it is done wisely, so as not to create another problem by trying to eliminate one,

“If you cut the drugs too much, those who do really have chronic pain will go to their dealer and get heroin,” Olson said.

Encouraging doctors and nurse practitioners to prescribe smarter is the way to go, they said.

“We have drug screens, pill counts, contracts that say if we suspect you’re not taking the pills the way it’s prescribed we can check,” Olson said.

The Bullhook employees said the approaches are working.

Montana DPHHS reports the death rate numbers began to improve during the 2012-2013 and ever since they have steadily declined and have been lower than the national average. In 2015, the absolute number of deaths from opioid analgesics, 35, was the lowest in nearly 15 years, DPHHS reports.

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Youth: Jumphead text ■ Continued from page 5 Chester and south as Big Sandy.

As a care manager, O’Meara provides children and families with extra circular activities, access to school supplies, clothing and sometimes food. She schedules doc-

tors appointments and teaches the children and guardians coping skills and life skills.

“I’m just a stable person they can trust and come to for anything,” she said.

Havre Daily News/Floyd Brandt Youth Dynamics Care Manager Tammy Jungers, from left, Care Manager Jordan O'Meara, Area Manager Briayan Flores, Youth Case Manager Janice Griebel and Therapist Andreya Taylor laugh while in their offices in the Atrium Mall in Havre.

Havre Daily News/Floyd Brandt Youth Case Manager Janice Griebel with Youth Dynamics waits to pick up a student who she is helping.

O’Meara said part of her job is giving them one-on-one attention they might not receive at home.

Youth Dynamics serves children between ages 2 and 18. Some have conditions such as autism, depression and anxiety. Others have behavioral issues, post traumatic stress disorder or substance abuse. And other clients are dealing with the lingering effects of abuse, neglect or readjusting to life in a foster home.

Having a condition or grappling with a traumatic event, isn’t necessary to be a client. Sometimes, Flores said, families come to Youth Dynamics are just looking for a little assistance.

“Sometimes they are just looking for a way to get organized in their home life,” Flores said. “Sometimes they are just looking for some extra people in their lives to

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Youth: Jumphead text ■ Continued from page 5 Chester and south as Big Sandy.

As a care manager, O’Meara provides children and families with extra circular activities, access to school supplies, clothing and sometimes food. She schedules doc-

tors appointments and teaches the children and guardians coping skills and life skills.

“I’m just a stable person they can trust and come to for anything,” she said.

Havre Daily News/Floyd Brandt Youth Dynamics Care Manager Tammy Jungers, from left, Care Manager Jordan O'Meara, Area Manager Briayan Flores, Youth Case Manager Janice Griebel and Therapist Andreya Taylor laugh while in their offices in the Atrium Mall in Havre.

Havre Daily News/Floyd Brandt Youth Case Manager Janice Griebel with Youth Dynamics waits to pick up a student who she is helping.

O’Meara said part of her job is giving them one-on-one attention they might not receive at home.

Youth Dynamics serves children between ages 2 and 18. Some have conditions such as autism, depression and anxiety. Others have behavioral issues, post traumatic stress disorder or substance abuse. And other clients are dealing with the lingering effects of abuse, neglect or readjusting to life in a foster home.

Having a condition or grappling with a traumatic event, isn’t necessary to be a client. Sometimes, Flores said, families come to Youth Dynamics are just looking for a little assistance.

“Sometimes they are just looking for a way to get organized in their home life,” Flores said. “Sometimes they are just looking for some extra people in their lives to

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Havre Daily News/Floyd Brandt Area Manager Briayan Flores of Youth Dynamics works in his office in the Atrium Mall. horses.

Andreya Taylor, therapist at the Havre office, said equine therapy can help children with a myriad of different conditions

such as depression, anxiety, anger.

Independent living skills is another option Youth Dynamics offers its clientele.

Either in a residential home or through a mentor, children ages 14 to 17 can learn about simple tasks and responsibilities that will help them make the leap into adulthood such as laundry, money management and other chores.

Griebel said independent living skills are a way to teach teenagers “kind of be an adult.”

Foster parents and parents of children in Youth Dynamics also receive 48 hours of respite care a year.

