The Opioid Crisis: What Former NFL Lineman Jeff Hatch is Doing to Help

Addiction is a disease that disregards an individual’s race, socioeconomic status, and prior achievements. Since 1999, deaths from prescription opioids have more than quadrupled. From 1999-2010, the number of prescription opioids sold to pharmacies, hospitals and doctors’ offices has nearly quadrupled as well. Yet the amount of pain Americans report has not changed during this time.1 In 2012, health care providers wrote 259 million prescriptions for painkillers. That is enough for every American adult to have their own bottle of pills.2

I was lucky to get the opportunity to speak with former NFL offensive lineman Jeff Hatch. Throughout his life, Jeff did everything the “right” way. He won the Presidential Award for his work with the homeless, graduated from the University of Pennsylvania, where he became unanimous first team All-Ivy selection and Division I-AA All-American, dated Miss Maryland, and signed a multi-year $1 million contract with the New York Giants – all by the age of 22. However, Jeff was not happy. According to him, checking off all of his accomplishments was a way to disguise his contempt for himself:

I was determined to be successful as I could be… On one hand, doing everything well enough could make me happy and on the other hand doing   things well… would keep people from looking too deeply into what was going on with me… It was a way I could mascaraed and keep people at bay

This contempt, in addition to a family history of substance misuse disorder, fostered Jeff’s relationship with substances.  The first time Jeff was exposed to opioids was following his career-ending spinal fusion surgery. He recalls the opioids working great to relieve his physical pain, but it wasn’t long before he was utilizing the pills to resolve the emotional pain he was dealing with.

People say [substance abuse] is a slippery slope that you go down. For me it wasn’t a slope, it was a cliff and I jumped off

Opioids and alcohol gave Jeff something that all his past achievements did not fulfill. It allowed him to be comfortable in his own skin. He shares how drug and/or alcohol consumption is different for someone affected by substance misuse disorder: “I think there’s a difference between somebody who suffers from the disease of addiction and somebody who can participate in using drugs or alcohol recreationally and not have a problem. For those of us who suffer from the disease, the use of drugs or alcohol is a tool by which we escape our reality, not a means by which we seek a good time.”

Jeff was fortunate to receive treatment in 2006 and has now been sober for over a decade. Though he continues to experience pain from a physically taxing football career, he believes exercise and NSAIDs are powerful analgesics that are often overlooked in the management of chronic pain.

Not only has Jeff successfully battled this disease, but he also uses his personal story and experiences to inspire others to seek and remain committed to recovery. Jeff works for Granite Recovery Centers, a New Hampshire based substance misuse disorder treatment provider. This comprehensive program treats individuals throughout all phases of recovery. The program focuses on the 12 steps then offers a bridge program, The Granite House, that continues to work on life skills necessary for community re-integration. Although getting quality treatment is a staple for those in recovery, Jeff states there are additional factors that need to be addressed to successfully combat the epidemic.

We need to continue to break the stigma down, we need to continue to fight against the insurance industry and them trying to close the portals by which people use to get treatment and we need to continue lobbying the government to treat this disease the way it needs to be and to really follow through with that Parity Act that got signed in 2008

Though it is easy to get caught up in the statistics surrounding the current state of the opioid crisis, Jeff explains how we should look at the glass as half full: “We look at the 23 million people suffering from substance misuse disorder in America and we go ‘Oh my God what a terrible problem’ but on the other hand there are 24 million people who are in long term recovery from it and we don’t ever really talk about that.”

For more on Jeff Hatch and his work with those in recovery, visit Granite Recovery Centers. To learn more about the APTA’s initiative to choose Physical Therapy for safe pain management, check out Move Forward and #ChoosePT. Jeff’s interview with Talus Media News can be heard in its entirety here.

 

 

 

 

 

 

 

  1. Centers for Disease Control and Prevention. Understanding the Epidemic. https://www.cdc.gov/drugoverdose/epidemic/index.html. Updated August 30, 2017. Accessed September 2, 2017.
  2. Centers for Disease Control and Prevention. Opioid Painkiller Prescribing. https://www.cdc.gov/vitalsigns/opioid-prescribing/. Updated July 1, 2014. Accessed September 2, 2017

What’s the Cost of Quality? New ABPTRFE standards mean an uncertain future for Fellowships.

