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How to Address Addiction in the ER

News  |  By Debra Shute  
   July 21, 2017

By connecting overdose patients with non-clinician 'recovery coaches' quickly, hospitals have a better chance of promoting long-term recovery.

For hospitals and health systems, truly treating substance abuse disorders means doing more than pumping stomachs, administering fluids, or giving emergency opioid-reversal drugs.

Such treatments, while life-saving, address only the surface of addiction.

One of the opportune settings to convert rescue into recovery is the emergency department, says Kyle Martin, MD, medical director of emergency services at St. Mary's Hospital in Madison, Wisconsin, part of SSM Health, a nonprofit health system that includes 20 hospitals and more than 60 outpatient care sites.

The ED is where many patients suffering from addictions interface with the healthcare system, he notes.

"A lot of them don't have primary care physicians, and aren't accessing care in any other way than through the ED, so that's really the only place we're going to be able to touch their lives," Martin says.

Optimize the Moment of Crisis

Outreach during the moment of crisis can make all the difference. "I'd imagine people have seen some adverse effects of their addictions, but it's a powerful moment to wake up in the ED and have a physician explain that you were basically dead."

Martin's ED in Madison, which receives about 38,000 visits per year, saw more than 180 cases of opioid overdoses in 2015—or about one every other day.

In the hopes of bringing overdose rates down, St. Mary's has launched a program modeled after the Rhode Island–based Providence Center's AnchorED, which deploys "recovery coaches" to the ED to counsel patients treated for opioid overdose and introduce them to resources for addiction recovery.

The coaches, all of whom have overcome their own addictions and received special training in counseling, also follow up with patients after meeting in the ED to help them stay engaged in the process.

Similar programs exist or are in development at hospitals in New York, Pennsylvania, New Hampshire, and Massachusetts.

Martin says he hopes to see his hospital's pilot succeed and expand throughout SSM Health and beyond.

"We in the ED can get into this cycle in which someone comes in and they have overdosed; we reverse them and watch them for a while, but don't actually know how to break the cycle. That's what this program hopefully will be able to accomplish."

Identify Funding Opportunities

The St. Mary's recovery coach program would not be possible without the organization's partnership with Safe Communities Madison and Dane County, a $7,500 grant from the Wisconsin Medical Society Foundation, and $15,000 from Dane County, Martin says.

He recommends that healthcare systems reach out to their outpatient addiction communities to learn about organizations that may be able to help.

"Often, I think the outpatient and inpatient worlds are kind of operating in isolation, or in parallel. The key is making a bridge through an organization like Safe Communities so you can get people who have real-world experience in the community and are really plugged in," he says.

With the passage of the 21st Century Cures Act in December 2016, which includes $1 billion in state grants over two years to address opioid abuse and addiction, such opportunities may expand.

Watch for Recidivism

While a degree of relapse is inevitable, lower recidivism rates are a key indicator of success.

"The most powerful question will be whether we're able to get [patients] to their own homes and maintain a recovery program so they don't have to come back to the ED," Martin says.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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