With ‘no game plan’ to follow, experts compare efforts in opioid crisis
WASHINGTON — Physicians from across the country spoke about their hospitals’ experiences and approaches to combating the opioid epidemic at a panel at the U.S. News & World Report Annual Healthcare of Tomorrow Conference.
At the start of her presentation, Halena M. Gazelka, MD, director of inpatient pain service at the Mayo Clinic, explained that panels such as this one allow health care professionals to see what other organizations are doing to combat the opioid crisis.
“We all had to start this at about the same time,” Gazelka said. “There was no pattern, there was no game plan to follow, and we’ve all had to work at it along the way.”
‘Forward-thinking,’ value-based health care system
Alicia A. Jacobs, MD, a family medicine physician and vice chair of clinical operations and associate professor at the University of Vermont Medical Center, explained that the state of Vermont initially created a “hub-and-spoke” system in which PCPs worked to get patients with opioid addiction stabilized in treatment centers, and then sent them to receive care at hubs and medical homes.
“Despite being this forward-thinking, inspired workforce, we were not meeting the demands of the opioid crisis in our state,” she said.
One issue, she noted, was the waiting list. There was a 1,000-person waitlist at her local treatment center for 10 years because people were not leaving the hubs to make room for other patients. During this time, Jacobs said, the state’s opioid addiction rates were twice the national average.
Recognizing that opioid use disorder a chronic, relapsing disease, Jacobs and colleagues changed their thinking and created a model with an addiction treatment program and implemented it in Vermont. The primary care workforce cared for patients in the hub, and then patients were sent to specialists in the psychiatry program for additional treatment. They were stabilized and educated on their future treatment, and finally sent back to the medical home.
The program has been so beneficial to patients that even the most reluctant physicians, according to Jacobs, have said that it is the most meaningful care they do.
In addition, the program helped contribute to a 50% reduction in Vermont’s opioid overdose rate, Jacobs said.
She explained that those involved in the program are firm believers in rapid access to medication.
“We don’t want somebody to even wait a day, because we know what can happen in that day,” she said.
Peer recovery specialists
Christopher F. Freer, DO, co-chair of the Tackling Addiction Task Force, system director of emergency medicine at RWJBarnabas Health and chairman of the ED at Saint Barnabas Medical Center, in New Jersey, discussed the use of peer recovery specialists as part of regular ED care.
Peer recovery specialists are former patients with substance use disorder who are at least 4 years in recovery. They help to break communication barriers between physicians and patients, Freer explained. They typically arrive at a patient’s bedside within 15 minutes of the physician’s request.
When patients present with opioid use disorder, he said, peer recovery specialists “lovingly stalk” patients and help them navigate through inpatient services to recovery.
When peer recovery specialists were first introduced to EDs, Freer said it was a “game changing” moment. The specialists talked with providers in the ED and explained that opioid use disorder should be looked at as a disease, and that patients should not just be labeled as “addicts” and “junkies” and sent home from the ED without additional treatment.
Freer explained that the program now includes more than 100 peer recovery specialists, and the concept has spread to all 11 EDs within the health system. There are even plans to expand it to inpatient services. However, they have not determined how to adopt these specialists into outpatient services.
“We’ve really turned into a substance use disorder-friendly ED, whereas if you asked me 4 years ago, we were like any other ED,” Freer said.
Procedure-specific opioid guidelines
The opioid crisis cannot be addressed without first looking at one of its major sources. Gazelka explained that her organization surveyed patients about the opioid prescriptions they received from surgeons after common procedures, identifying some who did not receive opioids and others with prescriptions up to 1,000 mg oral morphine equivalents.
They also surveyed patients to evaluate opioid use after discharge. They found that 63% of the pills prescribed to patients were not used.
Because other guidelines are broad and do not take into account the effects of different surgical procedures, Gazelka and colleagues worked with surgeons to create their own procedure-specific guidelines for opioid prescribing.
These more specific guidelines cut opioid prescribing in half in surgical specialties, Gazelka explained — a decrease that equates to a million fewer opioids prescribed in Rochester, Minnesota.
In addition, Gazelka and colleagues at the Mayo Clinic are working to educate physicians and patients, and are reaching out to leaders in the community to help expand health care for patients with opioid use disorder and to help prevent it from happening.
American Hospital Association efforts
Jay Bhatt, DO, the senior vice president and chief medical officer of the American Hospital Association, noted that caring for active drug users in a way that helps them toward recovery and supporting them through the recovery process is essential.
He said the American Hospital Association supports policies — including the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, known as the SUPPORT for Patients and Communities Act — to help combat the opioid crisis.
Bhatt also explained that the organization is focusing on stewardship, alternative treatment, medication-assisted treatment, and providing a system of care to support patients. In addition, they are working with the Surgeon General to help advance areas to support caregivers.
“You see suffering and you think the world needs changing,” Bhatt said. “That inspires people to want to change the world, and then you see sources of hope that give you a sense that the world can be changed. We’re seeing a lot of sources of hope for positive change.” – by Erin Michael
Sternberg, et al. The hospital’s critical role in battling the opioid epidemic. Presented at: U.S. News & World Report Annual Healthcare of Tomorrow Conference; Nov. 17-19, 2019; Washington.
Disclosures: Healio Primary Care was unable to confirm relevant financial disclosures prior to publication.