NJ Biz : Ambulatory detox centers starting to catch on

Center for Network Therapy in Middlesex becoming a model for the health care industry

When the Center for Network Therapy first opened its doors in Middlesex and asked for referrals to its ambulatory detox service, New Jersey’s medical community wasn’t very eager.

But in the past two years, the service has become popular and hospitals with existing outpatient detox programs, such as Trinitas Regional Medical Center in Elizabeth, are looking at the model.

We have been getting calls for ambulatory detox, even by some patients themselves, said Marlyse Benson, senior director of behavioral health and psychiatry at Trinitas. We are looking seriously at moving forward in that arena to add to our current continuum.

ambulatory

CNT Medical Director Dr. Indra Cidambi in a one-on-one session with a patient at the Center for Network Therapy. – (PHOTO BY AARON HOUSTON)

The program aligns with patients’ daily schedules, allowing them to attend a four-hour session (during which they are provided a meal) and return home to their families at night, according to CNT Medical Director Dr. Indra Cidambi. A requirement of the detox and recovery process is having a strong involvement of family or other life support members.

Cidambi said others opening similar facilities around the state is welcome growth, as it would make referrals easier.

“I would love to see more centers open up” she said.

Cidambi has spent her career in addiction services and learned over a period of time that it was “a revolving door pattern”.

After seeing many patients go through inpatient detox programs, she would see them go right back to using the substances.

Being surrounded by the same stressors associated with the addiction pulls them back, Cidambi explained.

A key factor for the success of the ambulatory care model has a lot to do with insurance. At half the cost of inpatient services, it isn’t hard to get a fair reimbursement, Cidambi said.

The idea for CNT was born when Cidambi saw research suggesting that at least 50 percent of addicts don’t need inpatient treatment. She picked it up and ran with it. But convincing the medical community to refer patients to the center proved a task.

“When we did marketing in first year, people looked at us like we don’t understand detox, and were not comfortable with referring patients” Cidambi said.

But now the center has treated more than 600 patients, many of which stay sober 90 days after detox — an impressive benchmark, Cidambi said.

Though others undoubtedly thought of the model, she said addiction is a baby industry — and it will take time to see a growth in solid business models and an emergence of best practices.

That doesn’t mean that inpatient centers are in danger.

This will be the future, but that doesn’t mean that inpatient will not be needed, Cidambi said. But many hospitals also have outpatient programs, like the five-day-per-week, five-hour, intensive abuse program at Trinitas, according to Benson.

The day treatment is geared toward women, and one of the first developed in the state that offers transportation and child care as part of the program, Benson said, adding that any new program would be a part of the existing center.

Mindy Altschul, the director of substance abuse services at Trinitas, said the outpatient program is right across the street from its 10-bed inpatient program.

“Sending someone away for treatment has its benefits and bonuses,” she said. But at the end of the day, at the end of the treatment, they are going to return to their community and are going to need to reintegrate into the community.”

Altschul ran an ambulatory program in Connecticut in the 1990s, when a heroin epidemic was making its rounds.

“It’s a pandemic now, it’s ongoing, she said. We refresh this idea of it being an epidemic. It has never gone away. It has morphed a bit.”

It has morphed into stemming from a dependency on pain drugs, and it is affecting a much younger population than before.

Which is why the ambulatory model is beneficial for younger patients whose fears of being sent away from home motivates them from hiding their addiction from parents, Cidambi said. The model for care introduced by CNT can be used by all ages, and there are strict factors to determine who should qualify for ambulatory versus outpatient or inpatient care.

Patients come from as far as 60 miles away and the number of referrals doesn’t seem to be slowing, Cidambi said. But the business model of CNT can handle it.

The staff at CNT includes nurses who work on per diem basis and can pick up shifts as it fits their schedule — this allows nurses to work part-time in addition to their jobs at other medical facilities, Cidambi said.

Medicaid or Medicare patients are not accepted, simply for the fact that the Centers for Medicaid and Medicare Services doesn’t have a billing code that CNT can use. But for those patients, paying out of pocket for the roughly $400 per day service is an option.

“It’s not a very big risk for someone to run a business like this,” Cidambi said. “This is the future model. We are in this industry ahead of time. So many players will come in to follow”

E-mail to: anjaleek@njbiz.com

On Twitter: @anjkhem

The insurance plan The Center for Network Therapy provides Medically Monitored Ambulatory Detox seven days a week from its location in Middlesex. Those services include detox from alcohol, opiates, benzodiazepines, stimulants, anesthetics and other substances.
CNT was the first of its kind when it opened and accepts major insurance carriers such as Aetna, AmeriHealth, Cigna, Horizon Blue Cross Blue Shield of New Jersey, QualCare, UnitedHealthcare Oxford and Value Options.
The center has seen at least 600 patients since opening its doors in 2013. It currently has 20 employees.

Playing Through Pain : NFL Gets Yellow Flag For Opioid Misuse

Playing Through Pain : NFL Gets Yellow Flag For Opioid Misus

Addiction Expert Dr. Indra Cidambi provides insight into the consequences of using opioid pain medication to mask pain in order to continue to play

New York, NY – March 31, 2017 –

As per research* by Washington University, retired National Football League (NFL) players misused opioid pain medications at a rate four times greater than the average.

The study provides a rare look into the NFL’s relationship with medications and how team doctors manage the pain in a physically bruising sport to keep players on the field.

“Professional football players and athletes have a long life to live after retirement and misuse or abuse of opioid pain medication can have serious long-term consequences, including addiction,” says Dr. Indra Cidambi, Addiction Medicine Expert & Medical Director at the Center for Network Therapy.

