McRISC.com: Learn More About Your Addiction

Dr. Mark Leeds [00:09] Welcome to The Rehab on the Mental Health News Radio Network. I am Dr. Mark Leeds and I will be your host. Join me in exploring the world of addiction treatment. How can we improve the ways that we help individuals to overcome addiction? The goal of treatment is to save lives and help people to get back on track to a path towards success and happiness in life. Welcome to the Rehab Podcast. Calvin and Joyce McGinn, founders of McRISC, innovative new software company. Welcome to the program and thank you for joining me. Can you tell me about what MCRISK is and what you’re doing with that now? And that would be great if you could just tell me more about it.

Calvin McGinn, PhD [01:01] Well, basically, MCRISK is the outgrowth of the work I’ve been doing for years now as a family therapist, working with a range of populations, including those with addiction issues. And I was program directing in a facility that was working with naltrexone and a range of options for helping people with substance use disorder. And in that process, I realized that the needs were just huge. And this was in Chicago area. They ran out of funding, and the program was cut back. But my interest continued. And so I got involved with the local task force that was managing the issue of opioid problems and the Lake County Opioid Task Force. And so in that process, I realized that there was so much interest and need to address this problem with 200 people dying a day from overdoses, that it was time to do something about it. And what was missing when I looked at the literature was the ability to actually risk stratify the population. And so McRisk was an attempt to create access by way of risk stratification to this population so we can actually target better what we’re doing with supporting the needs and creating longer-lasting remission. So that’s what McRisk was started from.

Dr. Mark Leeds [02:16] You’re a family therapist, and as one of my previous guests on the show mentioned, family is a significant issue with addiction. In fact, he said addiction is a family problem. What do you think about that?

Calvin McGinn, PhD [02:35] Absolutely. We are our relationships, and to the extent that our relationships are healthy and mutual and connected, we have resilience. We develop all the time to manage the otherwise risks that come with various factors that we know in the environment, in our genetics. So family connectedness and cohesion, adaptability is very important factors in supporting resilience. My dissertation study in the 1980s related to an ER population. We looked at the connection between visits to the ER and family resilience factors, and we found that clearly there was a connection between those variables. So, yes, family factors impact certainly the ability to manage illness. As far as the onset of illness, we’re not finding that it means they don’t get it’s just the issue of how to manage it. Family factors become helpful.

Dr. Mark Leeds [03:38] What do you think about the issue of tough love? And I know that this has been an issue with addiction where in the past people were often encouraged to, you know, when someone had an issue with addiction in the family to cut off all access to maybe to money and to a place to live and to make things difficult. So they would come around and hopefully ask for help or look for help. And then now there’s the issue with you know if you’re too tough on a person they may just go out and overdose and die and so now some experts are recommending you know not to do that same sort of thing and maybe to provide more harm reduction you know maybe keep the person in the house and give them a place to live and maybe even provide them with clean needles and syringes and that sort of thing

Calvin McGinn, PhD [04:21] Yeah I think it’s a really good question and it’s an important one to address The pendulum does swing in our culture in how we address these kinds of problems. And I think that, frankly, the harm reduction mode of management does make the most sense in terms of giving people a sense that we’re not, when someone has a disease like this, to expect them to just cut off their using without a process that includes certainly getting the support they need to deal with it. But the tradeoff is that when families just allow somebody to have all the support they want to continue to use and live at home and do whatever they want to do without any kind of consequences at all, then that’s a problem too. So there is a balance here. And I think the harm reduction model does not mean you don’t create boundaries. It just means that you’re not expecting someone to entirely solve their problem by abstinence 100% before they’ve had a chance to approximate healthier options. So families find ways to do that by first having the loving and the caring that translates into really noticing where someone’s in trouble. What are their things that will help them feel supported? And at the same time what’s not going to feed into the problem. If you’re giving somebody money to buy drugs versus giving them a bed to sleep in, they’re two very different things. So I think that, yes, you can draw the line, but at the same time you can be there for them.

Dr. Mark Leeds [05:59] And that makes sense. And when it comes to specifically opioid addiction, there’s been some debate in the past and maybe even currently about the use of medication. And clearly medication is needed. That’s been proven that abstinence within the current opioid crisis, abstinence-based addiction treatment is just not working. And the use of medications such as methadone, buprenorphine, and naltrexone have been proven to be beneficial. So how do you feel about that as far as the issues of medication? How do you know when to start medication? How long to take medication? And also there’s the issue of patients when they come in it’s recommended that they go for therapy and you know if possible you know some sort of group therapy but then there’s a lot of the patients they tend not to go for therapy you know they put it off indefinitely and but and they still tend to do fairly well on medication it works that well but then you know the issue is how do you stop the medication when no changes have been made because if you do stop for example with buprenorphine and the person hasn’t made any changes in their life, very likely they’re going to go right back to where they were before they started medication.

