Southwest Pathways  

What is Southwest Pathways?

Southwest Pathways, at the Public Health Region 5 Office in Las Cruces, began as an Access to Recovery Project funded by the Substance Abuse Mental Health Services Administration (SAMSHA) in 2004. For approximately two years, Southwest Pathways functioned as the Central Intake Unit (CIU) performing assessment and referrals for persons needing outpatient substance abuse treatment in network of area private providers via a voucher-based payment system. 

Presently Southwest Pathways is a cross-program unit in Public Health Region 5 (PHR5) comprised of multiple behavioral health specialists, including a licensed counselor, clinician, nurse, and educator. This team focuses on mental health and substance abuse issues common to different patient and client groups accessing public health services. For example, patients referred to these professionals may be females with post-partum depression in the WIC Clinic, the Family Planning patient suffering from domestic violence, the STD patient with hazardous drinking habits, the TB or HIV patient with co-morbid conditions interfering with medication compliance, hepatitis C or diabetes patients with depression, teens with suicide ideation identified in a school-based health center, and inmates with chemical dependency just released from the county jail. Besides providing direct services in a safety-net to such persons who are uninsured or have low income, these staff members and others work multi-level community approaches in coalitions, councils, and consortia to enhance access to and continuity of care for persons with chronic behavioral health challenges.

A key principle of Southwest Pathways is to programmatically bridge the gaps among infectious and chronic diseases/conditions and behavioral disorders. The foundation for this public health model is harm reduction for preventive interventions with at risk persons using drugs and telehealth with Project ECHO from the University of New Mexico Health Sciences Center (UNMHSC) to bring the expertise of academic medicine to southern New Mexico.

Top 10 myths about drug addiction

Harm Reduction Program

What is Harm Reduction?

Harm reduction is a philosophy of public health, intended to be a progressive alternative to the prohibition of certain lifestyle choices. The central idea of harm reduction is the recognition that some people always have and always will engage in behaviors which carry risks, such as casual sex and drug use and recognizing this, efforts are made to minimize the negative health impacts of those behaviors on communities.

Harm reduction initiatives range from widely accepted designated driver campaigns, to more controversial initiatives like the provision of condoms in schools, needle exchange programs and heroin maintenance programs. The main objective of harm reduction is to mitigate the potential dangers and health risks associated with the behaviors themselves. New Mexico is taking the philosophy of Harm Reduction a step further by including diabetes syringe use in its program. Both the distribution and collection of diabetic syringes are included in the Harm Reduction Program.

Reducing Harm: Treatment and Beyond

Syringe Exchange Program

Syringe Exchange is a program provided by the New Mexico Department of Health in which clean needles and syringes are given out and exchanged after being used to administer intravenous drugs or diabetic medication. The New Mexico Harm Reduction Act was passed in 1997 to reduce the spread of diseases such as HIV and hepatitis C that are transmitted through blood, often by the reuse of needles and/or syringes.

Studies have shown that syringe exchange programs can reduce the transmission of HIV and other bloodborne diseases in people who inject drugs. Syringe exchange sites also provide health information; referrals to social, human, mental health, and substance abuse treatment services; HIV and hepatitis A/B/C testing; and hepatitis A and B vaccines. There is no charge to enroll in this program.

Syringes are usually given out ten at a time and can be exchanged for clean (sterile) ones as often as necessary, usually on a one-to-one basis. Arrangements can also be made for a community representative to exchange multiple-user needles/syringes for clean, sterile ones. Syringe Exchange users can enroll in the program anonymously, and testing, such as for HIV and Hepatitis C, can be done anonymously. Free condoms are also available. Some sites offer physical examinations for enrolled clients along with clinical care for abscesses and other conditions related to injecting drugs.

Most Public Health offices throughout Region 5 now offer the Syringe Exchange Program (SEP) services. Interested persons should call their local office in advance to check for open clinic dates and times and staff availability.  Walk-ins are usually accepted, but waiting times may vary if you do not have an appointment.  Region 5 provides SEP service in outreach settings, such as mobile and free clinics, homeless shelters, and when persons are released from county jails or detention centers.

Syringes can be bought at retail pharmacies in New Mexico without a prescription.  If you experience problems with this purchase, please advise our program staff at 575-528-6008.

Most Public Health offices now have syringe collection boxes located outside building entrances. These boxes, about the size of mail boxes, can be used by anyone to safely deposit used syringes and needles to protect the general public and sanitation workers from accidental needle sticks. The boxes accept containers of used needles up to the liter or quart size.

