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BATON ROUGE – Louisiana saw the nation’s steepest spike in drug-overdose deaths between 2019 and 2020, and over 70 percent of those deaths involved an opioid, according to the Centers for Disease Control and Prevention. While access to treatment for opioid use disorder is limited in the state, access to opioids remains broad. In 2019, Louisiana providers wrote 75 opioid prescriptions for every 100 persons, compared to the national average of 47. In parishes such as Caddo, Evangeline and Rapides, there are more active opioid prescriptions than there are residents; and parishes like East Baton Rouge, Iberia, Jefferson, Lafayette, Ouachita, Orleans, Richland and St. Landry have exceptionally high prescription rates also. Through a growing partnership with Our Lady of the Lake, or OLOL, Regional Medical Center, LSU Professor of Psychology Julia Buckner is helping to add critically needed behavioral health services for patients who misuse opioids and other substances. Her team has already helped hundreds of patients.

Through treatment known as CBT, or cognitive behavioral therapy, Buckner aims to help patients become better managers of their own drug use and align behaviors with personal goals, going from misuse to use, or finding other ways to deal with pain.

“As the largest provider of mental health services in Baton Rouge, OLOL was an excellent facility for us to partner with,” Buckner said. “Our shared goal is to offer therapy to more patients in need, but also to train more mental health professionals, including our LSU clinical psychology graduate students, to help combat the opioid crisis and save lives.”

What makes opioid use disorder different from other types of substance abuse is the common connection with chronic pain as well as anxiety around pain. CBT takes the approach that thoughts, feelings and behaviors are connected. By recognizing and purposefully changing one’s thoughts, one can change how one feels and behaves. The treatment method is based on personal patterns and unique triggers; there is no one-size-fits-all solution, which makes CBT appropriate in diverse populations.

“We’re especially focused on bringing evidence-based treatment for opioid use disorder to underserved and high-needs populations, and that is certainly Baton Rouge,” Buckner said. “We want to reduce barriers to therapy.”

OLOL is the largest provider of health care to low-income residents in the Greater Baton Rouge area. About 70 percent of the approximately 300 OLOL patients seen by Buckner’s team so far rely on Medicaid, Medicare or are uninsured, and roughly 40 percent are persons of color. Buckner is careful to point out, however, that there is no “typical” patient with opioid use disorder.

“We see people across the whole socio-economic spectrum,” she said. “You simply cannot say who will misuse opioids, continuing to use despite experiencing problems and who will not. And although there are trends—we see more patients who also suffer from anxiety, depression, PTSD or chronic pain, for example—this doesn’t translate to predicting which individual may misuse opioids.”

“While many start with legally prescribed pain medication and then maybe use more than what is prescribed to help manage their pain—or maybe their insurance doesn’t cover the medication and it becomes cheaper to get it other ways—not everyone with chronic pain goes on to develop an opioid use disorder,” Buckner said.

The joint LSU-OLOL effort is now in what Buckner describes as a third phase. They started in 2019, before COVID-19, but had to rapidly shift to telehealth to continue to provide services to both established and new patients in 2020. However, they were able to continue to provide in-person therapy in the inpatient psychiatry unit. Now, as more people are receiving the vaccine, there is a gradual return to in-person treatment, although the team will continue to offer telehealth as an option.

“This is something we learned; we’ve been pleasantly surprised at how successful we’ve been with telehealth,” Buckner said. “For some, transportation is a big issue, so being able to access therapy using videoconferencing helps them access treatment. But some patients don’t have reliable access to Internet, which makes in-person therapy a better choice. It’s really up to the patient.”

The team is already working in three units at OLOL — the outpatient clinics, the medically assisted treatment clinic and inpatient psychiatry — and is planning to expand to other units of the hospital to increase access to care.

Buckner received nearly $850,000 in support from the U.S. Health Resources and Services Administration for the work, which includes recruiting, training and retaining three cohorts of three doctoral students in clinical psychology to gain experience in providing this kind of therapy.

“The hospital has been very supportive of us being there and our new goal is to figure out ways to help us stay there once the three-year HRSA grant expires over next year,” Buckner said.