Calvin McGinn, PhD [07:12] Yeah, these are really important questions. And, you know, the Lancet article that came out in 2017 was really the first large study looking at comparing suboxone to naltrexone. And what was interesting in that study was they had about 572 people and both substances were equally successful, approximately about 50% on each side of enabling people to have one year or 12 month abstinence. But what happened in the study was they showed that when they used naltrexone, there was about 30% dropout at the beginning of the study because people couldn’t go through detox, a certain percentage of those who had these problems, couldn’t go through the detox to succeed on the naltrexone. Other than that, once they were on either one, their success rates were the same. So that tells us that there’s a population, a percentage of people who can’t handle the stress of detox the way other people can. So what is it in those people that make them susceptible to that problem? If we know that, then we can more likely look at how you pick and choose which medication, which kind of medication. An agonist which would be suboxone versus an antagonist the agonist being one that’s a replacement medication so a person is then can go straight from using to a replacement and not have to go through detox versus a person going to a going through detox to get the opioid out of their system entirely so that they can then their brain can start to heal fresh with without an opioid. So how do you pick and choose? So I think this is where we get into the usefulness of medications is clear. And as you said, that is the standard of care now for using these, working with substance use disorder. The reason being that the brain has been hijacked. You can’t support the brain healing and provide the medication that augments that. You know, if someone has diabetes, we give them insulin. We know that they need that support. The issue with substance disorders and other chronic illness needs to be treated with the same level of attention. So as a chronic illness, it needs to be looked at this way too. Now, as far as the using only medication, I think we really run a problem, especially with substance disorders, because this is a multi-variable problem. And you can heal a brain, but as you do that, if the psychological addiction is not addressed and how it’s impacting the whole life, then all the triggers that are still in the life come to bear as soon as the person gets out of treatment or stops the medication then they’re confronted with all the reasons that they couldn’t resist in the first place because it’s their life their lifestyle it’s the associations they have it’s all the triggers for a given person based on the risk variables so that’s why it is important to actually address both parts both the medication needs and find out which medication a given person you’d be using, and then the psychological, psychosocial addiction. And with that process, you need risk stratified answers. So that’s what was missing in the research when we reviewed it. So we looked at ways to come up with a method of really seeing through the literature and through what we know about the illness, how to actually treat it, assess it, prevent it, and treat it. And that’s what McRisk is all about.

Dr. Mark Leeds [10:33] Okay. And now getting to the specifics about McRisk, did you have to study, did you have to interview a large number of people to get information, do some sort of testing, or was it using data that had already been put together for other studies?

