One Patient at a Time: Mendocino Providers Addressing Substance Use

Mendocino County is beloved for its miles of gorgeous, unspoiled coastal beaches, gently rolling hills and charming towns. But the bucolic landscape hides another picture, which isn’t as pretty. The rural northern California county is also known for extreme poverty, serious unemployment with limited options for upward mobility, and some of the highest rates of substance use and addiction in the state.

“Over the past 10 years, I’ve seen a disturbing increase in young people who are using heroin,” says Dr. Juliet La Mers, an emergency room physician at Adventist Health Howard Memorial Hospital in Willits. “All three of my children, who are in their 20s, have had friends who have overdosed and died.”

She tells stories about people who had developed a dependence coming into the emergency room in excruciating withdrawal. “They wanted more narcotics, and the law says I couldn’t give it to them. They got angry and belligerent. I felt awful, too, because I didn’t have anything to offer.”

Frustrated, she looked for solutions and heard that CA Bridge was looking to expand and offer medication for addiction treatment (MAT) in more hospital emergency rooms to people with substance use disorders.

With enthusiastic support from the hospital CEO and president, La Mers started a CA Bridge program at her hospital. She hired Mary Anne Cox Gould as a substance use navigator to introduce patients to treatment programs and coordinate their care.

Cox Gould grew up on the Mendocino coast and knew the community had normalized drug use. Working as a life coach, she watched a client addicted to heroin go from withdrawal to health after getting MAT treatment. She became interested in transitioning to becoming a substance use disorder counselor. The timing was perfect.

Both La Mers and Cox Gould credit CA Bridge for giving them the resources, tools, trainings, energy, and confidence to successfully implement MAT, a safe and effective way to treat people with substance use disorders at Howard Memorial Hospital.

Ironically, La Mers’ emergency room colleagues were the hardest sell at first, but La Mers and Cox Gould persisted. They contacted every provider in Willits and the medical board. They started going to various medical staff meetings and set up a series of trainings to help providers get an x-waiver. As the substance use navigator, Cox Gould “bridges” patients from the hospital to the clinic, providing a warm handoff to a case manager and a drug and alcohol counselor. If anyone relapses, she comes back into the picture and supports them.

After the first year, all four hospital-based nurse practitioners and 10 of the 13 ED physicians now have the required x-waivers to prescribe buprenorphine, a primary component of MAT. Today patients suffering from opioid addiction coming into the emergency room or hospital can get buprenorphine immediately and be referred to the on-site CA Bridge clinic for next-day follow-up and continued care.

La Mers wears a CA Bridge button on her lab coat that says, “I can start you on buprenorphine today.” A man who lives on the Mendocino coast recently came into the Howard Hospital ER for a rash and asked her about the button. She told him what it meant. He admitted that he uses heroin every day and wanted to get off drugs but didn’t know anyone who could help him. La Mers started him on a prescription and gave him Cox Gould’s phone number for follow-up.

The CA Bridge program at Howard Memorial Hospital is helping one patient at a time to safely and effectively treat their drug addiction. Since the inception of the program a year and a half ago, La Mers and Cox Gould have accumulated dozens of  success stories and testimonials such as this one:

This impact story first appeared on the CA Bridge site.