FERGUSON 鈥 Maurice Bostic was in a vicious cycle of using alcohol to deal with pain, which only led to more pain 鈥 struggles with relationships, money and drugs. When his 6-year-old granddaughter was accidentally shot seven years ago in her home, Bostic drank even more.
鈥淚f I had kept her with me, it wouldn鈥檛 have happened,鈥 said Bostic, 55. 鈥淚 drank so much that I was going to kill myself.鈥
Bostic finished a 90-day inpatient treatment program, but addiction continued to haunt him. What finally worked was a monthly injection of Vivitrol, a medication that blocks the euphoric effects of alcohol and opioids.
Bostic received the expensive shot at no cost at the in Bridgeton, which opened just over five years ago to treat those with behavioral health disorders such as schizophrenia, bipolar disease and substance abuse disorder.
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The symptoms of mental illness can make it difficult to stick to a daily medication regimen. The clinic allows patients to substitute daily oral medications with injections given every month, sometimes even longer.
Because of the clinic鈥檚 success, SSM Health opened another and is poised to open a third LAI clinic this spring in the former 狐狸视频 University Hospital building off Grand Boulevard.
The DePaul clinic went from serving 1,100 patients in its first year to 4,331 last year, while the Wentzville clinic grew from serving 340 patients in 2020 to 1,641 last year, hospital officials say.
The clinics have greatly reduced the number of patients landing in the emergency room because of uncontrolled symptoms, and patient success stories abound.
鈥淢y life has changed,鈥 Bostic said. 鈥淚 don鈥檛 feel depression. I don鈥檛 feel suicidal. I don鈥檛 feel like I want to go drink. I feel like I got my life back together.鈥
Pointing to SSM Health鈥檚 success, Mercy officials in July 2022 opened a small LAI clinic on its Mercy Hospital South campus to reach those in the southern parts of the metropolitan area.
In November, the Missouri Hospital Association awarded DePaul Hospital鈥檚 LAI clinic its annual , which recognizes hospital innovation.
鈥淭he clinic represents the exact kind of innovation we want to celebrate and replicate,鈥 said Jon Doolittle, MHA president.
Revolving door
SSM Health opened its DePaul clinic after seeing the need for mental health care far outpace the resources, said Michelle Schafer, SSM鈥檚 regional vice president of behavioral health. People were ending up in emergency rooms because they had nowhere else to go for help.
Providers were caring for a revolving door of patients. 鈥淲e would admit them and get them stabilized, but it wouldn鈥檛 be long before we would see them again,鈥 Schafer said.
Patients were struggling to take their medications, she said, often not able to keep up because of other overwhelming issues such as lack of transportation, housing or food.
鈥淲e really wanted to find a better way to care for the patients and to really assure their long-term stability and path to wellness,鈥 Schafer said.
What emerged as a solution were long-term injections, which in side effects and options over the past 20 years, said Dr. William Wang, psychiatrist and medical director of DePaul鈥檚 outpatient behavioral health program.
The shots have grown in use over the past decade and, other than temporary pain at the injection site, have similar side effects as oral versions of the drugs, Wang said.
With injections, there鈥檚 no daily regimen that can be difficult for some to keep up with. And, he said, there鈥檚 a more steady level of the medication and its effects in the blood, rather than the peaks and valleys that occur with daily pills.
鈥淭his is a great advancement to me,鈥 Wang said. 鈥淲hen I used to give a patient medicine, and the patient goes home, in the night I would get anxious, 鈥榠s he taking the medicine?鈥 And now I know, OK, once you get the injection, for one month, you are safe.鈥
SSM Health also realized it needed to take a holistic approach with its clinic 鈥 pairing the treatments with free lunches, transportation to appointments, regular phone calls, individual and group therapy, and connections to help with social needs such as housing.
鈥淲e wanted to make sure that we could provide a therapeutic environment so that we could check on them and we could understand where there were things coming down the path that might lead them to go into crisis so that we can intervene,鈥 Schafer said.
Results were dramatic. Patients treated at the clinic are far less likely to end up rehospitalized within 30 days of a hospital stay 鈥 going from 70% to less than 5%, she said.
The anecdotal evidence, however, has been the most apparent 鈥 patients reconnecting with loved ones, going back to work or school and feeling proud.
鈥淭he more significant things really are the patient鈥檚 ability to return to the lives they鈥檝e always wanted,鈥 Schafer said.
Danger to price program
Long-acting injectables are expensive, costing at least $1,000 a dose, with some as expensive as $8,000, Wang said. With cheaper pills as an option, the injections are not often covered by insurance.
SSM Health funds the array of services at its clinic using the federal , which allows hospitals and clinics that care for low-income and uninsured patients to buy outpatient prescription drugs at a discount of 25% to 50%.
Providers who qualify get to keep the difference between the discounted price and reimbursement rate from private insurance or Medicare. They must use those funds to reach and provide more comprehensive care to financially vulnerable patients.
The 340B program, however, has grown significantly since its inception in 1992, prompting drug manufacturers to call for more transparency and oversight into how providers are utilizing the dollars.
More than 2,600 hospitals across the U.S. 鈥 over 40% 鈥 participate in the 340B program, .
Over the past few years, some manufacturers have tried to institute their own restrictions on the program, between the drugmakers, providers and federal policymakers. The pending cases could change who benefits from the program and how.
Schafer says the 340B program has allowed SSM Health to improve and expand access to mental health care through its LAI clinics.
鈥淚t鈥檚 the quintessential purpose of why the government put 340B in place,鈥 she said.
The importance of treating chronic mental illness and substance use disorders has become more apparent to lawmakers and providers over the past few years.
鈥淵ou鈥檒l see more folks leveraging a model like this to help provide services, because it鈥檚 really important for us to be able to stabilize folks 鈥 otherwise, the need is going to grow and outpace our ability to provide care,鈥 Schafer said.
Mercy鈥檚 LAI clinic on the Mercy Hospital South campus served three or four patients a month when it opened a year and a half ago, and now serves about 80, said Mercy South鈥檚 director of behavioral health Kristin Eveland.
Among patients who frequently ended up in the hospital, Mercy has seen their readmission rates drop from 74% to 15%, Eveland said.
But like at SSM, seeing patients flourish has been the biggest testament to the clinic鈥檚 effectiveness.
鈥淭he success stories out of that clinic are just wonderful,鈥 Eveland said. 鈥淛ust seeing them come back every month and watching them really bloom and become productive members in society, it鈥檚 an amazing space to sit in on.鈥
The clinic is currently only open on Wednesdays, but administrators are looking to expand its service hours because of the growth, she said.
Bostic said with the injections, he has zero cravings for alcohol or drugs. Even when he鈥檚 around others who drink, he said, his only focus is on staying sober.
When he tried to stay sober using daily pills, Bostic said it was easy to forget to take the pill or be tempted to skip it.
鈥淲hen you have that medication, you think I can skip taking that medication and I can drink some today. I can go back tomorrow and take that pill,鈥 he said. 鈥淏ut with the shot, you can鈥檛 do that.鈥
Bostic said he鈥檚 become a husband, father and grandfather again. He鈥檚 saving money. He鈥檚 no longer hungover at work. He鈥檚 much healthier. He no longer has to worry about ending up in dangerous situations during his drinking binges.
鈥淢y grandkids get to see a sober granddad, and that is the most important thing in the world to me, that my grandkids get to see someone they can look up to,鈥 he said. 鈥淭hey don鈥檛 have to be ashamed of me.鈥