Narcan

Narcan (Naloxone) is a specific opioid antagonist drug that rapidly reverses the effects of opiate drugs, including heroin. Naloxone is often life-saving in heroin overdose, but it should be viewed as one of several tools and skills that can prevent heroin overdose death.  

This New Mexico Department of Health (NMDOH) policy establishes guidelines

for the dispensing of Narcan through NMDOH Public Health Offices (PHO) and contracted providers in order to reduce fatal opioid overdose. The primary reason for establishing an Opioid Antagonist Administration Program by trained targeted responders is to improve response to drug overdose, which may prevent unnecessary loss of life. While opioid antagonist administration does not automatically guarantee to reverse the effects of overdose due to substance abuse, it is the only definitive care currently available for reversing the effects of opioid substances.

Opiate users who have participated in Department-sanctioned heroin overdose preventionand treatment education programs are eligible to receive naloxone from Department personnel. 

Opiate Replacement Therapy (ORT)

Opioid addiction can be to many substances, such as heroin, codeine, hydrocodone and oxycodone. Prior to the introduction of Office-based Opiate Replacement Therapy, the only available treatment for opioid addiction was with Methadone, available only at federally licensed methadone clinics. With the introduction of Buprenorphine (link to YouTube video), a safer alternative to Methadone, treatment options have increased.

Buprenorphine can be administered from any physician’s office, once the physician hastaken a one-day Buprenorphine training course, and has received DEA recognition of that training. Similar to Methadone, Buprenorphine reduces the cravings for opioids but significantly reduces the potential for abuse and overdose. By allowing any trained physician to prescribe Buprenorphine, opportunities for opioid treatment have potentially expanded from the few Methadone Clinics in the state, to any physican’s practice. 

The Las Cruces Public Health Resource Center offers Opiate Replacement Therapy (buprenorphine, Suboxone) for persons that meet financial and clinical requirements for eligibility. Region 5 staff participate in weekly Project ECHO sessions for the Substance Use Disorder Clinic.

For additional information on ORT, please click here, or contact Patrick Stafford @ 528-6008, or email:  Patrick.Stafford@state.nm.us

SMART Recovery® (Self-Management And Recovery Training)   

A Region 5 behavioral health clinician has completed the Facilitator training for leaders of SMART meetings. SMART stands for Self-Management And Recovery Training, which enables professionals to lead self-help groups to assist people to gain independence from addictive behaviors according to evidence-based best practices. The SMART Program is often used to augment 12-step recovery programs or as an alternative to these groups. It helps people recover from all types of addictive behaviors, including: alcoholism, drug abuse, gambling addiction, food addictions, and addiction to other activities. For additional information, please contact Meribeth Hauenstein at 528-6007 or visit the Internet at http://www.smartrecovery.org.

Mental Health Services for Adolescents

As part of school-based health center services in Doña Ana County, mobile medical carts from Second Opinion (http://www.2opinion.com/medindex.htm ) for telehealth sessions (via videoconferencing) are located at four sites:  two are in the Gadsden Independent School District at Gadsden High School and Chaparral High School and two are in the Las Cruces Public Schools District at Las Cruces High School and Oñate High School.   With this technology, providers in primary care and behavioral health may remotely examine and counsel their patients, including the use peripheral equipment such as stethoscopes and spirometers.  This service delivery option has improved access for teens in rural sites while reducing provider travel time to distant clinics and downtime between patient appointments.  During the summer of 2008, one of these mobile medical carts, nicknamed “See-More”, was on loan to the Doña Ana County Juvenile Detention Center as part of a pilot project to test the feasibility of offering “blended” clinical services (i.e., primary care and behavioral health) to youths in the facility.  The experiment was well accepted, since the offender may engage in rather confidential conversation with the off-site therapist, even though a corrections officer may be in the same room.  The patient inmate may wear a headset so the guard cannot hear questions asked by the clinician and even communicate with the clinician back in the Region 5 Office Headquarters with text messaging for sensitive responses during the therapy session.  This type of telehealth direct care is very appropriate in our border area since the bilingual therapist is often in high demand for Spanish-speaking clients, geographically widely dispersed throughout the county.  The following summer in June the Juvenile Detention Center purchased their own medical cart so the telehealth service with Region 5 could be offered again on a regular basis to incarcerated youth.