Respire care, Griebel said, provides parents and foster parents with a break either to do chores or just have “some me time.” Youth Dynamics can arrange for children to stay with another licensed foster home during that time.

Youth Dynamics will soon offer common-sense parenting classes to the public.

A handout provided by Youth Dynamics says common sense parenting is a “high qualify evidence based parenting class that helps parents have consistent, accountable, interactions with their children.”

Basic and easy- to-use parenting techniques are taught, the handout says. People who take part in the program, the handout says, report better family management practices, less substance use and a significant decrease in the risk of child abuse taking place.

Flores said the classes will be offered online or at the Youth Dynamics office.

Participants can opt to either take one eight-hour class or two four-hour classes over two days.

The classes are free of charge, Flores said, and will be taught by someone who has been working with Youth Dynamics for 14 years.

No date has yet been set for the classes.

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Youth Dynamics expands to meet an expanding need for youth services

Youth: Will be offering common-sense parenting classes keep things going.”

Families, he said, might sometimes need a mentor for their children.

Services Youth Dynamics provides, he said, include therapy, classes and support for the children and their families, foster and respire, parent education and support, educating parents about the mental health system, therapeutic group homes, substance abuse treatment, youth mentors and independent living skills and treatment for overly sexualized youth or youth with substance abuse issues.

Youth Dynamics operates ten specialized therapeutic homes where children can stay throughout the state, said Janice Griebel, a case manager with the Havre office. For example, a home in Helena serves children ages 6 to 13 while others serve children ages 14 to 18.

Some homes are only for males, others only for females and some are for both genders. Youth Dynamics has therapeutic homes tailored to children with certain needs.

Griebel said some therapeutic homes are tailored to children with a specific disorder. One home in Billings., she said, is meant for children with substance abuse problems. Another, in Boulder, is designated for highly sexualized youth.

One therapeutic home practices equine therapy, where children ride and care for

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Youth Dynamics is also looking to increase its partnerships with primary care providers to make sure children are receiving medical care.

“Some of our kids are on medication too, so that just helps us coordinate between the therapy and other care aspects of it with … the medical side of it,” Taylor said.

In addition to the parents of children, Youth Dynamics also works with area school districts. Family support assistants sometimes go to meet with the children, speak with their teachers or have lunch with the child, sharing a meal with someone and interacting with their FSA or other Youth Dynamics personnel.

“They love it,” Griebel said.

Youth Dynamics gets the bulk of its funding from a mix of grants, donations and money from Medicaid.

Tammy Jungers, a care manager, said Medicaid covers all of the services Youth Dynamics provides as does private insurance. It uses a sliding fee scale based on income.

As an office in a frontier area, the Havre office has to cope with obstacles that it’s counter parts in cities and more populated areas of Montana do not have, such as the distance clients have to travel for the services Youth Dynamics matches them clients up with.

In places like Bozeman, Griebel said, someone can maybe walk to a hospital or to see a specialist. Given the distance from Havre to larger cities, a lot more travel is involved.

Youth Dynamics also helps to resolve the issue by helping clients find transportation.

Finding enough people to fill openings can also be a challenge.

“You can’t compete the resources here to like Billings or anything like that.”

Flores said.

He added that finding enough people to serve as FSAs can also be difficult.

Though their office is now fully staffed, Flores said they are in “dire need” of more FSAs. Candidates interested in a working as an FSA need to be 18 years older, have an insured vehicle and undergo a background check.

The Havre office also does the best it can to make itself known in the community.

Griebel said Youth Dynamics will take part in medical health fair at Sweet Medical Center at the end of October. The office will host a Halloween party Oct 31 at 3 p.m . Griebel said it will give people a chance to ask about the services the office provides.

Staff and people will be encouraged to dress up and is free of charge.

People interested in the services Youth Dynamics can find out more can call the Havre office at 265-3226 or visit the Youth Dynamics website http://www. youthdynamics.org.

Alex Ross aeross@havredailynews.com Youth Dynamics in Havre has experienced such an influx in demand for its services that they recently had to enlarge their staff.

“It just seems like these past couple of weeks, it has been busier and busier,” said Briayan Flores, area manager of the Havre office.

The Havre office, on the upper floor of the Atrium Mall, has in recent months gone from having an in office staff that fluctuated between one and four and sharing an area manager with their Shelby office, to now having five employees including their own area manager and an onsite therapist. A case manager and two care providers round out the staff.