Calvin McGinn, PhD [10:49] Well, the variables themselves came from other studies that gave us a sense of what we know, you know, that 40% of people with brain illnesses or mental health have substance use disorder. You know, 50% or more of those with PTSD get in trouble with SUDs. We found that the research tells us that a 12-year study out of Northwestern showed that when people have been incarcerated for like 12 years, they do an longitudinal study. And they found that 91% of the males and about 78% of the females had a substance use disorder when they left incarceration versus when they started. So you’ve got these huge variables. Homelessness, again, another high population for substance use disorder. So the literature told us that this is the frequency showing up for these populations, these kinds of issues. And all I did was I took what the research told us and develop an assessment tool that actually asks the questions that target those particular problems we know show up with increased risk. So by doing it, I was able to create actually a model that’s called the BUILD model. The BUILD model basically looks at the five key variables that relate to substance use risk, increased risk. The first is B for blueprint, which includes the genetic and epigenetic factors that a person has in their history. The U is user traits, things like impulsivity, their motivation to use, their attraction to substances, their tolerance of using, and the entrapment that occurs over time to certain individuals. Plus the number of times they quit or the relapses that they have. These are user traits we see that are recurrent and similar. The third variable in the build, BUI, is for injured developing brain. We know that the brain is developing right up through age 30 at least and then beyond that, actually. And because of that, the brain susceptibility to injury that will be long-term and more lasting is showing up very early. And the earlier people are exposed to substances, the more likely they’re going to have a more lifelong risk for developing and maintaining a problem with it. So looking at injured developing brain and how young people were with what substance they started, how many substances, what their dependent years were, and how early they started, very important risk factors. Then life stressors or life trauma that occurs. We know the associations with those coming back from the war, military issues, PTSD, all the stressors in life that people are exposed to. We know the relationship with sexual abuse, with other kinds of abuse that increase risk for substance use disorder. So a variety of life stressors come to bear. Chronic poverty, for example, and loneliness, chronic loneliness. There’s a number of variables that people don’t think about but actually coincide with increased risk for substance use disorder. So, again, life trauma feeds into the fourth main factor. Finally, damage in the BUILD model. Damage from using, which creates increased risk. Because if a person is actually using and they’re having all these consequences, all the DUIs and the court things and they lose relationships and they get more, they get cirrhotic livers, they get all kinds of other physical things, they get HIV, they get hepatitis. All the things that happen that have a damaged consequence and they continue to use. That says something about how hijacked they really are, their brain and their life. And so these five areas became the basis of then creating an inventory that would give people questions to respond to, that would target these areas. Also, built in was a denial scale to see if someone’s actually sharing what’s really true about them or if they’re having a hard time being honest, which makes sense. It’s all part of the illness, too. And finally, there was a readiness scale that was developed. The readiness scale in particular was a unique way of helping people to see where they are on a continuum of readiness to deal with their illness. If somebody has no need because they don’t have any substances they’re involved in, or no interest because they’re really not ready to deal with this at all, or if they’re really feeling just pressured to do it, but they really don’t have a personal stake in it because their family wants them to change, or they feel guilty because the consequences on people they care about or their life, but they’re not quite ready to do more about it, or they’re afraid to try because of their connection to the illness and what will happen if they try to stop something they really need versus being unsure, versus being tired of the consequences, versus being afraid not to try because now their life is at stake and they’re feeling more connected to what it’s costing them, versus from there getting to a place where they actually want their life back, versus now they’re being ready. They’re really ready, they say, and then they say they’ve never been more ready. So this range of readiness, if you can capture it on a current readiness scale, really it helps you decide when someone’s ready for treatment. And so you don’t waste their time and energy at something they’re not ready for. Although if they’re ready to go in, and even if they’re not totally ready, I would say we bring people in at whatever point they are ready so that we can at least help them to the extent they’re ready to receive help. So these things compiled then the assessment tool. And it started out with just 17 questions and it’s morphed into about 87 now but they’re all branching questions so that a person takes only five to ten minutes to answer them because they’re really efficiently put together in a way that no one gets all the questions you only get the ones they need and the result of taking the 10 minute survey is that they’re able to have now we get the information, and it automatically collates and spits out two profiles. The first profile is a personal profile, which is a narrative that allows the person to actually understand their risk factors in their life and to know a little more about themselves. So it’s a self-discovery process for someone to be more clear about what their risks are. The second is a clinical profile, and that profile is actually much more detailed and breaks down. It has a graph in it has the details of, for example, the five risk factors that I mentioned were significant, which of those are significant for that person, to what extent they are, and it gives them actually a risk index, which helps us then determine whether they have a low, moderate, or high risk for having lifelong susceptibility to substance use disorder. This then helps us figure out what to do in terms of treatment options. So there’s over 1,100 permutations of what someone’s backdrop can have by way of how severe their illness is, because we also evaluate DSM-5 criteria for acute illness over 30 days, 3 months, 12 months, and remote in the tool. And we put that against a person’s risk level, which could be low, moderate, high, or very high. We look at things like homelessness, because if someone’s in a homeless situation, they’re much more at risk to not succeed in treatment if it’s outpatient. So for them, residential treatment for homelessness, it makes more sense for people, depending on how level the risk is. Things like brain illnesses that they’re having impact the recommended treatment also. And the medication is impacted by, again, the overall risk severity. So all these variables come together, and they give us a reference point on how to determine what treatment matches a person’s risk. And that’s what the tool does. And it started out with nine clinics that we worked with to test the tool out. We took what we do from the literature. We applied it to nine different treatment settings and got really good results that showed there was a correlation, high correlation between the risk severity that the tool showed, demonstrated, and the number of substances, the number of times they quit, the dependency years they had. And so we were seeing these clear indicators that said, you know what, somebody who has this risk factors, the tool shows up, what do you know? They’re having this kind of problem with substances over time. And so the correlation showed up. And so then we decided we need to really, you know, get this out to the public and allow other people to be more aware of what they’re doing. So then we developed a method to do that. And that’s what we’ve been doing now. We have a website now that people can actually go to the website and they can take the assessment tool and they can give them a pin is generated for them when they want to give us their email they want a result from is all HIPAA compliant. So whatever they’re giving us, it’s held in a HIPAA compliant manner, they can then download their results, their personal profile. And from that information, they can decide if they want to get some help. If they do, we can then, they let us know, we can then send them with a release to their provider so that they can then have the more advanced, more involved profile. So yeah, we did it on a study on furry population, and now we’re ready to actually increase the study to a much larger group since we know it actually works.

Dr. Mark Leeds [19:45] I think you partially answered my next question. I was trying to figure out where the best place would be for the first place a person might take this test. Initially, I was imagining my own situation where I have a small practice where I take care of some patients by treating them with buprenorphine. And I imagine doctors going through, we go through an eight-hour course to learn how to do this, which is not really that much training. I mean, you basically learn how and when to give the medication properly, but you don’t really learn much about addiction. I mean, how much can you learn in eight hours? So, you know, it seemed like a great tool for doctors who are prescribing, for example, Suboxone to have all their patients sit down and take this. Maybe on their first visit or patients they’ve already been seeing, you know, have them go back and sit down and take this test or, you know, engage with the software. But then I was thinking, you know, maybe that’s not, maybe it would be better to do this before. And it sounds like this is something that could be used in large treatment centers, residential, outpatient, you know, and everything in between. And then also even better at home, you know, in that what we were talking about before, that harm reduction situation where a parent has their child and maybe they want the child to give them a urine drug screen and, you know, not give them money and be careful watching them. And maybe they want to also say, if you’re going to live in my house, I want you to sit down at the computer and do this test, you know, so we have this. And another thing is also the growth of telemedicine, where pretty soon doctors and other providers will be treating people for addiction without even meeting them in person. And this would be, sounds like something ideal to have this information before or during treatment.