Back in February at the Combined Sections Meeting, the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) announced their new quality standards for post-graduate education. The release of the new standards marked ABPTRFE’s first step towards its initiative of revamping old policies and procedures. According to Tamara (Tammy) Burlis, Chair of ABPTRFE, the intent is to“ultimately enhance patient care and support overall goals of the physical therapy profession”. An external consultant company specializing in accreditation and compliance solutions for higher education helped with the development of the new standards. After a 6-month call for comments, the standards were finalized and are now slated to take effect on January 1, 2018. Residency and fellowship programs have until January 1, 2019 to comply. Physical therapy news outlet Talus Media News featured this story in their August 14th episode.

Behind the buzz of the shiny new standards, however, is the discontent expressed by some fellowship directors. The biggest concern regards the change in admission criteria into fellowship programs. Historically, there were three ways to be considered for admission into fellowship: (1) complete an accredited residency, (2) earn board certification in a related field, or (3) have adequate prior experience as judged by the program directors. The new standards have removed the third option, leaving residency training or board certification a mandatory requirement prior to applying for fellowship.

Pieter Kroon, program director and co-owner of The Manual Therapy Institute (MTI), a fellowship program started in 1994 for advanced manual therapy training, spoke up in an interview on Talus Media, “I understand where [ABPTRFE] wants to go with it but…there are some nasty consequences that come with that which threaten the viability of the physical therapy manual therapy fellowship programs…We have given input, but we always have the feeling it doesn’t get listened to a whole lot at the ABPTRFE level.” According to Pieter, fellowship directors don’t seem to have much of a voice in the decision-making process at ABPTRFE. The way in which program directors currently share their concerns is akin to a bad game of telephone. The manual therapy fellowship program directors share their thoughts in their Special Interest Group (SIG) meetings. SIG representatives then report to the Board of Directors at the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). After that, it is AAOMPT’s responsibility to talk to ABPTRFE and pass the messages along. It’s not hard to imagine why Pieter describes the communication between program directors and ABPTRFE “tenuous at best”. Of note, AAOMPT declined to comment on the potential impact of the new standards.

The consequences Pieter referred to are a few in number, but of primary concern to fellowship programs is sustainability. Or, as Pieter more bluntly puts it: “we would be out of business”. To illustrate his point, 95% of the fellows that graduated from MTI in the past five years were admitted via review of prior experience, the route now deemed obsolete. Without such a large section of the cohort, his program would not have had enough overhead to be self-sustaining. Pieter shared off record that he runs his program because he loves teaching and helping clinicians become their best; the revenue the program generates is marginal. The new standards pose a big bottleneck to fellowship admissions, limits student accessibility, and places programs like his on a pathway to an uncertain future.

But what makes fellowship programs think they won’t get enough applicants?

Though there has been a paradigm shift in recent years where clinicians are looking towards residency training soon after entering the work force, there has yet to be an identifiable fiscal incentive for clinicians to become experts in the field given their low ceiling of professional compensation. Furthermore, time is of the essence. The American Board of Physical Therapy Specialties currently only offers certification exams once a year. So, not only are the additional certification exams expensive, it also requires foresight and planning to fit it into one’s professional and personal timelines. There is additionally a current lack of evidence that suggests being a resident-trained therapist and/or having board certification contributes to being a more prepared fellow. Though that’s not to say there won’t be evidence of this in the future, it does call into question how this new admission standard was arrived at. Did it consider any of the current evidence in post-graduate education? Or, was it developed with more philosophical underpinnings? To that end, it remains to be seen…

PT Think Tank community: the point of this piece isn’t to say that the new admission standards are “bad”. Rather, I hope it makes us consider how its proposal potentially overlooks the current reality of the residency/fellowship climate. What parameters are in place, if at all, to help address the worries of Pieter and other program directors? What will be in place to aid them during this period of transition?

I’ll end it here, but do think on this last part of ABPTRFE’s position on the new admissions criteria: “Our goal is to support residency and fellowship programs, while addressing and planning for the future…As a part of our own continuous improvement process, we will continue to monitor the data that occurs as a result of this revised change. We will go back to this concept if we find that it has been detrimental to fellowship programs.”

Pieter and Tammy’s full interviews are available on Talus Media Talks.