Four family support assistants, or FSAs, are also employed by the office, and spend the bulk of their time working with clients outside the office.

Grants and donations and some money from Medicaid provide “We support them in the home, at school and in the community wherever they may need that support,’ Jordan O’Meara, a case manager at the Havre office said.

The office serves children ages 2 to 18.

Its services communities as far east as the Fort Belknap Indian Reservation, west as

■ See Youth Page 6

Havre Daily News/Floyd Brandt Care Manager Jordan O'Meara, left, and Youth Care Manager Janice Griebel discuss the days activities at Youth Dynamics office in the Atrium.

Opiods: Way prescribed is changing ■ Continued from page 4 jittery. The psychiatrist recommends switching John to another medication, sertraline.

Ms. Cook passes the information on to John’s primary care physician, Dr. Stevens, through the electronic health record. Dr. Stevens then writes a prescription for the sertraline the next day and John agrees to try it. Ms. Cook goes over the side effects with John and then gives him her’s and the psychiatrists’ contact information in case he has any problems.

“By constant communication and sharing of tasks, the collaborative care team can work at their optimum level of efficiency and competence and share in the management of patients in a coordinated fashion,” the report says.

The Bullhook staff talked about reasons why opioid abuse has gotten out of control.

Olson said opioids became a huge issue when pain became one of the vital signs.

“It started with doctors who said ‘If you are in pain, you shouldn’t ever be in pain — let’s treat it so you shouldn’t ever have pain,’” Derry said.

“We put it in the forefront of our treatment and people are under the impression they shouldn’t have any pain — and that’s just not realistic,” Olson said.

But the shift, she said, has begun.

“We want to better control your pain so you can function. The different scales we use are not 0 out of 10 pain. It’s more, ‘Can you go spend time with your kids and see your family and feel better and function?’”

Different ways of managing the pain is an-

other aspect of trying to curb opioid prescription, ways which can include physical therapy, meditation, acupuncture and yoga.

Other ways to curb use may include prescribing less.

“Instead of getting prescription for 30 days, maybe you only get it for a week,” Derry said.

It’s important, the group said, that when reducing the amount of drugs prescribed it is done wisely, so as not to create another problem by trying to eliminate one,

“If you cut the drugs too much, those who do really have chronic pain will go to their dealer and get heroin,” Olson said.

Encouraging doctors and nurse practitioners to prescribe smarter is the way to go, they said.

“We have drug screens, pill counts, contracts that say if we suspect you’re not taking the pills the way it’s prescribed we can check,” Olson said.

The Bullhook employees said the approaches are working.

Montana DPHHS reports the death rate numbers began to improve during the 2012-2013 and ever since they have steadily declined and have been lower than the national average. In 2015, the absolute number of deaths from opioid analgesics, 35, was the lowest in nearly 15 years, DPHHS reports.

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■ Continued from page 3

treating, it’s important find out what caused someone to develop drug problems. Sometimes, the women said, the drugs throw them into mental health. Other times family history can be a contributor — the environment

in which they were raised. And then there’s trauma.

“Trauma as a child is huge,” Derry said.

One of the major changes in treating mental health and substance abuse issues has been

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Trying to get sober? NIH offers tool to help find good care

Opioids: Derry: ‘Trauma as a child is huge’

Havre Daily News/Floyd Brandt Addictions Case Manager Sandy Derry works in her office in Bullhook Community Health Center.

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Havre Daily News/Floyd Brandt Nurse Practitioner Laura Shellman talks in Sweet Medical Center in Chinook. the implementation of the collaborative care model, or, as the Bullhook staff call it, “wraparound treatment.”

“Before, you had medical here, behavioral here, mental health here, substance counseling over here,” Smith said. “Now … everyone is starting to talk together.”

In 2009 the National Council for Community Behavioral Healthcare issued “Behavioral Health/Primary Care Integration and the Person-Centered Health Care Home,” a report that summarized a collaborative care model to delivering mental health and substance use services in primary care service and primary care service in mental health and substance use settings. The Echo Institute says that more than 40 percent of patients with substance use disorder seeking treatment also have a mood disorder.