Calvin McGinn, PhD [21:32] Yeah exactly mark and what you’re mentioning is all the stuff that came to bear when we try to figure out what’s the best what’s the need here how do we really address the need and what happened is we looked at what was out there and all the assessment tools there were two things wrong okay all the assessment tools there’s like 40 odd that SAMHSA publishes that shows what’s out there so far and they’re all about they’re either a brief screen that shows if someone actually has symptoms of having a disorder right now or having a substance use dependence right now, or they’re more extended interviews. And if you look at the ASAM, the American Society of Addiction Medicine, they have their criteria, which is phenomenal. They’ve spent many years, started in the 90s, developing this tool. And it comes from the Addiction Severity Index is where they developed it from. But again, it’s an acute illness-based tool. And it provides for a physician or a provider can take the course and learn about the 90-minute guided interview. The computer helps you ask questions of the person in your room, in your office there, to get them into treatment. And it is a really useful tool. It’s got the standard for a level of care placement, how to decide where to put somebody. But again, it’s 90 minutes of an interview, and the provider has to learn how to do this and go and take the course to learn it first. So you’re tying up someone’s time, significant time, investment in learning to become a provider to support this population. When, in fact, most primary care providers, they’re not going to take that kind of time. You’ve got addiction specialists who may be invested to do that’s true. But the majority of, you know, on the lines there where it’s all happening in the trenches, Providers need a quicker ER docs, for example, urgent care facilities and primary care facilities and hospitals. They need a quicker way to do something that also is useful and comprehensive as much as possible. And so because they were looking at acute illness versus chronic illness, they were missing the boat. And because it was done in a longer term process, instead of giving people the safety on their smartphone, wherever they are, finding out what their needs are, we needed that level of support. And so this is why this tool was developed.

Joyce Ann McGinn [23:48] The other thing I want to add is that we can translate McRisk into any language. So we don’t have the language barrier. And when somebody is doing an assessment tool on their own, there’s a little more room for freedom of honesty because nobody is standing over them. They’re not looking at an interviewer and having to answer questions and those types of things.

Dr. Mark Leeds [24:07] That’s true. There’s a lot of, you know, I think often when people come into the office and tell me what they were using and, you know, how many bags of heroin or how many oxycodone tablets, you know, in the beginning, they’re not completely honest about it a lot of the time. And, you know, like if they say they’re taking two or three oxycodones, most likely that’s a, you know, gross underestimate.

Calvin McGinn, PhD [24:27] Right. Right. Yeah, and that’s the thing. People need a place to be honest with themselves. And sometimes the best way to be honest is to self-discover in the privacy of your own space where no one’s going to be judging you. There’s nothing to be, you know, proven or there’s nobody looking at you’re just taking this assessment tool and sorting out what you want to share about it and learning about yourself. And then you can decide what to do with that learning curve instead of feel like you’re forced or pressured to do something about it. So, again, catching people where they are, giving them the chance and the sense of their own self-discovery gives them a more likelihood of being honest with themselves. And therefore more likely to find the truth of what they need and then getting the support they need to follow through with it.

Joyce Ann McGinn [25:05] And it gives people an opportunity also to go back. So if they answer a question and later on they read another question and say, hey, maybe that isn’t quite accurate what I did before. So they can go back until they’re actually done with the actual tool, back and forth in it, without somebody saying, are you sure you’re telling me the truth?

Dr. Mark Leeds [25:23] Okay, so they can go back and redo or fill something in that they weren’t honest with the first time through.

Joyce Ann McGinn [25:29] Right, until they hit done and actually, you know, submit.

Calvin McGinn, PhD [25:32] They can leave the site, too, and come back to it, and it will hold where they were the last question. And they can go back and continue at that point and then finish it. So it has that opportunity for people to kind of be ready when they’re ready, and even if they’re partially ready to start it and then finish it later on.

Dr. Mark Leeds [25:48] Have you set this up in any way to help maybe catch a malingerer, like a person who doesn’t belong in treatment, which is a concern now with both law enforcement and also doctors and medical providers of people coming in to get prescriptions for medication like buprenorphine. It really shouldn’t be getting it. And it can be really hard to tell or to decide what to do sometimes. You know, when you have someone come in and say, I’ve been taking this medication, I’ve been getting it on the street, it helped me get off of heroin. And you don’t know if what the person’s telling you is true. And maybe is this tool set up to help with that?

