by Maggie Marks, communications specialist, South Country Health Alliance
South Country has a history of identifying areas of need for our members and developing innovative programs that meet that need in unique and effective ways. Ruth Boubin of the behavioral health department said, “The risk of developing opioid dependency or addiction varies from person to person. However, there are important educational and preventative measures that are right for everyone. Prevention has been the foundation of our Opioid Case Management Program.”
The topic of opioid dependency and overdose is a relevant issue, which makes the Opioid Case Management Program incredibly important. In the United States, more than 106,000 people died from drug-involved overdose in 2021 — including illicit drugs and prescription opioids according to the National Institute on Drug Abuse.
Ruth Boubin works in the behavioral health department at South Country as a behavioral health professional and has been involved in the creation of multiple programs. These programs include the Opioid Case Management Program, the Restricted Recipient Program, mental health hospitalization case management as well as others. “South Country's behavioral health department serves our members regarding their mental health and substance use disorder concerns. We provide outreach to members to connect them with services that will effectively address their mental health and improve overall health and wellness,” Ruth said. Who better to speak with about the incredible work that the Opioid Case Management Program is doing in our communities than Ruth herself. She has been with South Country for 14 years – and if there had been any concerns about the belief she has in the program’s necessity or effectiveness, they would have immediately been quelled by the passion brimming from her with every answer during our interview. Ruth believes in the Opioid Case Management Program.
The Opioid Case Management Program identifies members who experienced a recent medical event such as surgery that resulted in acute pain and were prescribed pain medication with at least two prescriptions within seven days. Once they have been identified and selected for the Opioid Case Management Program, Ruth explained what happens next. “We do a follow-up call and ask them where they are having pain, if they had a recent surgery or an injury, if they need any kind of services or support, and how their recovery is going.” These calls help Ruth and the behavioral health department determine how they will move forward with the support for these members. The initial call also covers the safe storage and disposal of opioids, which reduces the risk of another person taking the medication. For the disposal of opioids, South Country may be one of the only health plans offering a drug disposal service. It is an important element of the program to provide free Deterra drug deactivation packets to dissolve opioids as well as education about safely disposing of unused meds. We also send a follow-up letter, so the member has a direct contact to call if they have any follow-up questions regarding health insurance benefits. Ruth explained the process of these calls and gave an example of someone who just had knee replacement surgery. She would ask questions such as “Do you need crutches or a prescription for a shower chair?” to help the member out while they are recovering. Some additional benefits individuals may not know are available are things such as physical therapy, acupuncture and chiropractic treatment. Ruth said, “We can send them a list of providers in the area and give them a list of mental health providers in their area if they are struggling with their mental health.”
The Opioid Case Management Program also identifies members who are treated with opioids for chronic pain, identified through claims information or prescription history. These members receive a letter regarding chronic pain management. “We actually started doing that this year, so our members know of other South Country covered treatments for pain management besides medication,” Ruth said. Both interventions help make members aware of benefits that South Country provides that may speed up their recovery.
The topic of mental health in relation to opioid use disorders is something that I could tell Ruth felt strongly about. There is a reason the Opioid Case Management Program is placed within the behavioral health department – and it wasn’t until Ruth and I started to talk more about it that I realized just how important that reason was. “There is some correlation between the risk factors of the misuse of opioids or dependence on opioids and mental health. That goes for any addictive medication or addictive substance If you have a history of or a co-occurring mental illness that increases your risk. But, there are plenty of people who have mental illness who don’t struggle with substance use,” Ruth said.
Ruth’s experience in behavioral health shined through as she explained this topic to me. I asked her more about the increased risk of individuals with mental illness and what her experience was with that reality. “Everyone has a different pain tolerance, that is just a fact and how our brains function,” Ruth said. “And sometimes the brain chemistry of someone or their past experiences increases their risk for mental illness like anxiety or depression. That impacts for some people their experience of pain – and there’s nothing right or wrong about it, that’s just your experience. When you suffer from depression, your experience of pain can be different. It can be harder to tolerate that physical pain because on top of that you have the pain of depression. Sometimes depression can cause physical pain. There is a huge correlation.” Ruth described this connection as somewhat of a circle, “People with chronic pain should always be assessed for depression. If you can’t do the things you want to do due to pain, that can increase your depression symptoms.” These things can go back and forth – one feeding the other and vice versa. “I think that’s why we landed with putting the Opioid Case Management Program in the behavioral health department.” The opioid epidemic for many people started out with a physical pain event but then the psychological piece of whatever is happening with them internally, such as a history of trauma – that’s what put them at increased risk.”
After speaking with Ruth, there is one thing that she said toward the beginning of our interview that stuck out to me as the key question that makes this program so important. She said, “It is really a holistic approach of addressing if there are any current needs to help with recovery, and also addresses any other social or mental health needs that may be present. I love this program; we’ve been doing it since 2018. So much in health care is reactionary right? They’re treating an illness, but can we prevent an illness?”
The Opioid Case Management Program has reached over 1,300 individuals in our communities. This shows how valuable this program is. Ruth believes that this program provides valuable support for these individuals – and it will continue to have a positive impact. Programs such as this are what makes South Country so important. We strive to prioritize our members’ health and bridge the gaps between the community and their health care.