An example of how the care model would is implemented is provided in a mock report written by the American Psychiatric Association Academy of Psychosomatic Medicine:

John is a 48-year-old man visiting his primary care physician for a follow-up to manage hypertension. During the visit, John’s depression test is in the moderate range for major

depression. John was treated by Dr. Stevens months ago for depression and is on a daily dose of 20 milligrams of fluoxetine. This is John’s first visit since the collaborative model has been implemented.

Dr. Stevens talks to John during their appointment before introducing him to Ms. Cook, a behavioral health specialist, who is available in the clinic to meet patients as they go from appointments at the request of any clinic staff.

Ms. Cook discovers that John has recently moved out of his house and is separating from his wife. He is staying with a friend and has had a difficult time making it on time to work.

He often goes to bed late and sleeps in, missing his alarm and calling in sick. Ms. Cook shares some of that information about John with Dr. Stevens, who then increases John’s fluoxetine to 40 mg a day. She also engages him in behavioral activation strategy to improve his mood.

Five weeks later, the consulting psychiatrist, Dr. Brown, notices that John’s depression score hasn’t changed. Ms. Cook tells Dr. Brown that John stopped taking the fluoxetine the week before because it was making him

■ See Opiods Page 5

AP Photo/Lauran Neergaard Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health, looks Sept. 19 in his office in Rockville, Md., at a new resource his institute is offering. Koob’s agency has released a novel online tool to help people get a better shot at high-quality care for alcohol problems — directories of treatment providers paired with the questions to ask before signing up.

By LAURAN NEERGAARD AP Medical Writer WASHINGTON — The phone calls come — from fellow scientists and desperate strangers — with a single question for the alcohol chief at the National Institutes of Health: Where can my loved one find good care to get sober?

Oct. 3, the government released a novel online tool to help — directories of

alcohol treatment providers paired with key questions patients should ask for a better shot at high-quality care.

“Most people think treatment is detox for 28 days or Alcoholics Anonymous.

There’s a vast in-between,” said George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism.

More than 15 million adults in the

U.S. have what’s called alcohol use disorder, meaning they either misuse or are addicted to alcohol, and fewer than 10 percent get treatment, according to federal estimates.

Many who do get treated don’t receive quality care that best fits their needs, Koob said. He ordered development of the Alcohol Treatment Navigator after realizing if medical professionals were

confused, families must be lost.

“It’s the hardest thing, navigating how do you find treatment,” said Linda Rosenberg, president of the nonprofit National Council for Behavioral Health.

She was not involved with the tool but praised NIAAA for developing it. “It’s desperately needed.”

The tool can’t solve issues of afford-

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Studying 1 million people to end cookie-cutter health care

By LAURAN NEERGAARD AP Medical Writer WASHINGTON — In a quest to end cookie-cutter health care, U.S. researchers are getting ready to recruit more than 1 million people for an unprecedented study to learn how our genes, environments and lifestyles interact — and to finally customize ways to prevent and treat disease.

Why does one sibling get sick but not another? Why does a drug cure one patient but only cause nasty side effects in the next?

Finding out is a tall order. Today, diseases typically are treated based on what worked best in short studies of a few hundred or thousand patients.

“We depend on the average, the onesize-fits-all approach because it’s the best we’ve got,” said Dr. Francis Collins, director of the National Institutes of Health.

That’s changing: The NIH’s massive “All Of Us” project will push what’s called precision medicine, using traits that make us unique in learning to forecast health and treat disease. Partly it’s genetics. What genes do you harbor that raise your risk of, say, heart disease or Type 2 diabetes or various cancers?

But other factors affect that genetic risk: what you eat, how you sleep, if you grew up in smog or fresh air, if you sit at a desk all day or bike around town, if your blood pressure is fine at a check-up but soars on the job, what medications you take.

Not to mention differences based on age, gender, race and ethnicity, and socioeconomics.

Laye r i n g a l l t h a t i n fo r m a t i o n i n what’s expected to be the largest database of its kind could help scientists spot patterns, combinations of factors that drive or prevent certain diseases — and eventually, researchers hope, lead to better care.

“The DNA is almost the easiest part,” Collins said. “It’s challenging to figure out how to put all that together to allow somebody to have a more precise sense

of future risk of illness and what they might do about it.”