Calvin McGinn, PhD [26:24] Well, the tool is set up to help to show discrepancies between what they’re reporting as their illness level that they believe versus what the answers to the criteria that they’re filling out indicate. So we can tell the difference between if somebody actually has the illness versus if they’re saying they don’t or saying they do. We can tell that part. And so to get at that, I think I would encourage all providers, when you have someone in front of you and you’re trying to decide what to do with that person, given that they’re showing up that they’re saying they have this problem, I think I would want to know to them, are you interested in your brain completely healing as much as possible? And do you want your brain back and your life back? And if they are, then they’re going to be less interested in staying on any medication for the rest of their life that keeps them somewhat needing that medication to have a normal life. They’ll want to eventually get their life back. If they don’t really care about getting their brain back and they’re more interested in getting the medication to keep them from using, then that brings to question a little bit. Not saying that isn’t an okay stance they may take, But it does bring up the risk that they’re looking for something to just keep them going on what they have. And so I would be looking at what their motivation is and what they’re really wanting. The end point, when they describe their life down the road, what does it look like? And now you’ve got indication of whether a person is serious or not. I think that the bigger issue, though, is you’re going to have people come into the office with these issues. And I think we need to connect not just medication support, but therapeutic support. If someone is just coming in and they’re on medication only, there’s always going to be a higher risk of diversion and using medication in the wrong way. If a person is committed to their illness recovery, they’re much more likely to be wanting and would be supported in being in support groups, in getting into the therapeutic relationship with others who they can’t hide from in the same way they can hide from you talking about medication only. So I think that’s where it really makes a lot of sense. And we know that the success rates are much higher when we combine medication with therapeutic support. And so I would encourage, I think providers who are just providing medication only are going to always have a higher risk of having people diverting medication in those kinds of practices. And so I think it’s important to develop relationships between providers and mental health providers and behavioral therapy so that people are actually connecting the dots with each other, the providers, and having a release form that allows them to talk with each other. So if someone’s committed to their health care, they’re going to want the people who are part of their care team to connect with each other. Now you’re giving opportunity for more information to be gained so you can catch these problems instead of think that somehow in an office visit, you can really manage that diversion issue because, you know, people are very tricky and they’re able to go after what they want. And people who are addicted to substances have amazing capacities to convince others of what they really are wanting to do when it’s not true.

Dr. Mark Leeds [29:31] Also, recently I’ve noticed in the last, I think just in the last few months, our state database, the PDMP, where we check to see if people are, what prescriptions are filling, controlled prescriptions, and, you know, just to catch issues of doctor shopping and that sort of thing. They just added some kind of a risk assessment, and they used some, I forgot the number, but a huge number of different factors to put this number together. And I think it’s from zero to 900, and it’s based on overdoses and medication that they’re taking and combinations of things like stimulants and, I guess, sedatives and opioids. I don’t know if you’re familiar with that or if other states are doing that and if it bears any similarity to what you’re doing.

Calvin McGinn, PhD [30:21] Yes, actually, McRisk does ask a lot of those kinds of questions and gets at the range of all the kinds of addictive medications they may be on and how long they’ve been on them for how long. So that information is available on the survey. And it allows us to actually look at the bigger picture of a person’s life. And yes, we do know that people who have a larger range of substances they’re using are much more likely to misuse. At the same time, that’s also part of the illness. And someone can really want help and have those variables going on too. I think that over time, looking at number of providers someone has gone to, I think that the prescription monitoring program in the States is the best chance we have right now to limit the process. And we’re seeing that it is affecting, I work in an ER environment. We’re definitely having less opioid prescriptions going out now. And we’re having pharmacies call us. We’re having much more connection because of the monitoring program that’s allowing us to capture this population and limit the access they’re getting from providers. And providers, now there’s more. The federal government’s also investigating providers and starting to now look at who’s doing what. And so providers have an incentive to be more careful, too. So I think the whole process is getting geared up to work better. And I’m very supportive of this kind of risk looking at on the state level. The research needs to be increased in doing this. In fact, we’re looking at doing research that compares prescription monitoring programs’ results to risk scores on the risk score and how they do in treatment to see if we can predict who’s going to do better by looking at hard numbers like how much are they still abusing the other medications through that database. So this is all important stuff. And yes, McRisk is tied into supporting that too. Which ER is it that you work at? I work with Advocate Healthcare. And I work at the Trinity, Advocate Trinity Hospital, which is on the south side of Chicago. I’m a care manager there. And so it’s my job to work with the patients coming in to get them resources and to help look at what their needs are. I also work with the physicians. To help the documentation for admission, observation status versus inpatient, what’s appropriate, how the documentation reflects all that. I’ve been a nurse for decades, and I was an ER nurse for years. So I have a medical background. I taught physicians and family practice medicine for about 10 years. I have a broad base through which I’ve seen this problem show up and really support providers getting the best tools possible to manage it. And that’s why this tool was developed, because of that context from which I could tell what was missing and the population and among the providers so that we could work together to get a better way of managing it.

Dr. Mark Leeds [33:13] That ER in Chicago, the ER that you’re at, do they provide medication-assisted treatment? Do they initiate it? Because I know that some ERs are starting to run programs where they initiate treatment in the ER and then also provide continuity of care and referral to clinics, especially for people who can’t afford treatment, to get into the system and get started and continue on treatment where they can get assistance with both the doctor visits, or the doctor visits the therapy and the medication.