Dr. Cidambi believes most professional athletes and football players do not get the complete picture about the medications they are taking in order to make informed decisions.

“They need to understand that opioid pain medications are designed to treat acute pain in the short-term and they should be used in conjunction with rehabilitative therapy so that the patient can be switched to non-addictive medications.” Professional athletes need to consider the following:

Opioid Use Does Not Enhance Physical Performance

Professional football players have to realize that using opioid pain medications is more likely to slow a person down than enhance physical capabilities. “Professional athletes are willing to cross the limit in opioid pain medication use for one reason – to be able to continue to perform near-peak despite injuries,” says Dr. Cidambi. Opioids, however, can cause euphoria, decrease anxiety, provide a false sense of invincibility and illusions of athletic prowess beyond their abilities, which may help a player psychologically, but increase the danger of further injuries.

When opioid pain medications are used to mask pain in order to continue playing, players may find that they have not given time for their current injuries to heal and have actually made the injury worse.

Live After Retirement – Stay Healthy

“Most professional athletes and ball players end their sports careers at an age when others are just getting going in theirs,” notes Dr. Cidambi. “They have a long life to live after they retire from their sport and long-term use or misuse of opioid pain medication has serious consequences.” Dr. Cidambi cautions that long-term (over six months) use of opioid pain medication actually increases one’s sensitivity to pain, requiring higher doses. Continued use also leads to decreased energy and drive, daytime sedation and sleepiness and constipation.

Ingesting higher doses over the long-term will likely cause tolerance and dependence, which can lead to brain damage due to respiratory depression (Hypoxia). The risk of overdose is always present.

Retirement is Traumatic

Opioids May Provide Escape“Professional athletes retire from their sport at a very early age. They usually have not had the time to develop other skills or even hobbies,” says Dr. Cidambi. “So they enter retirement in a vacuum and they also find that the media’s attention has moved on to the emerging star in their sport. They oftentimes suffer from a chronic injury resulting from ignoring rehabilitative treatment and using opioid medications to play through their pain.” Consequently, they face tremendous trauma in their life at retirement.

“In the absence of a strong social support system, it is easy for them to turn to pain pills to mask their feelings and escape from reality, especially if they have misused pain pills during their careers.”

Chronic Opioid Use Will Likely Lead to Addiction

When used over an extended period, opioid pain medications do not work well due to increased tolerance and sensitivity to pain requiring higher doses of medication to achieve a similar effect. Dr.Cidambi notes, “This is a trap many legitimate users of pain medications fall into and they are unable to quit, as their bodies have become chemically dependent to the medication.” This dependence is real and severe, as they face acute withdrawal symptoms (shakes, chills, etc.) when they try to quit or switch to non-narcotic pain medications. “So they keep taking the pain pills in order to be able to feel normal and function.”

Coming Off Opioids Is Not Easy, But Doable

Opioid pain pills can be very addictive – they are made from the same stuff as heroin! Additionally, the fear of facing withdrawal symptoms keeps the user from trying to quit. But detoxification centers can make the process of weaning off of opiates easier by using medication-assisted treatment (usually buprenorphine). “Medication alone is not the answer,” cautions Dr. Cidambi. “The person who has become dependent on opioids also needs therapy to effect needed lifestyle changes and find other modalities of care to alleviate the pain.” Yoga, meditation, biofeedback, and acupuncture could be introduced to deal with the pain and lead a healthy life.

For more information on opioid abuse and addiction or to learn more about the Center for NetworkTherapy please visit, www.RecoveryCNT.com.

About Dr. Indra Cidambi

Indra Cidambi, M.D., Medical Director, Center for Network Therapy, is recognized as a leading expert and pioneer in the field of Addiction Medicine. Under her leadership the Center for Network Therapy started New Jersey’s first state-licensed Ambulatory (Outpatient) Detoxification program for alcohol, benzodiazepines, and opiates four years ago. Dr. Cidambi is Board Certified in General Psychiatry and double Board Certified in Addiction Medicine (ABAM, ABPN). She is fluent in five languages, includingRussian.3

About Center for Network Therapy

Center for Network Therapy (CNT) was the first facility in New Jersey to be licensed to provide ambulatory (Outpatient) Detoxification Services for all substances of abuse – alcohol, anesthetics, benzodiazepines, opiates and other substances of abuse. Led by a Board Certified Addiction Psychiatrist, Indra Cidambi, M.D., experienced physicians and nurses closely monitor each patient’s progress. WithCNT’s superior client care and high-quality treatment, Dr. Cidambi and her clinical team have successfully detoxed over 1,000 patients in nearly four years. The Center for Network Therapy also offers step down to Partial Care (PHP and Intensive Outpatient (IOP) levels of care.

 

* The study was conducted by researchers at Washington University in St. Louis School of Medicine and was commissioned by ESPN, with additional funding provided by the National Institute on Drug Abuse, a division of the U.S. Department of Health and Human Services.**Reference Articles: https://www.washingtonpost.com/sports/redskins/nfl-abuse-of-painkillers-and-other-drugs-described-in-courtfilings/2017/03/09/be1a71d8-035a-11e7-ad5b-d22680e18d10_story.html?utm_term=.368d434c42e7# # #

Insurance

In-network with:

Aetna
AmeriHealth
Anthem BCBS
Beacon Health Options
Emblem BCBS
GHI
Empire BCBS
Horizon BCBS (EPO, HMO, PPO)
Oscar
QualCare
United Health/Optum/Oxford
Emblem GHI*
Humana*

 

* If the QualCare logo is on the
insurance card