Pilot testing is under way, with more than 2,500 people who already have enrolled and given blood samples. More than 50 sites around the country — large medical centers, community health centers and other providers like the San Diego Blood Bank and, soon, select Walgreens pharmacies — are enrolling patients or customers in this invitationonly pilot phase.

If the pilot goes well, NIH plans to open the study next spring to just about any U.S. adult who’s interested, with sign-up as easy as going online.

It’s a commitment. The study aims to run for at least 10 years.

The goal is to enroll a highly diverse population, people from all walks of life — specifically recruiting minorities who have been under-represented in scientific research.

A n d u n u s u a l fo r o b s e r va t i o n a l research, volunteers will get receive results of their genetic and other tests, information they can share with their own doctors.

“Anything to get more information I can pass on to my children, I’m all for it,” said Erricka Hager, 29, as she signed up last month at the University of Pittsburgh, the project’s first pilot site.

A usually healthy mother of two, she said she hopes the study can reveal why she experienced high blood pressure and gestational diabetes during pregnancy.

Heading the giant All Of Us project is a former Intel Corp. executive who brings a special passion: How to widen access to the precision medicine that saved his life.

In college, Eric Dishman developed a form of kidney cancer so rare that doctors had no idea how to treat him, and predicted he had months to live. Only two studies of that particular cancer had ever been done, on people in their 70s and 80s.

“They didn’t know anything about me because they’d never seen a 19-year-old with this disease,” said Dishman.

Yet he survived for two decades, trying one treatment after another. Then, as he was running out of options, a chance encounter with a genetics researcher led to mapping Dishman’s DNA — and the stunning discovery that his kidney cancer was genetically more like pancreatic cancer. A pancreatic cancer drug attacked his tumors so he could get a kidney transplant.

“I’m healthier now at 49 than I was at 19,” said Dishman. “I was lucky twice over really,” to be offered an uncommon kind of testing and that it found something treatable.

Precision medicine is used most widely in cancer, as more drugs are developed that target tumors with specific molecular characteristics. Beyond cancer, one of the University of Pittsburgh’s hospitals tests every patient receiving a heart stent — looking for a genetic variant that tells if they’ll respond well to a particular blood thinner or will need an alternative.

The aim is to expand precision medicine.

“Why me?” is the question cancer patients always ask — why they got sick and not someone else with similar health risks, said Dr. Mounzer Agha, an oncologist at the University of Pittsburgh Medical Center.

“Unfortunately I don’t have answers for them today,” said Agha, who said it will take the million-person study to finally get some answers. “It’s going to help them understand what are the factors that led to their disease, and it’s going to help us understand how to treat it better.”

And NIH’s Collins expects surprises.

Maybe, he speculates, Type 2 diabetes will turn out to be a collection of genetic subtypes that require varied treatments.

“This looks at individual responses to treatment in a way we couldn’t do previously with smaller studies,” he said.

The study starts simply: Volunteers get some standard health checks — weight, blood pressure and heart rate.

They answer periodic questionnaires

about their health, background and habits, and turn over electronic health records. They give a blood sample that, if they agree, will undergo DNA testing sometime next year.

Eventually, researchers will ask some participants to wear sensors that may go beyond today’s Fitbit-style health trackers, such as devices that measure blood pressure while people move around all day, or measure environmental exposures, Collins said.

I n P i t t s b u r g h , t h e R e v. P a u l Abernathy made a health change after signing up for the pilot study. Surprised to learn his BMI was too high despite regular weight-lifting, he began running.

“I’m praying I have the discipline to continue that, certainly in midst of a busy schedule,” said Abernathy, who directs the nonprofit Focus Pittsburgh that aids the poor and trauma victims.

“We have a chance really to influence history, to influence the future of our children and our children’s children,” added Abernathy, who said he hopes the study will help explain racial disparities such as lower life expectancies between African-Americans and whites who live in the same areas.

At NIH, Collins said he plans to enroll, too. He’s had his DNA mapped before but can’t pass up what he’s calling a one-in-a-million experience to be part of a monumental study rather than the scientist on the other side.

“I’m curious about what this might t e a c h m e a b o u t mys e l f . I ’ m p re t t y healthy right now. I’d like to stay that way.”