Calvin McGinn, PhD [33:44] That’s an excellent question, Mark, because that is the next place. In fact, ERs are where all the ODs come. That is the place, the recipient of most of the problem. It shows up there eventually. And so ERs need to be well prepared to manage this problem by being a better handoff and referral source. And so we’ve started having conversations about this. And I’ve talked to all the ER docs there about it. I’ve encouraged them to be aware that every, you know, you don’t have to be actually a waivered provider to start somebody on buprenorphine from the ER. That there’s a 48-hour window. They can get them started. As long as there’s a good handoff to a provider in Illinois, it’s this way. I’m not sure how it is in Florida. Them but that handoff is an option so that they if they and this is where the ER docs the reluctance to prescribe is mostly or do anything with people in ER has to do with if they don’t think there’s going to be follow-up in the community especially when it’s a problem when you’re starting somebody on something that’s an addictive product so they will there are some that we do have a waiver provider in ER one of the docs who’s doing it and the others have been encouraged to really consider either becoming waivered or to, we can help them get connected with those in the community who actually provide the continuity of care so that we can connect the dots with them. That’s what we’re hoping will continue and we’ll get more expanded use in that way. So yes, we’re looking at that and it’s becoming more of a conversation in lots of ERs and it needs to be. It’s huge, the need.

Dr. Mark Leeds [35:14] Yeah. And I’ve identified a few programs around the country that provide the full continuity of care that they also coordinate with a clinic that can provide affordable ongoing medication-assisted treatment. And that is a concern I know of some ER doctors locally that if they do start buprenorphine, that there won’t be a clinic that they can refer them to, or if they do refer them, that the patient might not be able to afford it because not a lot of them take insurance. But they’re definitely here. We do have a, just for example, there’s a program in Palm Beach County, I think JFK Hospital has a complete program, although they don’t have a lot of spaces, from what I heard. Memorial Hospital in Hollywood, and I know there’s a couple others around the country. Now, are you involved in or aware of the, I think it’s called the Opioid Crisis Act? I can’t remember the name off the top of my head. The new law that was just signed that addresses the opioid crisis and may provide significant funding and grants for people who are helping out and providing opioid addiction treatment.

Calvin McGinn, PhD [36:19] Yes, and I think that, you know, a billion dollars to go out and to go across the country and help these processes, it’s so needed. And I’m really glad that was signed. And what it’s doing is, too, the Medicaid population in particular is needing to be addressed because that is, we know in the research that there is a socioeconomic connection between substance use disorder and prevalence. And so those who can’t afford, who don’t have the private insurance, who rely on state insurance, need to have access. And so that’s where the monies are more available now on a statewide basis that the federal government’s putting the money into the states. The states now can pay for assessments, for example, like this, that provide the support to get people in the right treatment, and then the treatment itself. So yes, that money is critical. And we’ve applied for some grants to try and get some to help support our website, because at this point, what we want to do is we really want to make our site automated entirely. At this point, I’ve created the spreadsheet that automatically spits out the data, but then we have to upload that to the site. So each person’s results have to be uploaded one at a time to the site to get the results. We want a site that’s fully automated that will allow so that a thousand people at a time could go in there, fill it out, and immediately get the results. That’s what we want. That’s what the public deserves. But to do that, we’ve got to raise about $85,000 to have the website be automated. So until that happens, we’ll be doing it. You know, my wife and I are doing this individually, trying to do it the best we can. And we’ve applied for some grants, but they take a while to get in. And we’re hoping to do some crowdfunding in March so we can actually get more support to get this out there. Because it’s a free profile. The personal profile is free to anyone. So anyone can get this information free from our website, which we want to serve the public. That’s our main intention. And then from there, with the profile that goes to providers, with the money that’s coming out now to support this epidemic, we’re able to get reimbursement for the provider profiles. And that reimbursement helps pay for what we’re giving freely to everyone. So that’s the way it’s going to work. So we’re really happy that this money has become available for that purpose.

Joyce Ann McGinn [38:42] Right. I’m not so sure that we’ll see it, though, because there’s a lot of hoops and a lot of jumping to get to that particular money. And it takes about 10 months for any federal funding to get to anybody. So what we’re going to be doing is a crowdfunding campaign starting March 1st and try to raise at least to get the website started so we can start to automate it. Right now we have it in three different places. We have one area where it’s just informational. We have another area to take the assessment, three different sites, different servers, and another one that’s getting it to people. So we want to be able to consolidate that and automate it in that way. So that’s going to hopefully start March 1st. So be on the lookout for that. The other thing I wanted to go back to is you were talking about the handoff of the physicians. And one of the other scopes of McRisk is we’d like to try to get more primary care physicians involved in working with the addictions. So that way it’s not, it can be a specialist, but there’s more handoff or more chances of people having that continuity of care when they leave an ER or another environment where it’s temporary.

Calvin McGinn, PhD [39:51] Yeah, because rural settings don’t have the resources. They’re going to rely on primary care providers. To get people to support they need. So we have to create answers that rural setting providers can utilize. Telehealth certainly helps with that, and there’s been projects created to support the telehealth process with working with substance use disorder. Arizona worked on this thing, New Mexico. So there’s things like that out there already, and we want to support that even more. So, again, these are ways to manage it.

