NORWAY — While some rural Maine hospitals have cut back on services, Western MaineHealth is introducing ways to provide healthcare to underserved populations.

One recent initiative has been to establish an addiction medicine program that extends care to WMH patients as well as inpatient care at Stephens Memorial Hospital.

The Western Maine Comprehensive Addiction Medicine Program (WM-CAMP), the first of its kind provided by a MaineHealth rural facility, became possible when longtime practitioner Lisa Miller entered a year-long addiction fellowship based at Maine Medical Center in Portland and the Togus VA Medical Center.

Miller had already begun a practice focus on addiction medicine starting seven years ago, integrated medication assisted treatment (IMAT), which inspired her to make it her specialty. She completed her studies last year and became officially board certified early this year.

Entering a program to become board certified required Miller to step down from her position as a family medicine physician. But leadership at Stephens Memorial Hospital put a plan in place that would bring her back and extend her expertise to meet a growing need in Oxford Hills – medical care for patients living with substance use disorder.

“Lisa started (this) in 2016, a clear recognition that our community had unmet need in the area of SUD,” said Stephens Memorial Hospital’s Chief Medical Officer Ryan Knapp. “Specifically, opiate use. Lisa and her partners in the primary care office went through some additional training and added it as part of their primary care practice.

“When Lisa decided to do the fellowship, it was still very clear to us that we had unmet need in two areas. One is the volume – just the number of patients who need care. But two, the complexity of care (is something) we need to meet locally.”

SMH formed a working group that included Knapp, Miller and Bonnie Roth, WMH’s senior director for practice operations, and colleagues from Maine BehavioralHealth. They began laying the groundwork to establish a program to provide enhanced care to patients with SUD as Miller progressed through the fellowship.

Miller and her team focus on inpatient and outpatient care, managing care for patients who have other medical conditions, often chronic like diabetes or hypertension, complicated by SUD.

“We don’t run an inpatient detox program,” Knapp clarified. “What Lisa does is offer specialized care to people who are in the hospital for various reasons. If they have an active SUD issue, she is available to provide expert consultation on how to manage that substance use issue. Or make a warm connection (while they are there) so that she can get them as outpatients.

“These patients will have medical needs related to their substance abuse issues. It is not residential rehab, even though we offer connections to those programs.”

WM-CAMP became an embedded program within WMH’s primary care practice last October.

“I had a full schedule the first week,” Miller said. “I had already partnered with a medical assistant, Breana Roberts, who became our program coordinator and did a lot of the groundwork while I was still in the fellowship, establishing connections and accepting consults.”

The WM-CAMP team includes Miller, Roberts, peer recovery coaches Candace Durgin and Kaleigh Freita, medical assistant Kristi Hall and Alyson Byard, LCSW and LADC.

Miller was not surprised to start off with a high number of patients to treat but expected it would tail off after the initial launch. Instead, consultations stayed steady even through the holiday season and into the new year.

“We have seen 80 new consults so far,” she said. “I am taken on more than a third of those as primary care patients. Some were already patients, but others have moved into the practice because of their complex substance use disorder.”

WM-CAMP referrals come from WMH but also community partners, like Common Ground Counseling in Norway, the Maine Options program based in Rumford, and from recovery court programs.

“It’s mostly opiate use but we’re seeing a lot of multi-substance use,” Miller said. “We’ll see amphetamines, cocaine, meth amphetamine.

“Fentanyl is always mixed in with it, even when patients don’t know they’re taking it. If people think they’re using heroin, they’re getting fentanyl. I almost never see heroin anymore. If they’re using opiates, it’s almost always all fentanyl now.”

The profile of patients who seek care that includes addiction medicine includes just about anyone. Miller treats teens as well as senior citizens. Many of her referrals are made by family members as word gets out that WMH now offers specialized care for SUD.

Provided services include case management through SMH’s Lend a Hand program, where health guides work with patients to enroll in health plans.

“There are a lot of people who qualify for MaineCare but are not enrolled when they first seek care,” Knapp said. “Our general approach is that we want anyone who has this issue to come to the program. If we need to work with that person to make it viable for them we will do that.”

“Those processes are complicated,” Roth added. “(Our Lend a Care team) know the resources that are out there, that are hard for many of us to keep track of. But they also know the process inside and out and take the time to work with people get through it.”

Case managers also work with patients experiencing homelessness, connect them with transportation and food bank services and help them find employment opportunities.

“There are many pieces for help and we help with those connections,” Miller said. “We keep food bags in our office for patients. We make them feel safe. They come into a place where they are not met with stigma. We want everyone walking through the door to feel comfortable.”

WM-CAMP currently is taking in a new patient daily, on average. Miller’s goal is that new patients be seen within a couple of days of their initial call. The process is to get patient information over the phone and prioritize them according to available appointments.

“We may have to triage some patients a little bit more because new consult slots quickly fill with follow-ups,” she explained. “We also work to stabilize patients who already have a primary care physician and transition their care back to their regular doctor if they are able to care for them.

”For the patients who have been identified as having complex SUD and don’t have a primary care provider, I will take them on so they can start trying to catch up on preventative care. If it’s been a long since they’ve had a physical, it may not be done during that first visit but we will get them scheduled and also start talking about things like routine health screenings.”

“Lisa and her team actively look at those referrals and call to triage them based on what is going on with that patient,” said Knapp. “It can be very individualized, depending on what’s going on. It’s not necessarily just overdose or chronic alcoholism. It’s more where are they at with their chronic condition? What precipitated them to get there?”

In addition to primary care and care supportive to substance-related illness, WM-CAMP assists patients with referrals to inpatient detoxification and recovery. WMH has two behavioral health clinicians for patients seeking outpatient therapy.

“It’s such a benefit that Lisa is embedded in our primary care practice,” Roth said. “We would never be able to manage all the patient needs with just (one physician). Even now, today, separate from the work Lisa is doing, some of our primary care physicians are still managing more stable substance use disorder patients, as we have done since 2016.

“Having Lisa with her additional expertise has allowed more our primary care community start to feel comfort in taking on those more stable patients. Having someone they can ask questions of, having someone who, if a patient starts to struggle on their (recovery) journey that there is someone to help with that patient until they can get back on their feet.”

WM-CAMP is located at Western Maine Primary Care on Pikes Hill Road in Norway. Its mission is to provide care for and work closely with patients to develop individualized treatment plans based on their specific health needs. Its services include consultations on all substance use disorders including alcohol, opioids, stimulants, cannabis and tobacco, as well as specialized treatment for hepatitis C and perinatal substance use disorders.  The team also coordinates primary preventative care for patients with complex substance use disorders.

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