—— This Associated Press series was produced in partnership with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Help: Provides script, list of question and explanations of importance of questions ■ Continued from page 9 ability or accessibility. Insurance coverage varies, and some parts of the country have shortages of providers that may leave patients traveling or turning to telemedicine, Rosenberg said.

The Navigator offers a step-by-step guide to assessing additional options beyond the well-known AA and detox.

First, it links to existing directories of thousands of board-certified addiction doctors or psychiatrists, accredited alcohol treatment centers and licensed therapists, searchable by ZIP code.

Licensing and accreditation information

mark an initial filter.

Next, the NIH defined five signs of quality to check: • Credentials. For example, look for a therapist who holds at least a master’s degree and has specialized training in addiction treatment, the tool advises.

• A comprehensive assessment.

Providers can use a battery of tests to determine the type and severity of alcohol disorders.

• Customized treatment. There is no one-size-fits-all approach, Koob stressed.

• Evidence-based practices. NIH

wants patients to consider scientifically proven options, including behavioral therapies and three FDA-approved medications.

• Continuing recovery support. “It’s not just an acute disorder,” said Lori Ducharme, a NIAAA specialist who led the Navigator’s development. “You want someone who will stick with you for the long-term.”

How do you know if a potential provider meets those quality indicators?

“You need to call them and ask them questions to see if they’ll be the right fit

for you,” Ducharme said.

The Navigator provides a script, lists of questions targeted to each type of provider plus an explanation of why each question is important and what answer to listen for.

For example, addiction is a disease, not a weakness, so watch out for providers who use stigmatizing language such as “drunk,” the tool advises. And if a provider automatically dismisses medication, that’s a warning sign about not practicing evidence-based care.

Havre Daily News/Floyd Brandt Sweet Medical Center stands on Pennsylvania Street in Chinook. oids and heroin — quadrupled. Overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. The amount of prescription opioids sold to pharmacies, hospitals, and doctors’ offices nearly quadrupled from 1999 to 2010, yet there had not been an overall change in the amount of pain that Americans reported, the U.S. Department of Pulbic Health and Human Services reports. Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999.

Montana Department of Public Health and Human Service says 693 deaths in the state were attributed to prescription opioid poisoning between 2000 and 2015. From 2000 to 2012, the opioid-related death rate in the state, a chart on its website shows, exceeded the national average, with the 2008-2009 period showing the largest discrepancy. During that period, there were nearly eight deaths per 100,000 people in Montana related to opioids, whereas the national average was slightly over four.

The grant money shows faith on the part of the government that community health centers are effective, Smith said.

One of the changes in addiction treatment is changing the stigma attached to those who have a problem with drug abuse. Changing perception includes taking out words the word addiction. The word addiction is no longer to be used, the staff at Bullhook said.

The Echo Institute says the key to success is a team-based approach in which the addiction is identified as a disease and not a character flaw.

Addiction is the wrong word, Smith said.

“Substance use disorders are a chemical thing that happens in your brain. It changes your brain function. The old myth that you just have to be strong isn’t so effective,” Smith said. “The addiction is the disorder.”

“I think changing the stigma of the wording makes it more acceptable for people to understand,” Geer said. “This isn’t a choice, it’s more of a disease. The model before said it is a choice — ‘it’s all about willpower, you can make that change.’

“But people can’t do it on their own. They need support. They need help,” Geer said.

Labeling it a disorder, is not an excuse to forego effort or dismiss personal responsibility, the group said.

“I think there is self-responsibility in every disease process, whether it’s diabetes or addiction. You have to be responsible and willing to get better,” Olson said.

“They don’t choose to be diabetic, but they can make changes,” Geer added. “It’s about choices, too. So, if you’re aware that you have

Havre Daily News/Floyd Brandt Bullhook Community Health Center stands on Fifth Avenue in Havre. this and you’re still making counterproductive decisions, you’re not going to be successful, or get anywhere.”

Motivation plays a role, Geer said, and for that “there’s all different kinds of skill building that we can do to help people understand what they are suffering from.”

The damage some poeple have incurred from the abuse is irreversible, Derry said.

Some have developed cognitive delays or de-

mentia.

“You can rebuild pathways and learn different skills and tools, but it’s always going to be some degree of damage,” Geer said.

Getting to the root of the problem, the reasons why someone turned to drugs is also part of treatment.