Dr. Mark Leeds [40:20] Now, just suppose I tell one of my patients or ask them to please go online in the privacy of their own home or on their cell phone and go into McRisk and take the assessment. And now they come back to me and they say, okay, I took the assessment and I saw the results. I got my free report back. And now I want to look at the results. And now the person might say, well, I’ll just print it out and bring it into you. But now there’s an issue of like, well, you know, I want to get it directly from them. I, you know, I can’t really trust what you’re going to hand me. I mean, would that, would that be the issue there that I need to properly get it from you for it to be an official report?

Joyce Ann McGinn [40:57] Well, there’s two reports. The first one goes to them. The physician would get a second report. It’s a totally different report. They get both. So you get the narrative that we send to the first person, the person taking the assessment, and then the clinical report has much more specifics about where the level of care placement is going to be, what kind of treatment, medication-assisted, which type of medication, what severity level they’re at. So it’s a very different report. So you would really need both. Yeah. And that we would not send them at all. That would only go to the clinician. With a release. With a release. A signed release. Yeah.

Dr. Mark Leeds [41:33] Okay. And what is the cost for that? And I assume the patient would probably pay the cost at this point.

Joyce Ann McGinn [41:40] Well, what our model is going to be that the clinic would bill the insurance for the CPT code for their particular insurance and get reimbursement as an assessment tool. So, for example, Medicare, Medicaid pays $48, I think it is, for an assessment. And commercial insurance pays about $33 for an assessment.

Dr. Mark Leeds [42:07] Okay. Yeah, that makes sense. And definitely that is a good way to get the busy doctors who are working in, you know, really busy clinics and having to see a lot of patients throughout the day. You know, that would work within that system. It would be definitely useful to say to the patients, you need to go take this assessment. And then the reports are sent back to us. I mean, we need the information either way. So, you know, that would be really useful.

Calvin McGinn, PhD [42:30] Well, what’s interesting about that question, what you just mentioned, is that we’re actually, the intention of McRisk is to create a self-evaluation process for every practice. So every practice gets to look at, we’ll be able to tell them, those who get licensed to work with us, their practice then now can be evaluated in ways that really give them the feedback they need to make better choices on the treatments they’re providing because we’re going to they’re going to be able to know what is the median level of risk of the population they’re serving are they serving a higher severity population or lower severity population and the severity they’re serving dictates that helps decide then if the outcome of their treatment is more effective and they have a high-risk population, that’s a really good treatment program they’re involved in. If their treatment program is treating a lower-risk population and the results are marginal, then there’s something not working here and they need to re-look at their program and think about how to adjust the program so they can actually have success on a population that should be responding given the severity of the risk that this population shows up. So we can give people that data. So every program involved with us now has an opportunity to really create a way of doing quality control of their practice. And so that was the other intention, to really build a more quality offered process of providing health care for this population across the country by getting the providers to buy into a process that actually helps them risk stratify their own population, target their treatment programs accordingly, and be able to evaluate the effectiveness over time because people can take the assessment, you know, at intervals and see how they’re doing too. And so, again, we’re getting a way to start to really do scientific evidence-based approach to managing substance use disorder as a chronic illness in a way that has not been done before, which is why the stigma has kept us from doing this well. And that’s the problem. The stigma kept us from doing the research in the first place, and once we did the research, applying that research in a way that was useful in the second place. And we’re still at the point where we have the research now, but we have not applied it yet. And McRisk is trying to answer that problem. Resolve it.

Dr. Mark Leeds [44:48] So in a clinic or a treatment program, they get more than just individual feedback on individual patients. They get feedback on their practice as a whole, which is interesting because currently there’s a trend that addiction treatment programs that were abstinence-based only are now waking up to the fact that they need to provide medication-assisted treatment as part of their programs, and not just short-term, not just the detox phase of using it to taper off over a period of 7 to 10 days, but proper ongoing medication-assisted treatment for addiction as a chronic illness. So now there’s all these programs that may have been around for a while but this is a brand new thing for them so and I’ve heard that some of them are you know just for example I heard one local program they’re limiting the amount of medication that they’ll start patients on that no patient will get more than eight milligrams of buprenorphine daily regardless of how they came in which it seems that a lot of patients need a little bit more than that you know a patient who was using a lot of heroin may benefit more from 16 milligrams a day, and in rare cases, maybe even up to 24 milligrams a day in the very beginning. So a program like that, where the doctor or someone has set an upper limit of eight milligrams, they can assess how things are going along the way and maybe get feedback and see if things aren’t really working out.