Reasons for abuse are many and when

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Health centers take on opioid addiction Paul Dragu pdragu@havredailynews.com

Community health centers in north-central Montana have received $350,000 in federal grants to use in the regional battle against rampant opioid abuse and to help treat people with mental health issues.

Bullhook Community Health Center in Havre and Sweet Medical Center in Chinook each received $175,000. The grants are part of $2.8 million in grants to 17 health centers in Montana and $200 million nationwide from the U.S. Department of Health and Human Services’ Health Resource and Services Administration.

The opioid epidemic has been federally recognized as a national crisis, and the Hi-Line, despite its geographical isolation or its national inconspicuousness, has not been spared from its ravaging effects. The need for care in the region, Bullhook CEO Cindy Smith said, is as great as it is anywhere.

“When these guys,” Smith said, referring to Licensed Clinical Professional Counselor and Licensed Addictions Counselor Misty Geer, Addictions Case Manager Sandy Derry and Nurse Practitioner Katie Olson — who is training to be psychiatric nurse practitioner as well — “don’t have enough slots to schedule the patients that are being referred, you know we have a big problem.”

The clinic’s backlog is an indication of two regional problems, Smith said. Geer is backed

Havre Daily News/Floyd Brandt Bullhook Community Health Center CEO CIndy Smith listens during a discussion of treating opioid abuse. up two weeks before she can see anybody.

That’s how bad care is needed and it is also a reminder of the continuing provider shortage in the region. Montana has, and continues

to have, problems getting and hiring qualified employees in the mental health field, Smith said.

Despite statewide personnel issues, community health centers have been effective, and for that reason, Smith said, the government saw fit to arm them with more resources.

“They realize the impact and have seen data and outcomes from community health centers. So that’s why they give to community health centers,” she said.

Smith said Bullhook sees about 5,000 patients a year for about 15,000 visits.

Sweet Community CEO Dana Pyette said about 2,000 patients a year come through their

health center at its Chinook and Harlem clinics.

Part of the grant money, Smith said, will be used to add staff so more people can get treatment faster. And although the backlog stretches for weeks, they still try to get patients seen by someone quickly.

“We try to get them in right away to see a case manager so at least somebody gets in touch with them and let them know we’re going to start working on this for them,” Smith said. “We want them to have access the minute they say they want help so we at least get them hooked up with somebody to talk to.”

A psychologist has already been hired and she will began work this month, Smith said.

She will be the only psychologist at the clinic.

Someone who is already working the health center in one capacity is being trained to be the second psychiatric nurse. And since an electronic medical records system has been implemented — all departments have access to patient records — a trainer is being brought in to teach employees how to best utilize the system. The goal is to insert patient information so it is accessible, as well capturable in the sense of being able to accurately determine the effectiveness, or lack, of treatment.

The grant money, Smith said, is to be evenly split between mental health and ubstance addiction counseling.

Pyette said the requirements for splitting the money between the two types of care apply to the Chinook health center as well.

Sweet Community will use some of the money to hire a licensed social worker and community health worker, Pyette said. In addition, the grant will also fund anti-stigma education and community education to raise awareness to the services provided by the health center.

The U.S. Department of Health and Human Services reports the majority of drug overdose deaths, more than six out of 10, involve opioids.

Since 1999, the number of overdose deaths involving opioids — including prescription opi-

Havre Daily News/Floyd Brandt Sweet Medical Center CEO Dana Pyette works in her office.

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Gene therapy helps boys with “Lorenzo’s Oil” disease

By MARILYNN MARCHIONE AP Chief Medical Writer The fledgling field of gene therapy has scored another win: A n ex p e r i m e n ta l t re a t m e n t seemed to help boys with the inherited nerve disease featured in the movie “Lorenzo’s Oil.” Fifteen of the 17 boys treated in a study had no major disability two years later — remarkable for a disease that often causes swift decline and kills within a decade.

“This appears to be a terrific new therapy” for many kids who had little hope before, said one s t u d y l e a d e r, D r. D av i d A .

Williams of Boston Childrens Hospital.

The news is bittersweet for Paul and Liliana Rojas, a couple from Dover Plains, New York, with two sons who have the disease. Brian, 7, received the treatment; Brandon, 10, didn’t.