Calvin McGinn, PhD [46:14] Yeah, and I like it that you’re looking at that differential that’s needed. And the taper process of buprenorphine. And now that we have lofexidine, we have products now that can help with our detox process, we can connect the detox process with a taper program with buprenorphine that allows us to now move toward, for example, an antagonist support. So I think, but we need the input of what person’s risk level and their likelihood of succeeding on that to help determine both the levels we start with and where we’re headed with medication support, in addition to the duration of support overall, which includes both medication and the biopsychosocial model that includes their psych needs as well, and the group support and the individual treatment and therapy and the family therapy if there’s the family support needed. All the things that are involved then, and McRisk actually offers a duration-based recommendation that says, you know, how long? Is this a six to 12-month need? Is this a one to two-year need? Is this a three to five-year need? Or is this a five-year to lifetime need, given their risk factors? And all that information is available, which then gives providers much more targeted treatment so that you can actually start to really make a dent in this population, which is why we really believe the answer we’re trying to provide here, that the risk is about, is really the way to actually end this epidemic. You can’t end an epidemic unless you actually address the causes of it, the risks involved, stratify the population, and then target what you do with that population. So you’re actually creating a sustained solution down the road. That really is the way you solve a problem that’s an epidemic like this. And so we really believe that this answer is the key answer right now to address this. Whether we do it or someone else does it needs to be done. So we just happened to get in on it early on. I’ve been working on this research for over two years now. So as this epidemic showed up, we were already looking at the solution. So that’s why we’re so far ahead of the curve right now in having an answer that’s actually available now to give providers and those sufferers alike a way to access what they need right now.

Dr. Mark Leeds [48:23] Now, if either patients or people with addiction or their family members or loved ones or providers, owners of treatment programs, physicians, what’s the best way to reach you to get more information?

Calvin McGinn, PhD [48:37] Well, we have a website. And McRisk.com is the site that actually has all the information about what McRisk is doing, what it’s about. […] Joyce is the one who handles a lot of the connecting with people. She’s really good at that. And I’ve been in the trenches of the spreadsheet itself and making sure we’re really doing the right thing with the answers. So we will respond to those inquiries, and we’re trying to reach out and get others to be more aware and then to decide if they’re interested in trying it out with us.

Joyce Ann McGinn [49:11] They can also get to the assessment from that website, McRisk.com. There’s links right into the assessment tool that they can take.

Calvin McGinn, PhD [49:21] That’s a good point because anybody interested in working with this or considering it should take the assessment, should try it out. Even if they don’t have any history of substance use issues, it’ll give them a sense of how the assessment works, why it’s so quick and streamlined. For those who have no issues, it’s a five-minute, really quick thing. For those who have moderate issues, seven to eight minutes. If they have significant issues, ten, maybe up to 12 minutes. So depending on their risk factors, they’ll see the assessment tool. And we routinely get feedback. I mean, just significantly, the feedback comes back that says, you know, this tool is so easy to do, and it’s really crisp, and the answers are clear, it’s straightforward. It’s not hard for anyone to take it and so it was designed on purpose to be user-friendly for those who’ve who’ve had their brains hijacked to some extent and need something that’s really easy to take for them so they can actually show up in an honest way as much as possible so yeah that’s what I would encourage people to try who are interested in considering working with us

Dr. Mark Leeds [50:17] Okay and it might also be a good you know when someone is alone in the room using drugs and they know that they need help and they just start searching around on the internet and usually the first thing you’re going to come up across is you know maybe one of these call centers you know call this 800 number if you have a problem and next thing you know you’re signing up for treatment across the country and all they really care about is your insurance card they could start start at McRisk.com and actually have a scientifically based assessment to start with right

Calvin McGinn, PhD [50:48] Yeah that would be more I think it’s preferable to know what you’re dealing with before you go out and get all the help. We do, by the way, also provide 800 numbers on the website too, to give people access. We don’t want people not having that support, but we also agree that it’s much more likely to work if someone up front knows what they’re dealing with first.

Dr. Mark Leeds [51:11] Okay, great. I mean, this is, you know, really incredible what you’re doing here, and I appreciate you coming on the program, and, you know, I hope that this is something that really takes off and grows and is available everywhere. Well, it already is available everywhere, but it’s something that’s really important and something that we need. And I’m going to be recommending this and using this with my patients. And I hope all the other doctors who are listening feel the same way. And I’m definitely going to share this with everyone that I come across because this is incredible. In fact, I’m going to go take the test too just to try it out. Thank you for joining me today on the Rehab Podcast. I really appreciate it.

Calvin McGinn, PhD [51:47] Thanks so much for your time and for what you’re doing. It sounds like, I mean, what you’re doing here is creating, you know, a platform that allows so many people that otherwise would not be made aware of all these options and the scientific basis of what we’re doing, that you’re doing with your work and that other primary care providers are trying to figure out how to do too. So I really, you know, we take our hats off to you and what you’re doing. We thank you so much for what you’re doing for the public and what you’re doing in this process to make the entire country more aware of the problem and the solutions that are showing up. So thank you for your work.

Dr. Mark Leeds [52:21] Thank you for joining us today on The Rehab on the Mental Health News Radio Network. I hope that you have found this show to be interesting and useful. If so, please subscribe to The Rehab Podcast and share on social media. I appreciate your taking the time to listen to The Rehab. Thank you. Thank you. Thank you.