Brandon was too far along in his disease to qualify for the study, his father said, adding, “ B r i a n wa s n o t . T h a n k s t o B ra n d o n h e wa s d i a g n o s e d early,” in time to be helped.

Study results were published O c t . 4 by t h e N ew E n g l a n d Journal of Medicine and discussed at a medical conference i n K a n s a s C i t y, M i s s o u r i .

Government grants and the therapy’s maker — Bluebird Bio Inc. of Cambridge, Massachusetts — paid for the study, and some researchers work or consult for the company.

Only one gene therapy is sold in the United States, a leukemia treatment approved in August.

Only a few are sold elsewhere.

Researchers increasingly are trying these approaches for diseases caused by a single gene, as this one is.

Called adrenoleukodystrophy, it almost exclusively strikes boys, who have only one copy of the X chromosome, where the gene that causes the disease lies. It affects a b o u t 1 i n eve r y 2 0 , 0 0 0 b oys worldwide.

They are unable to make a protein that helps break down certain fatty acids, causing the acids to build up and damage nerves, muscles and the brain.

Their plight became better known after the 1992 movie about a couple who, desperate for a cure for their son, developed a treatment from olive and rapeseed oils that seemed to help him. The real life Lorenzo died in 2008 at age 30, having lived two decades longer than doctors predicted.

Katherine C. Cohen/Boston Children’s Hospital via AP Paul and Liliana Rojas speak to their sons, Brian, second from left, and Brandon, Aug. 29 at Boston Children's Hospital. The young boys suffer from adrenoleukodystrophy, an inherited nerve disease featured in the movie "Lorenzo's Oil." Brian was able to benefit from an experimental treatment while the disease had progressed too far in Brandon to qualify for the gene therapy study. Study results were published Oct. 4 by the New England Journal of Medicine and discussed at the Child Neurology Society conference in Kansas City.

Lorenzo’s oil did not turn out to be a cure. The only effective treatment is a stem cell transplant from a matched sibling, but only about 1 in 5 boys with the disease have such a donor.

The gene therapy tested a way for boys to serve as their own cell donors.

Doctors remove some of the patient’s blood stem cells, modify them in the lab to carry the healthy gene and give them back intravenously.

Before the modified cells are returned, patients take strong medicines to destroy much of their native bone marrow. That helps the genetically modified cells take hold and multiply, so they can supply the protein that the boys lack.

The study tested this treatment in 17 boys ages 4 to 13 with

the most severe form of the disease that affects the brain. Two years after treatment, 15 were neurologically stable. The other two died, one from worsening disease and the other from complications of a donor transplant a t t e m p t e d a f t e r h e w i t h d rew from the study.

The results suggest this therapy is at least as good as stem cell transplants given to boys who have suitable donors “and it i s p o s s i b l y s a f e r, ” D r. M a rc Engelen of Emma Children’s Hospital in Amsterdam wrote in a commentary in the medical journal.

The main questions are how long the benefits will last, how much the treatment will cost if it wins approval, and whether it will replace stem cell transplants from donors, he wrote.

T h e U . S . Fo o d a n d D r u g Administration requires gene therapy participants to be monito re d fo r 1 5 ye a rs, s o t h e s e patients will continue to be studied, Williams said. Eight more patients are being added to the study as part of Bluebird’s plans to seek approval of the therapy in the U.S. and Europe.

Brandon Rojas now needs a wheelchair and feeding tube. He had been a healthy, normal child until suddenly starting to drool and have learning problems in school about the time he turned 7. He was diagnosed three years ago and doctors advised the couple to have Brian tested too.

They were on a Make-A-Wish Foundation trip when the results came.

“We were driving to one of the Disney parks and had to pull

over to get the call,” Paul Rojas said. “Once we got off the phone, we both looked at each other and said we need to move forward now and save our younger son any way we can.”

The couple has joined an e f fo r t to i n c re a s e n ew b o r n screening for the disease, especially now that a therapy may soon be available to help — if it’s tried soon enough.

—— Marilynn Marchione can be followed at http://twitter.com/ MMarchioneAP —— This Associated Press series was produced in partnership with t h e H owa rd H u g h e s M e d i c a l Institute’s Department of Science Education. The AP is solely responsible for all content.

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